Mary Ruth Smith, 71, of Altoona was surprised when she was notified that her insurance company would not pay two medical bills.
She had a routine test and the insurance company had always paid for it in the past. Smith, a retired pastor, receives health care benefits through the policy her husband acquired from his employer. She also has Medicare coverage.
"When you are on Medicare, your supplemental plan is primary and Medicare is secondary," she said, explaining that the insurance company should pay the bill.
(Mirror photo by Gary M. Baranec) APPRISE coordinator Jennifer Park (left) shows seniors (from left) Patty Marx, Mary Ruth Smith and Vergie Shannon some information about supplemental health insurance. Seniors will have an opportunity during open enrollment to change their Medicare Advantage Plan or prescription coverage.
"We were at an impasse," she said.
To straighten out the problem, Smith consulted with Jennifer Park, APPRISE coordinator for Blair Senior Services.
Using a speaker phone, Park set up a conference call with the insurance provider, Smith and herself. The mix-up occurred when the hospital outsourced the reading of the test results and the insurance company thought the test was conducted out of network. But the doctor and hospital administering the test were in-network.
Times for open enrollment help
APPRISE counselors will be available by appointment at the following locations to assist Medicare beneficiaries in deciding on a Prescription Drug or Medicare Advantage Plan for 2013. Times are:
9 a.m. To 3 p.m. Oct. 15, 22 and 29, Central Blair Senior Center
9 a.m to 3 p.m. Nov. 5, 12, 19 and 26, Central Blair Senior Center
9 a.m. To 3 p.m. Dec. 3, Central Blair Senior Center
9 a.m. To 1 p.m. Nov. 22, Claysburg Senior Center
9 a.m. To 3 p.m. Nov. 29, Northern Blair Senior Center
To schedule an appointment, call 946-1235.
"All parties are happy. The bills are paid," Smith said. "It felt so good."
She is among the thousands of seniors who come to the center each year, seeking answers about supplemental insurance and Medicare through the APPRISE program.
For retirees or soon-to-be retirees, making a decision that once was made by their employer can be mind-boggling. Many sift through the pamphlets, letters and brochures that stuff their mailboxes, unsure of which plan from companies vying for their dollars is best for them.
Others, especially those who plan to retire in a few years or whose health insurance is provided by a working spouse, are unaware they need to sign up for Medicare at age 65 or face a penalty.
But seniors have somewhere to turn through APPRISE, a statewide program to assist them in reviewing insurance information.
In Blair County, APPRISE is at the Central Blair Senior Center of Blair Senior Services, 1320 12th Ave. The free health insurance counseling program offers counselors to meet with seniors on a one-on-one basis to answer questions about Medicare, supplemental insurance and long-term care insurance. Although the counselors do not make recommendations, they do explain what the various supplemental plans provide so the senior can make an educated decision.
"People don't understand the Medicare booklet," said Margaret Greene of Altoona, who has been an APPRISE volunteer for about 10 years. "They are afraid of making a mistake."
Park and her team of APPRISE volunteers are available throughout the year, but answer a lot of questions during Medicare Open Enrollment, a period when seniors either enroll in supplemental insurance or make changes by signing up for a different policy, switching to another insurance company or changing or Medicare Part D (prescription coverage).
The open enrollment program begins Oct. 15 and ends Dec. 7. Once the period ends, seniors have to wait another year to make changes in coverage.
Enrolling in a Medicare Advantage Plan is often beneficial because Medicare Part A only pays for hospital or nursing home care on a short-term basis.
Retirees pay a monthly fee for Medicare Part B which includes doctor visits, outpatient treatments and tests. Medicare Part D covers prescriptions. APPRISE can help with Advantage Plan and prescription services.
Vergie Shannon of Altoona was able to find a plan that met her needs using the service. Shannon, who also is an APPRISE volunteer, said her original supplement insurance plan was good, but the rates kept going up. She said APPRISE was able to find her a less expensive plan and she no longer has a copay on her prescriptions.
Patty Marx of Altoona consulted with APPRISE about prescription programs several months before her 65th birthday.
"I never knew it was here, and I lived her all my life," Marx said. "I thought people came here for lunch" she said of the center.
Now Marx assists Park by volunteering to do office duties such as scheduling appointments and calling consumers with answers to their questions.
Questions vary because each situation is unique. One senior may need health insurance coverage that pays for physical therapy while someone else may want protection when they travel.
"Everytime I turn around, I see something I not seen before," said counselor John Vellone, a retired insurance representative who had owned his own agency.
"I understand the complications of Medicare as well as the other programs," he said, adding that he had to deal with them in his work.
He said when seniors approach age 65, they get stacks of information in the mail from insurance companies about supplemental insurance.
"They are asked to read it, understand it and make a decision. It is not always easy," he said.
Jessica Lippert, APPRISE program support manager for Pennsylvania, said more seniors are working past age 65 because the age of eligibility for full Social Security retirement benefits has been bumped up. However, those workers still need to alert the Social Security office at age 65 about their Medicare choice, even if they intend to continue using health insurance benefits received through their employer.
She said otherwise, they could face a penalty when they apply for Medicare Part B.
Lippert, whose office is based at Central Blair Seniors Center, said someone intending to work past age 65 can inform Social Security online, by phone or visit the local office.
With all the changes in health care insurance options, Park said APPRISE is seeing an increase in the number of seniors asking for its guidance, and more volunteers are welcome. She said last year, the Blair County office served 2,754 people and the telecenter assisted 1,478 people. By the end of August, the office has served 2,086 people and assisted 950 people in the telecenter.
"This job is a challenge," she said. "I enjoy learning the volumes of information and presenting it in a way that people can understand it. They learn from it. Take it home and know what to do with it."