GETTING ANSWERS FOR MEDICARE HEALTHCARE OPTIONS
HARRRISBURG » Seniors should be aware that Open Enrollment is the time to compare healthcare options for 2021.
And state agency APPRISE is there to help.
Susan Neff, APPRISE Director, Education & Outreach Office, Pennsylvania Department of Aging, said the APPRISE Program is available year-round and offers free and confidential Medicare counseling to Pennsylvania’s Medicare beneficiaries and those nearing Medicare eligibility.
“APPRISE counselors are specially trained to answer your questions and provide you with objective, easy-tounderstand information to help you find the best coverage for your situation and assist you with applying for cost-savings benefit programs,” Neff said. “We look forward to assisting you! Please call the APPRISE Helpline at 1-800-783-7067 or visit aging.pa.gov for more information.”
Neff answered five questions about the program and how to reach out for assistance:
1. How does APPRISE counsel help Medicare beneficiaries understand their Medicare coverage and insurance?
Pennsylvania Department of Aging’s APPRISE program provides education and assistance to Medicare-eligible individuals, their families and caregivers to assist them in making informed health insurance decisions that optimize cost-savings and access to health care and benefits.
Trained counselors provide free, objective information to assist Medicare beneficiaries to explore their Medicare choices. One-onone, unbiased, personalized counseling is available year-round at local Area Agencies on Aging (AAA) throughout the commonwealth. All services are free and confidential.
Medicare’s Annual Open Enrollment Period (AOEP) happens every year from Oct. 15 through Dec. 7. During this time, Medicare beneficiaries can join, switch or drop Medicare Advantage or Prescription Drug Coverage. New coverage begins Jan. 1.
The Medicare & You Handbook is mailed out to all Medicare beneficiaries in September. Medicare Advantage participants receive an Annual Notice of Change in September that details the changes to their plan for 2021. Older adults’ healthcare needs or situation may have changed, too, so it’s important to review these documents, think about what benefits will matter to them, compare plans and make any changes.
The APPRISE program can assist with comparing plans and costs and making changes. Aging adults may even save money.
2. How does APPRISE help compare prescription drug coverage?
APPRISE helps older adults understand their prescription drug coverage options by using the Medicare Plan Finder tool to find local plans that cover their drugs, and pharmacies that can fill their prescriptions. By comparing coverage, costs and convenience they can find a plan to meet their needs. The booklet, Your Guide to Medicare Prescription Drug Coverage, available at Medicare.gov or by calling 1-800-Medicare, is a great resource for more information.
3. How does APPRISE help with preventative care, long-term insurance?
Early detection and treatment of health conditions can help reduce medical costs and maintain health. APPRISE can help aging adults understand the many Medicare preventive care services, like the annual wellness visit, that are covered at a low or no cost. More information about preventive services can be found at Medicare.gov. Medicare doesn’t cover long-term care. APPRISE counselors can help older Pennsylvanians understand their benefits under long-term care insurance policies.
4. How does it help with Medigap and prescription drug coverage?
Medicare is made up of several primary components including Original Medicare (Part A & Part B), Medicare Advantage (Part C), Prescription drug coverage (Part D) and Medigap. These parts of Medicare cover a range of services from hospital and doctor visits to vision, dental, hearing and transportation.
Anyone with Medicare will pay for a portion of their expenses, but what they pay will depend on the type of coverage that they have. What older adults pay will also depend on where they receive services and if they have other forms of insurance. Depending on the coverage they have, they may be expected to pay premiums, deductibles, and copayments/coinsurances out-of-pocket.
APPRISE helps older adults compare Medigap and prescription drug coverage options and costs by using comparison tools to find the plan that best meets their needs and save them money. APPRISE can also help them with applying for cost saving programs like Extra Help, Medicare Savings Programs and Pennsylvania’s PACE (Pharmaceutical Assistance Contract for the Elderly) program available to help pay for services.
5. How will counseling sessions be different in the pandemic?
For this year’s AOEP, the APPRISE program has competed readiness activities and is fully prepared to offer appointments for counseling sessions to be conducted over the phone, via virtual platform or, at the discretion of the AAA, faceto-face sessions with proper health and safety precautions in place.
Older adults can call their local AAA or the toll-free APPRISE Helpline at 1-800783-7067 to schedule their counseling session. Consumers may also visit Medicare.gov or 1-800-Medicare for assistance and more information.
APPRISE counselors will be at the Chester County Library in Exton on Nov. 21 from 9 a.m. to 4 p.m. Call APPRISE at 610-344-5234 to schedule an appointment.
Berks Encore offers Medicare counseling year-round through a staff of APPRISE trained counselors. Counselors can help with enrolling in Medicare, Medicare Prescription Plans, Medicare Advantage Plans, Medicare Supplemental Insurance, Medicaid, long-term-care insurance and screening and applying for financial assistance program.
Appointments can be arranged at any of six community centers in Berks County or at the Berks Encore office at 40 N. Ninth St., Reading, by calling 610-374-3195 ext. 208.
Before COVID, Berks Encore held @Night educational programs where they presented general sessions at facilities around the community. Many were held at senior living facilities or Penn State Health St. Joseph.
Berks Encore now offers people who are turning 65 and want more information about Medicare the option for a one-on-one telephone consultation, with appointments available days, evening or weekends by calling 610-374-3195 ext. 227.
Maria Speicher, Berks Encore community educator/ APPRISE, advised: “Everyone should take some time to review their plan during open enrollment as plans often change. When you talk with a counselor, make sure you have a complete list of all your prescriptions.”
Pennsylvania operates a Medicare hotline that is staffed by 10 different counties in designated regions. Berks Encore staff and volunteers man the hotline for Berks County on Wednesdays from 9 a.m. to 4 p.m. and Fridays from 9 a.m. to noon. The hotline is open Monday through Friday 9 a.m. to 4 p.m. at 800-7837067.