Cay Bowman takes a phone call about Medicare plans at ServiceLink in Concord. The State Health Insurance Assistance Program provides free, confidential counseling for seniors about their Medicare options.
Cay Bowman, a volunteer with the State Health Insurance Assistance Program, takes a phone call at ServiceLink in Concord on Friday. The program provides free, confidential counseling about Medicare options.
Cay Bowman counsels her fellow senior citizens about their Medicare choices at the ServiceLink office in Concord. Bowman is a volunteer with the State Health Insurance Assistance Program.Medicare “is a very confusing little beast,” she says.
Cay Bowman takes a phone call about Medicare plans at ServiceLink in Concord. The State Health Insurance Assistance Program provides free, confidential counseling for seniors about their Medicare options.
Cay Bowman takes a phone call about Medicare plans at ServiceLink in Concord. The State Health Insurance Assistance Program provides free, confidential counseling for seniors about their Medicare options.
Cay Bowman takes a phone call about Medicare plans at ServiceLink in Concord. The State Health Insurance Assistance Program provides free, confidential counseling for seniors about their Medicare options.
Cay Bowman, a volunteer with the State Health Insurance Assistance Program, takes a phone call at ServiceLink in Concord on Friday. The program provides free, confidential counseling about Medicare options.
Choosing a health care plan can be confounding at any stage of life.
But for seniors grappling with the choices offered around Medicare, the challenge is downright daunting.
“It’s incredibly confusing,” says Terri Vineyard.
Coming from the state Medicare director at the state Department of Health and Human Services’ Bureau of Elderly and Adult Services, that’s saying a lot.
Medigap or Medicare Advantage?
Part C or Part D?
Plan A, B, G or K?
It’s a veritable alphabet soup of options. And it’s something everyone should think about before they turn 65.
Those TV ads that play ad nauseam — featuring celebrities such as Joe Namath, William Shatner, Jimmie “JJ” Walker and William Devane — only add to the confusion, experts say.
“Regardless of which option you are considering, it is critical for consumers to get information from reputable sources,” D.J. Bettencourt, deputy commissioner of the state Department of Insurance, said in a recent webinar about Medicare.
“Let’s be honest,” Bettencourt said. “Insurance is complex for a lot of us, and when you’re a senior, it can seem almost insurmountable to understand, particularly if you’re someone going through this process for the first time.”
Here’s why.
Traditional Medicare, or “original” Medicare, includes Part A (hospital coverage) and Part B (doctor visits, lab tests and other outpatient services).
Part D, sold by private insurers, offers prescription drug coverage.
But those aren’t the only options to consider.
Medicare supplement insurance, sometimes called Medigap, is sold by private insurance companies and can help pay some of the costs that original Medicare does not, such as co-payments and deductibles. There are 10 standardized Medigap plans, named by letter (Plans A, B, C, D, F, G, K, L, M and N).
Medigap only works with original Medicare and does not cover prescription drugs; you still need a Part D plan for that.
Then there’s something called Part C, or Medicare Advantage, offering Medicare-alternative plans sold by private companies that contract with the federal government. These plans may offer coverage for services Medicare does not, such as vision, hearing or dental care.
Confused yet?
Options create confusion
Christina FitzPatrick, the state director of AARP New Hampshire, said choosing the right Medicare plan is a “double-edged sword.”
“Having more choices means you’re likely to find something that really suits your needs, but it adds so much complication, it’s hard to sort through to find the thing that’s going to be best for you,” FitzPatrick said.
Advocates recommend that seniors contact the State Health Insurance Assistance Program (SHIP), where trained counselors provide free, unbiased information about the range of plans out there. Provided through ServiceLink, there’s a SHIP office in every county. You can find your local office by calling the ServiceLink Resource Center at 866-634-9412.
Vineyard, the state Medicare director, said literally hundreds of plans are available to New Hampshire seniors, varying by insurance company and even by county. And those plans can change from year to year.
“There is no sugarcoating it,” she said. “It’s overwhelming, and it’s under constant flux.”
Vineyard said SHIP counselors can’t recommend one approach over another, and they can’t tell seniors what they should do. “However, what we can do is help the beneficiary evaluate their options based on their individual needs,” she said.
“Someone might not need that much medication; they might be relatively healthy,” she said. “Someone who maybe has some more things healthwise going on is going to have significantly different needs than someone who just has to take a statin once in a while.”
Not necessarily an advantage
Becky Rostron trains the SHIP counselors who help people figure out their best options based on their personal situations.
“We listen to the consumer and what their needs are and what their concerns are and we take it from there,” she said.
For many consumers, when it comes to Medicare, she said, “You don’t know what you don’t know.”
No one has to sign up for a supplemental or Advantage plan, Rostron said. If someone is on traditional Medicare, they can sign up for prescription Part D coverage during their initial enrollment period for Medicare.
Medicare Advantage plans are required to provide the same benefits offered by original Medicare, Rostron said, and such plans can also offer additional benefits that Medicare does not.
“However, they may apply, and often they do, different rules, different costs and restrictions such as provider networks or referral requirements,” she said. “If you’re seeing a provider that’s not in that network, you may pay more or may have no coverage.”
These are all difficult, emotionally fraught decisions, Rostron said. “You’re dealing with your money, you’re dealing with your health care,” she said.
And no one can predict what their future medical needs may be. “You can say you’re really healthy now, but none of us know what tomorrow brings,” she said.
‘Confusing little beast’
Cay Bowman of Concord has been a SHIP counselor for 15 years, working at the Community Action Program office for Belknap and Merrimack counties in Concord.
At 71, Bowman puts in the equivalent of a fulltime job as a SHIP volunteer. “This is my passion,” she said.
Medicare, Bowman said, “is a very confusing little beast.”
“So many people struggle with trying to get connected with the right coverage that they need for their care,” she said.
Bowman helps people understand the options that are out there, and how much various plans will cost based on their medical conditions and prescription drug costs. “We can show them everything, but the final decision is theirs,” she said.
Cay Bowman counsels her fellow senior citizens about their Medicare choices at the ServiceLink office in Concord. Bowman is a volunteer with the State Health Insurance Assistance Program.Medicare “is a very confusing little beast,” she says.
SHIP trainer Rostron said she’s had seniors come in asking for plans pushed by their favorite celebrity in those ubiquitous TV ads.
“We have to explain to them that you have the right to enroll in what you’re asking about and if that is what you want, we will help you do that,” she said.
But she also points out the tiny print at the bottom of those national ads, warning that plans may not be available in every area.
In rural New Hampshire, she said, “Ninety percent of the time, what they’re advertising that’s catching their eye does not apply here,” she said.
Those TV ads have been ramping up lately, with the impending Dec. 7 deadline for Medicare beneficiaries to sign up for Part D plans.
“You can’t watch a Hallmark movie or even listen to a hard rock station without being bombarded by open-enrollment advertising,” said Vineyard, the state Medicare director. “And they’re all promising different things.”
Vineyard said she understands why those ads work for some seniors. “You have a familiar face, a comfortable personality, telling you ‘Hey, sign up for this plan,’” she said. “I would imagine that it would feel comforting and a little bit like a lifeline: OK, I’ll do that and that solves the problem for me.”
“The problem is that particular plan Joe Namath or William Shatner is hawking might not meet your needs.” Vineyard said.
In the recent webinar, Bettencourt, the assistant insurance commissioner, said his department has seen an increase in complaints to its consumer division from seniors about “confusing, misleading, deceptive and aggressive advertising of these types of plans.”
“So it is critically important that consumers are discerning when choosing between a Medicare Advantage or Medicare supplemental product,” he said.
State wants ad oversight
The Insurance Department approves Medicare supplemental rates and policies, and it licenses the companies that offer and sell those plans. The department also has oversight over advertising for such plans, and handles complaints about inappropriate sales practices.
But it has no authority over Medicare Advantage products; that lies with the federal government, officials said.
That could change.
Bettencourt said his department has asked the state’s congressional delegation to push for state oversight of advertising for such products, to better protect seniors.
“We’re talking about a group of consumers that we know is particularly vulnerable to those deceptive advertising campaigns,” he said.
Meanwhile, some ads may be having the opposite effect on many viewers.
A recent online story warning seniors about celebrity ads unleashed a torrent of complaints.
“Years of exposure to the Namath/Walker ads has convinced me that I want nothing to do with the program or the folks who choose and pay them,” one person wrote.
“What is going on here,” another said. “Are you people trying to drive us seniors completely berserk ...?”
Vineyard said the Centers for Medicare and Medicaid Services is tracking complaints about such ads.
Her advice: “If an offer sounds too good to be true, it probably is.”
