On My Watch – Sorting out the Puzzle of My Medical Insurance at the Wallace Center
By Anne W. Semmes
On this past Fourth of July weekend this reporter was feeling gratitude for an organization in town that is supporting my ability to maintain my independence, regarding that important part of my life, my health. The story goes I received a phone call from someone I did not know who was offering me, for free, an improvement of my health insurance. How he was referred to me was a mystery. But he was a friendly gentleman, listed on the web, and he convinced me I could save substantial money with his insurance plans. Yes, I learned he is one of many insurance brokers out to “sell” insurance plans, to be compensated by those health insurance programs he assigns his clients.
But errors followed, a new plan had my first and middle name but not my last. My primary care doctor did not take my new insurance. Time to get help – the Commission on Aging at the Wallace Center – and yes, I am over 65. I was alerted that the Center offers counselor service on Medicare. I was assigned an insurance counselor, Heidi Nolte, who rescued me along with the prowess and leadership of Lori Contadino, who heads up the Commission on Aging. Surprised I was to be ushered into the conference room by Lori and Heidi to sort out my medical insurance situation.
Needless to say, my health insurance is back to where it was, and this counsel was all free! Time to spell out this worthy service with the help of Lori and Heidi. Lori begins. “I am the staff person who helps coordinate or lead the team – myself and four certified counselors… We’re certified through the Southwestern Connecticut Agency on Aging Choices program…We accept no fees for service, and anyone, regardless of where they live, can avail themselves of the service that we provide.” But “predominantly we serve folks in Fairfield County and the majority of folks live here in the town of Greenwich.”
Back story of Health Insurance Counseling program
It was in the 1990’s that this Health Insurance Counseling program kicked off tells Lori, “The first such counseling effort in the Southwest Region if not in the state. The original program was started by Maxine Goldstein, who was the Director of the Commission on Aging in co-operation with Family Centers.” Begun to counsel seniors on Medicare Supplements, “it grew to include Medicare D with the passage of the bill in 2006,” says Lori, adding that the Town’s Human Services Department has and continues to offer Medicaid counseling.
The especially busy time for that counseling team of five is during open enrollment from October 15 to December 7. “We track how many people we see during that time period,” tells Heidi, “Typically 350 to 500 people.” Add 150 “at least during the year, and with those new to Medicare,” says Lori, So, some 700 are getting free help, not counting numerous telephone inquiries.
The fact is, as this reporter has learned from her experience, and as Lori has stated, “The complexity of our health care is almost criminal – it’s so hard to navigate.”
“So first, we want to make certain that the plan that someone is enrolled in is the best possible plan for their individual needs,” says Lori. “And if we can help someone realize a financial savings, that’s what our goal is, and to make certain that all of their drugs are on a plan.” Heidi adds, “So when we enroll someone in a better drug plan for their particular list of medications, we track the savings of what they would save by switching drug plans.”
“We want folks to be in the driver’s seat to really understand their options,” says Lori. “Both Heidi and I teach folks how to navigate the Medicare plan finder, and how to understand the supplemental insurance. We know the complexity that’s inherent in Medicare and it’s shifting all the time, and we need to stay current with that.”
“So, we try to tease out in our conversation what are the most important things to the client,” tells Heidi. “And for some people it’s purely financial. For some people it’s ‘I want to have the most f lexibility when I’m any place in the United States to make sure I have good coverage.’ So, by understanding an individual’s priorities, we can help them prioritize what would be the best option.”
Couples, individuals, and caregivers
Count in couples seeking that necessary guidance. “Even if you come as a couple,” says Lori, “we count people as individuals because especially with drug plans and supplements, everyone needs their own. And the drug plans are based on an individual’s unique medication profile. You can have one drug company that is the best for you. And your spouse may have a completely different drug plan than you have. The same thing with a supplement. You may have a different health profile than your spouse, and perhaps you’re on a highdeductible supplemental plan and your spouse is on one of the most comprehensive coverage plans based on what they need. So, we listen to what the client tells us… The interactions are confidential, and we are bound by that.”
Count too Lori adds, “Sometimes it’s an adult child that has power of attorney for an older adult, and that person may be the decision maker on behalf of a parent.”
“It’s a pretty wide range of ages,” notes Heidi, “because we have people who are just hitting retirement who have always had a company plan, and now suddenly, they’re going to Medicare and they’re in a complete panic. When they worked for a company, they had a choice of two plans, and it was pretty easy. And now all of a sudden, they dive into this world of Medicare…And then we have much older adults who have been with the program for years, and they just come in and say, ‘I just want you to check that my plan is still good for next year.”
Those insurance recruiters
But, returning to those pitfalls of seniors being recruited by insurance brokers, Lori addresses. “They have something to sell, right? There’s something to gain. We have nothing to sell. This is a service. People seek us out. We’re not making cold calls to anyone’s home. People that have seen us in the past will receive one mailing a year from the office of the Commission on Aging, reminding them that Medicare D open enrollment is coming. If you want an appointment to meet with a counselor, we give them the date that we will start scheduling… But we find that it’s a very predatory environment around Medicare, Medicare Advantage plans, drug plans, supplemental plans… And if it sounds too good to be true, it’s often too good to be true. Our rule of thumb is if they want to send you information, you accept the information, you can bring it in to review it with us but make no decisions over the phone.”
Those wanting basic information on Medicare can visit the Commission on Aging website at greenwichct.gov/1785/medicareinsurance-counseling. “We also put the supplemental plan rate sheets on the website,” tells Lori, “And there’s a registration form if you want to meet with our counseling team.”
Heidi has a final suggestion. “We would just encourage people who are approaching retirement at whatever age to come talk to us if they want help sorting this out, and to remind people, that just like with your eyes, an annual checkup of what your insurance coverage is, is very reassuring and potentially money saving.”
For more information on insurance counseling call the Greenwich Commission on Aging at 203-862-6710.
