Medicare Counseling Session Saves Family Over $10,000 in Avoided Costs

Medicare Counseling Session Saves Family Over $10,000 in Avoided Costs

State Health Insurance Assistance Programs (SHIPs) work with beneficiaries across the country, educating them on Medicare, providing free one-on-one unbiased counseling on Medicare benefits and related health insurance questions, and advocating for their health care rights and entitled benefits. SHIPs serve over 7 million beneficiaries each year. In California, our SHIP is called the Health Insurance Counseling and Advocacy Program. As Medicare has grown and become more complex, understanding and navigating the A, B, C and D’s of Medicare has become increasingly overwhelming. SHIPs’ services are invaluable and have tripled in the numbers of people reached in the last 10 years.

Highlighted below is one of many such success stories of our state’s SHIP, HICAP. In just one session, HICAP Counselor, John Lee of Contra Costa County counseled a woman becoming eligible for Medicare, looked at her father’s coverage and helped her find a much less expensive plan for him that included all his doctors, examined her husband’s coverage and pointed out he could switch to another Medigap plan and save over $3,000 a year, and noticed her disabled daughter, soon-to-be-on-Medicare would qualify for a Medi-Cal program. All of these adjustments would help this family save over $10,000 in health care costs this year. And all that happened in one face-to-face HICAP counseling session.

Through our membership program, California Health Advocates works closely with HICAP programs statewide, providing training and technical support to equip counselors with the necessary tools to handle these type of cases and report such successes. Below is John’s account of their successful session.

“Betty came to a HICAP counseling appointment in Martinez seeking information to enable her to sign up for Medicare, which was imminent with her 65th birthday just two months away. I was able to abbreviate a 2-hour long ‘Welcome to Medicare Course’ to about 45 minutes because of the ability to focus on her particular situation. She knew she would have to contact Social Security soon to enroll because she was not yet receiving benefits.  It seemed that based on the information we discussed, a Medigap Plan N would fit her needs in order to see her specialist in San Francisco.  She would have plenty of time to enroll and ensure continuity of benefits as she celebrated her birthday.


Towards the end of the presentation, she said that her father, who was in good health, had been in a plan that seemed to work. She was now taking over his financial affairs, though and noticed the plan was quite expensive. She discovered that he could save a lot of money each month by choosing a Medicare Advantage Plan without giving up any of his current doctors.  Potential savings here approached $7,500 a year!


It also became apparent to her that her husband had not chosen the most cost-effective Medigap plan.  She realized that now he would be able to change to a less expensive insurance company and plan (without giving up his particular doctors) during the 30-day period after his upcoming birthday. This is because of the California ‘Birthday Rule’ which she learned about in our counseling session. His savings would be about $3,000 a year.


But wait! She also said that her daughter was severely disabled and would soon be receiving Medicare because of that disability and coming off Betty’s employer plan. We were able to discuss some other potential options her daughter had with the state Medi-Cal program. Betty was going to make arrangements to attend a Medi-Cal presentation focused on those benefits. So, as a result of our session, Betty better understands what her daughter’s Medicare and Medi-Cal options and benefits are.


Wow – a lot to cover, but now Betty had HICAP as an ‘Anything Medicare’ resource for her questions.  So what was to be a simple information meeting for her, turned out to benefit four people, and amount to potential savings of over $10,000.  It was a twofer times two.”

Find your local HICAP and learn more about their services here.

Also, you can support the SHIP program by contacting Congress and urging them to keep SHIP funding in place. Here’s a recent advocacy letter with some good points to mention:

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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