Health advisers help ease Medicare confusion

Resources available for seniors navigating coverage

Dec. 7 marks the end of Medicare's annual fall election period and the only time most seniors can make changes to their health and prescription plans under the federal insurance program.

For those trying to determine whether their prescriptions are still covered under Part D, how their coverage requirements might have changed or are looking to find a better premium, don't fret. There are a number of resources available, including independent brokers who can help seniors age 65 and older navigate the system at no cost.

Steve Blandino, an independent broker at Redwood Shores and founder of the nonprofit Educate U, which educates people approaching 65 about how the Medicare system works, said those looking for assistance shouldn't be scared to use an independent broker as an adviser.

He said independent brokers are authorized to represent a wide variety of insurance providers and can provide valuable assistance in guiding people through their Medicare choices -- for free.

"There's no cost to work with them -- (They're) compensated by the carrier. You pay exactly the same premium, but now you have an adviser," he said.

Having a go-to adviser who knows your insurance plan can be essential during the annual election period, especially if you're trying to sort through paperwork to understand if your coverage has changed. This is also a time when a deluge of health plan advertisements come in the mail, adding confusion to the process.

"You have an adviser, and as you get older, you establish a wonderful relationship," Blandino added.

He said Medicare's Part D plan, which provides coverage for prescription drugs, is a top concern among seniors he assists. The plan changes every year, so many people check with him to determine whether they need to switch their drug plans.

"People are asking, 'With all this (advertising) mail, do I need to change my drug plan?' And the answer is, 'probably not,'" Blandino said. "There wasn't that much disruption in the market this year in this area. But people absolutely do need to reassess if they got a letter from their carrier saying, 'We're not covering your drug next year, or we're going to change the way we cover your drug."

If insurers are changing their coverage of a certain drug, they are required to notify Medicare clients who took that drug during the last year, he said.

He said seniors should also review their Medicare Supplement, also called Medigap, which can help pay some of the health care costs that Medicare doesn't, such as deductibles and copayments. Determine if the premiums on this private supplement have changed or if it's necessary to switch carriers, he said.

Those with Medicare Advantage plans may have to deal with more significant changes, not only in premium amounts but also in the plans themselves, he said.

Blandino said one of the most commonly asked questions he hears is: "Do I have to enroll in Medicare when I turn 65?"

People approaching 65 can apply for Medicare up to three months before their birthday and -- if they sign up promptly -- coverage will kick in on the first day of their birthday month.

Blandino said he recommends enrolling in Part A of Medicare, which covers hospital care, because there's no cost. Enrollment in Part B, however, can be delayed, he said.

"You can delay Part B enrollment (until retirement) if you or your spouse are actively working and included under a group plan," he said. "Where you have to be careful is with COBRA or severance packages -- you're on a group plan but you're not actively working, so you may need to enroll. But as long as you're actively working under a group plan, you could go to 95 years old (without enrolling in Medicare Part B)."

If employed people 65 and older have expensive coverage through their workplace, they may save money by going onto Medicare, he said. If they don't like it, they can always go back to the company's group plan.

"You can come on and off Medicare as long as you're actively working," he said.


Choosing an independent broker

The election period is a prime time for Medicare scams, so before seeking advice, make sure to find a reputable broker:

* Make certain the insurance broker is licensed in California and appointed to do business by each company he/she represent.

* Find out how long the broker has been in business.

* Find out how many insurance carriers the broker is appointed with. (Ten or more carriers is a good number).

* Guard your Medicare number the same way you would protect your bank and credit card information.

* Be on the alert for anyone claiming to be an agent who contacts you with a promise of a special deal, wants money, is offering a gift, or is trying to sell a particular plan.

Other resources

Free Medicare counseling is available from the Health Insurance Counseling & Advocacy Program (HICAP) of California Health Advocates, a nonprofit Medicare advocacy and education organization supported by public and private organizations, including the federal Administration on Aging. Counselors provide free and objective information about Medicare and healthcare options.

* To make a counseling appointment in Santa Clara County, call 408 350-3200. Call 800 434-0222 to make an appointment in San Mateo County. Help is also available through the Medicare website ( or customer service center, at 800-633-4227.

* For more information about HICAP, go to


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