During the last two decades, Medicare reforms including Medicare Advantage and drug coverage have offered millions of older adults and people with disabilities more choices and greater control over their health coverage. By understanding and comparing their options, Medicare beneficiaries can save money and better match their coverage to their unique circumstances and health care needs.
Yesterday, ACL Principal Deputy Administrator Mary Lazare and Centers for Medicare & Medicaid Services Principal Deputy Administrator Demetrios Kouzoukas got an up-close view of a program helping beneficiaries make the most of their Medicare options. The Virginia Insurance Counseling and Assistance Program (VICAP) invited ACL and CMS to a community center in Reston, Virginia, to meet with program participants, sit-in on a Medicare counseling session, and speak to a packed Medicare 101 workshop.
VICAP is part of a network of State Health Insurance Assistance Programs (SHIPs) offering information, counseling, and enrollment assistance to Medicare beneficiaries. ACL funds SHIPs in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.
Many of the participants Lazare and Kouzoukas spoke with said that before VICAP, they did not know what their Medicare options were or even where to begin finding out. They described feeling confused, overwhelmed, and stressed. They said that much of the information they did hear about Medicare came in the form of advertisements by companies trying to sell a particular product. Their feelings were summed up by Dick Titus who described Medicare as “a Rubik’s cube.” Each shift, be it a new policy change, diagnosis, or medication has the potential to create a new set of problems somewhere else.
"Where do you go for help?" Jorjanne Gausman, the mother of an adult son with spina bifida, asked. "You can't call the insurance company, you just have to find some neutral place that will give you the information you need to make the right decision."
Mary Dueno agreed. She had heard about VICAP during a yoga class at her local library. At the time, she was very concerned about the costs of her medications.
"We brought in our list of medications and they put the whole list in for you and you could actually see… what plans are available and what is the least expensive," she said, describing the process. "And they help you work out, based on your income, which would be best for you."
During the last five years, the program has helped her save more than $90,000 on prescription drugs. Many others in her yoga class also have benefitted from the program.
"We'll all tell you, without VICAP, we would not be able to get our medications, we just don't understand how to work (the process)," she said. "I don't know what we would do without VICAP."
Together, SHIP staff and volunteers have empowered millions of older adults and people with disabilities to make more informed decisions about their healthcare and realize the promise of increased competition and choice in Medicare.
"Some people have told us… why not make (Medicare) simpler by reducing the number of options," Kouzoukas, who also serves as Director of the Center for Medicare, told a Medicare 101 workshop. "We don't have to make that difficult choice when we have things like the SHIP program, because we have counselors here available to you to explain some of the complexity, who understand the ins and out, and are here to provide resources to people in the community."
In 2017, an army of dedicated volunteers and staff in the SHIPs across the country provided 142 million hours of one-to-one assistance to almost 2.8 million Medicare beneficiaries, their families, and caregivers. SHIPs also hosted 95,000 outreach events including interactive presentations, participation in community and health fairs, and more than 14,000 enrollment events. In addition to enrollment support, SHIPs can help those eligible for Medicare navigate Medicare benefits, coverage rules, written notices and forms, appeal rights and procedures, programs to help people with limited incomes pay for their health care, Medigap plans, long-term care insurance, and more.
According to VICAP Program Coordinator Mari de Leon, VICAP's Medicare counseling services save about 200 beneficiaries $1.6 million a year in Fairfax County alone. These results are accomplished by the equivalent of 1.5 full time staff members.
Fall is a particularly busy time for SHIPs because of Medicare Open Enrollment, offering a brief window when Medicare beneficiaries can select or change their Medicare Advantage and prescription drug plan.
"The most important thing is to shop every year," Kouzoukas told the workshop, noting that he gives the same advice to his own family.
During the roundtable, participants agreed saying they come back to VICAP every year to make sure they are still in the best plan. One couple learned this lesson the hard way. In 2016, VICAP helped them enroll in a prescription drug plan that saved them $2,100. Assuming that the plan was still their best bet, they stuck with the same plan in 2017, only to discover too late that changes in the plan's drug formulary would cost them an extra $7,000. This year, they made sure to return to VICAP and enrolled in a new plan that will bring their costs back down.
Both beneficiaries and staff were clear about what they saw as VICAP's secret to success, it was all about the personal touch. "Everyone here is in it because they have the heart for it, the heart to help the beneficiaries." VICAP Program Director Pam Smith told Lazare after the event.
De Leon, who was the lead VICAP counselor for Fairfax County, was singled out for praise. "We're not just numbers to her, we're people and that makes a big difference… It just gives you such comfort knowing there's someone that's there," Dueno said. It came down to the difference between "actual people I can look at and know their names" and an automated phone recording, she added before narrating the phone experience, "Press 1. OK. Then press 2. Then check this for that…"..
As the event was concluding, Gausman said she wanted to take a moment to thank De Leon one more time for all she had done to connect her family to programs and resources.
"I actually feel like I can die in peace because I know that my son is being taken care of now, and that was not going to happen until you reached out to us," she said with emotion in her voice. "It’s huge what you've done for just one human being in Fairfax County and I will be grateful to you all the days of my life."
The deadline for this year's Medicare open enrollment is December 7, find the SHIP in your state.