Benefits Assistance Program Provides Updated Information on New Medicare Benefits

Article submitted by Ann Marie Grande, MS, RD, Benefits Assistance Program Manager, Area Agency on Aging, Region One
To learn more about the Benefits Assistance Program, please call 602-264-2255 or the 24-hour Senior HELP LINE at 602-264-4357.

President Bush signed the Medicare Prescription Drug Improvement and Modernization Act (MMA) into law on December 8, 2003. Medicare is being modernized to reflect changes in the healthcare system. This law provides the largest number of fundamental changes in Medicare since its enactment in 1965. Beneficiaries will need to make many decisions about how they receive their health insurance over the next few years. There are many directions a beneficiary can take. So how do seniors take the right path?

Beginning January 1, 2006, new Medicare prescription drug plans will be available to all people enrolled in Medicare. These drug plans will provide insurance coverage for prescription drugs. Like other insurance, if you join you will pay a monthly premium and pay a share of cost for your prescriptions. Drug plans vary in what prescription drugs are covered, how much you have to pay, and which pharmacies you can use. When you join a drug plan, it is important for you to choose one that meets your prescription needs. Some people with an income at or below a set amount and with limited assets will qualify for extra help in paying the monthly premium, and/or for some of the cost they would normally have to pay for their prescriptions.

Also starting in 2006, Regional Preferred Provider Organization (PPO) plans will be available across the country. This new type of Medicare managed care may include extra benefits, like extra drug coverage, eyeglasses, or dental coverage. Regional PPOs will only charge one deductible for all services and must have an annual limit on the amount you pay for both in- and out-of-network care.

So how do you make an informed decision on how to receive this new prescription benefit? Where do you find the answers to how this new benefit fits in with your current health insurance? Should I choose a Regional PPO plan? The Benefits Assistance Program (BAP), part of a national network of State Health Insurance Assistance Programs (SHIP), is a program of the Area Agency on Aging, Region One that can provide direction through the Medicare maze. The BAP counselors provide information, education and assistance to people on Medicare, their caregivers and social service professionals helping Medicare beneficiaries. Explaining options and helping people make informed decisions is paramount to the program's mission.

Frequently clients are over-burdened by unpaid bills and the great amount of paperwork generated by a hospital stay. Often, clients have been ill and leave the paperwork pile up until they feel better. BAP counselors can assist clients to organize their medical paperwork, and in some situations, reconciliation of bills.

Program services are provided by staff and trained volunteers on the phone or face to face at community locations or in the client's home. An average client contact takes 30 to 45 minutes, however, a counselor may spend many hours over many weeks or months assisting a client resolve a problem. The BAP counselors can advocate with health insurance providers on behalf of elderly or disabled clients. Many clients are turning 65 and are seeking a basic understanding of this new method of receiving health insurance. Others want or need to make changes to their current situation. Often the client has a problem or is in crisis, for example, receiving a notice from a collection agency, and turns to the program for assistance.

Medicare is a very complex system. Staff and volunteers can provide information and educate people without the time constraints often placed on "customer service reps." Keeping current with the multiple and on-going changes in Medicare takes considerable time. Update training is provided on a regular basis to all volunteers so they can keep current with the latest Medicare information.