Fall issue: Elder health costs
Counselors in a state program that helps seniors navigate the health insurance maze had a relatively relaxing summer, working just a few hours a week. During the next few months, however, they expect to be plenty busy.
Officials at the Serving Health Insurance Needs of Elders, or SHINE, program said counselors' workloads will increase significantly next month when Medicare announces its new insurance plans. The release of the plans marks the start of the preenrollment period, in which seniors may evaluate and then pick the plan they want.
Lincoln resident Virginia M. Lemiere , 70, who has worked for seven years as a SHINE counselor for the Concord Council on Aging, spends much of her free time trying to help other people through the Medicare maze. This summer, she averaged two to three calls a week from seniors. She expects to receive 10 to 12 calls a week during the fall.
Under Medicare, a federal program that provides health insurance for the elderly, there are a variety of ways to receive insurance benefits, including fee-for-service plans, PPOs, and HMOs. Seniors who need help paying the difference between what Medicare might pay and the full cost of medical treatment also may opt for medigap , or supplemental plans, sold by private insurance companies.
Many observers say health insurance options for seniors became even more complicated last year with the introduction of Medicare Part D, which helps seniors pay for prescription drugs.
Massachusetts seniors on Medicare may choose one of 44 different Part D plans, Aspinall said. Enrollment for the plans runs from Nov. 15 to Dec. 31, during which a senior citizen may sign up for a new plan or adjust his or her current one. The plans cover brand-name and generic prescription drug costs and are available to anyone on Medicare, regardless of their income or drug expenses.
The state's 450 SHINE counselors, all of whom are unpaid volunteers, are trained to help seniors pick their way through many options and find the best plan, Aspinall said.
The counselors must complete 40 hours of training and take a 30-page exam before becoming certified. They must then be recertified every year and attend monthly meetings to stay updated on any changes made to the plans.
Lemiere said the Part D prescription drug plan has caused a lot of confusion among seniors and counselors.
``We as SHINE counselors had training on Part D for months and it kept changing. It was so frustrating for us to sit there and find out the plan had changed," said Lemiere, who has a 6-foot stack of informational health insurance papers in her home. ``It's not a good bill that Congress passed."
``Most seniors can get something in the mail and they'll say, `I can't cope with that right now,' and they put it down. They are just afraid.
``I've had people who were very well educated who were just not able to cope."
Concord resident Donato Bracco , 85, a retired associate director of research for GTE Laboratories in Waltham, sought guidance from Lemiere in July. At the time, he needed to help his elderly sister, who had just moved to Massachusetts, transfer her health insurance.
Bracco found the Medicare Part D choices overwhelming. ``None of it is really available in easy-to-understand terms," he said. ``That itself is a confusing business for people who are not accustomed to dealing with bureaucratic procedures, which is the majority of the people."
While the number of options may be confusing, Medicare Part D does offer an important benefit, Aspinall said. ``It's the first time that Medicare offers prescription medication to all of its beneficiaries: A lot of people are definitely saving money and getting medication they couldn't afford.
``I think with any new program it takes time for people to understand it." She estimated that between 550,000 and 600,000 Massachusetts seniors are enrolled in the prescription drug plan.
Brazilian native Ana Cristina Oliveira , an outreach coordinator and SHINE counselor at Marlborough's Council on Aging, helps Portuguese- and Spanish-speaking seniors choose insurance plans.
``Medicare and prescription drug coverage is so complex, so it's hard for people to understand it in their own language," not to mention a foreign language, Oliveira said.
There are 35 counselors and 10 new counselors in training in SHINE's MetroWest region, which covers 22 cities and towns, including Holliston, Sudbury, and Wellesley, said associate regional director Dorene Nemeth.
Medicare offers a prescription drug plan finder on its website, but that's not much help to some seniors.
Natalie Weinberg , 83, of Framingham, owns a laptop but doesn't trust herself to surf the Internet. ``I'm not that good at it. I wouldn't know what to do in the first place."
A former legal secretary, Weinberg thought she would have little trouble choosing a prescription drug plan. ``I was so confident in my own ability. I said, `This is not going to be a problem for me,' but it became a problem."
After working with Nemeth and other SHINE counselors at Framingham's Callahan Senior Center, Weinberg found relief.
``They turned chaos into calmness. I really don't know what I would have done without them."
