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The Villages
Thursday, March 28, 2024

SHINE offers information as Medicare open enrollment approaches

Betty Cunningham
Betty Cunningham

The 2014 open enrollment period is approaching for seniors to choose their healthcare insurance coverage for the year beginning Jan. 1, 2015.

Open enrollment will be from Oct. 14 to Dec. 7.

Are there any new surprises on the horizon?

“We just don’t know,” said Villages resident Betty Cunningham, who is the area coordinator for SHINE (Serving Health Insurance needs of Elders). SHINE is a free program offered by the Florida Department of Elder Affairs and your local area Agency on Aging. “No 2015 information is yet available. None of the plans has yet downloaded data to www.medicare.gov.”

“During the past year, some of our volunteers have reported increases of up to 33% in their current health care premiums, and some have noted increased prescription drug costs,” Cunningham continued, “where drugs in the lowest cost ‘tier one’ changed without notice into a more costly ‘tier two.’

Very shortly, as Medicare and the insurance companies finalize their data, people approaching retirement age, and those already receiving healthcare through Medicare and other plans, will be bombarded with promotional mailings plus radio and TV ads. There will be myriad invitations in local newspapers to attend breakfast and luncheon seminars where benefits will be outlined by various companies.

SHINE volunteers encourage people to read the literature, attend seminars and do their own research, if they wish — and also to avail themselves of the informative, unbiased assistance SHINE offers.

There have been some big bumps in the senior healthcare insurance road over the past couple of years. First, the very popular zero-premium Medicare Advantage plan ‘Preferred Care Partners; was bought out at the end of 2012 by United Health Care. PCP subscribers were forced either to go with a higher cost UHC plan in 2013 or change their insurance coverage.

Then in 2014, clients covered by another zero-premium Medicare Advantage program, Physicians United Plan (PUP), were stunned when the State of Florida shut PUP down abruptly due to insolvency. “It happened suddenly, because it was a State shutdown and not a buyout or typical corporate bankruptcy,” Cunningham explained. “To ensure all former PUP clients had healthcare coverage, the State stepped in and immediately switched them to the more costly regular Medicare plus a Humana Part D drug plan.”

“That took a tremendous amount of work, and I’m glad the State made sure everyone had some healthcare coverage,” Cunningham said. “While I don’t fault the government’s good intentions, I don’t like the way that was handled. These matters are always complex, but looking back, it would have been better if the State had switched the PUP subscribers to another (similar cost) managed care plan instead of regular Medicare. Why? Because some patients in hospitals or nursing homes at the time were shocked to receive much higher bills for services than they expected under their PUP plan. Not everyone can afford those bills. Some of these cases are still being negotiated and remain unresolved.”

SHINE’s mission is to provide free and unbiased health insurance information through a dedicated network of volunteers, empowering Florida seniors to make informed health care choices.

For people approaching Medicare age, SHINE is offering one remaining ‘Understanding Medicare’ seminar, on Wednesday, Oct. 8, 1 to 3 p.m., at Colony Cottage Recreation Center.

It is important for everyone in this group to familiarize themselves with all the options. SHINE volunteers can assist each individual to decide the most cost-effective course of action for them — for example, whether or not to carry-over insurance they may have from an employer. There are large cost differences between the option of having original Medicare, plus a supplemental plan plus a ‘part D’ prescription drug plan vs. several types of managed care plans.

The lowest cost ‘Medicare Advantage’ programs (HMOs or health maintenance organizations) generally have a limited roster of physicians and other health care providers from which to choose. Preferred Provider Organizations (PPOs) cost more, but offer a larger number of doctors, hospitals, diagnostic laboratories and geographic coverage areas.

Moving upward on the cost scale, one can opt to have ‘original Medicare,’ which pays eighty percent of ‘allowable costs.’ Most who choose this option enroll in an additional Medicare Supplement plan; plus an optional Part D Rx program for those wanting drug cost coverage. This highest cost option provides the broadest range of provider options and is often chosen by snowbirds who spend only part of their year in Florida.

“It’s very important,” Betty Cunningham reminds residents, “to review costs and benefits — including the roster of providing physicians, diagnostic laboratories, hospitals and pharmacies — for each plan option under consideration. to be sure the care they want and need is available within the plan.

Once the 2015 Medicare information becomes available, SHINE will offer counseling as follows:

On Tuesdays:

Lake Miona Recreation Center: 9:00 a.m.-Noon: October 14, 21 and 28. November 4, 11 and 18. December 9.

Eisenhower Recreation Center: 9:00 a.m.-Noon December 2

On Wednesdays:

At the Villages Pinellas Plaza Public Library: 9:00 a.m.-12 Noon October 1, 15, 22, 29; November 5,12,19 and December 3.

At the Lady Lake (Guava Street) Public Library: 2:00-4:00 p.m. October 8, 15, 22, 29; November 5, 12,19 and December 3.

 

On Fridays:

At Chula Vista Recreation Center 3:00-6:00 p.m., October 3, 17; November 7, 21 and December 5.

At Eisenhower Recreation Center: 3:00-6:00 p.m. October 24 and November 14.

At Sea Breeze Recreation Center: 3:00-6:00 p.m. October 31.

SHINE counseling will NOT be provided during Thanksgiving week (November 24-28).

A total of 29 SHINE volunteers, including Ms. Cunningham, cover all the above counseling locations and accomplish this daunting task. “Everyone receives help on a first-come, first-served basis,” Cunningham promises, “and our volunteers stay until everyone present at closing time has been helped. People must bring a list of their medications, including drug names, dosage strengths and frequencies. We don’t sell, endorse or recommend any one company — we just provide data comparisons so each senior can make informed decisions on which program will provide the best benefits for them.”

www.floridashine.org

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