Racing against a Dec. 7 deadline for making changes to senior citizens’ Medicare and prescription drug policies, the Jewish Family Service of MetroWest New Jersey (JFS) is dispatching trained volunteers throughout Essex County to explain complicated requirements to recipients.
“There is a lot about Medicare that people don’t understand,” Siobhan Flynn-Higgins, the Essex County coordinator of the State Health Insurance Assistance Program (SHIP) and a clinical social worker at JFS, told NJJN. “A lot of times when they turn 65, they don’t have the full picture of the choices available. That is the purpose of this program.”
Flynn-Higgins supervises volunteers from Essex County who have been trained by the New Jersey Department of Human Services in the intricacies of Medicare rules and have been giving dozens of briefings as the deadline draws near. In addition to her SHIP responsibilities, Flynn-Higgins works at JFS as a consultant to caregivers for senior citizens. As of November 2017, the county has 119,325 people eligible for Medicare.
At a Nov. 21 meeting at Congregation Ahawas Achim B’nai Jacob and David in West Orange, volunteer Burt Henry told some 15 Medicare recipients they should pay special attention to their prescription drug plans and consider changing coverage before the deadline.
“You have to look at all your prescription drugs, enter their names and dosages in a computer program, and it will give you the cheapest plans for New Jersey residents,” Henry, a retired insurance executive from North Caldwell, told the seniors. “Don’t just assume that the plan you have now is best for you going forward.”
Because some drug plans have increased premiums, while others have added new drugs to their coverage, and still others have removed certain drugs from their lists, “the changes in cost to you can be significant,” Henry said.
Although Medicare drug plans are not mandatory, Henry said, they are essential. “When some people sign up for Medicare, they say, ‘I’m not going to sign up for a drug plan,’” he said. Then, two years later, they may face a 24 percent penalty when they try to enroll, and, he told the seniors, “You will be charged for the rest of your life.”
Flynn-Higgins told NJJN that it’s possible that the seniors could get a better price for a prescription plan.
“The plans change every year in regard to copayments and what drugs are covered,” she said. “Sometimes people pick the plans with the highest premiums without realizing that they may not have the best prices for the medicines they need.”
She added, “This is the only time of year everyone on Medicare can make changes to the prescription plans. Otherwise, you can only make a change if you meet criteria for special circumstances.”
Changing prescription coverage is not the only item the seniors will have to address by Dec. 7. Medicare recipients can also enroll or make changes in one of several Medicare Advantage plans, which may be more expensive for consumers, but could also offer broader coverage areas, including hospitalization, nursing home, vision care, and dental health coverage,
Following the meeting, Jay Mayesh, a fellow SHIP counselor and a retired attorney from Livingston, told NJJN, “Because drug plans change yearly, the most frequent question we get is: ‘Am I on the right plan, and how do I figure out which is the right one for me?’”
“The only way to do is it with your computer,” he said. Trying to get the answers through any other means, he said, is confusing, and you’ll run the risk of getting incorrect information.
“The problem,” Mayesh said, “in comparing Advantage plans with others, is we cannot know what is going to happen to us over the next 12 months.”
Stanley and Lee Saal of West Orange, who sat together in the first row of the audience, were pleased with the information about their coverage that was provided at the meeting.
“Stanley has arthritis and has a lot of pain and has a slight heart condition,” Lee said. “We have both had hip replacements. All of the treatments were paid for by Medicare.”
Stanley agreed with his wife’s assessment, but with caveats. “Medicare for us has been wonderful. But we are very concerned about what is proposed in the tax program and in Obamacare,” most notably in the possibility of eliminating coverage for pre-existing medical conditions. “This is a major concern for our two children and eight grandchildren.”
“We are very concerned about the tax plan as it hits New Jersey, and we are very concerned about the talk of reducing the benefits of Medicare,” Stanley said. “It is going to hurt everybody — even people in Congress.”
The SHIP helpline is 973-637-1717.