Vital Medicare counseling service escapes U.S. budget cuts for now

(Reuters) - (The opinions expressed here are those of the author, a columnist for Reuters)

Catherine Jones lives on $930 a month in Social Security benefits, so every dollar counts for the retired Detroit nurse. Her income is low enough to qualify for a special Medicare program that covers Part B premium copayments and deductibles, but last April, something went wrong. For some reason, Medicare started charging her $134 each month for Part B.

“I called the Social Security office and told them someone was taking my money,” said Jones, 67.

Problems like this occur frequently, the result of paperwork snafus between interlinked Medicare, Social Security and state government systems. Jones - a widow who is in remission from a serious bout with cancer - found herself stuck in a complex bureaucratic web, and the Part B deduction continued for 10 months. Ultimately, she found her way to the Detroit Area Agency on Aging, which was able to straighten out the paperwork; Jones will be receiving a refund from Social Security of $1,340.

The agency is funded through the national network of State Health Insurance Assistance Programs (SHIP), a vital federally funded program that provides free assistance to seniors around the country as they attempt to navigate their way through Medicare’s complexities. Funding for the program has been under attack - the Trump administration and House Republicans proposed to eliminate all SHIP funding for fiscal 2018, and funding levels have been cut repeatedly in recent years.

But SHIP funding is on track to survive as part of the $1.3 trillion omnibus spending bill under debate in Congress this week. The legislation was approved on Thursday by the U.S. House of Representatives and is now headed to the Senate. It contains $49.1 million for SHIP – a $2 million increase over the fiscal 2017 level, but still below fiscal 2016, when $52.1 million was appropriated.

Jones’ story is just one example of how SHIP helps people deal with Medicare’s myriad complexities. Seniors often need help during the annual open enrollment period selecting prescription drug plans, supplemental insurance and determining if they qualify for special subsidies available to low-income enrollees.

Would the state of Michigan pick up the $1.3 million in federal funding the state receives if the grants end? “It’s highly unlikely,” said Jo Murphy, executive director of the Michigan SHIP program, citing the state’s budget struggles.

Last year, SHIP counselors helped more than 3 million U.S. seniors with everything from prescription drug plan selection to claims problems and special assistance programs for low-income seniors, according to the National Council on Aging (NCOA), which is battling to keep the program funded. More than one-third received help during the annual fall open-enrollment period, which runs from Oct. 15 through Dec. 7.

LOCAL EXPERTISE

The SHIP program is especially crucial for lower-income seniors like Jones. More than half of seniors on Medicare receive annual income of $26,200 or less, according to the Kaiser Family Foundation. Saving money on Medicare costs can mean the difference between medication, food or keeping the heat turned on.

Says Jennifer Goldberg, directing attorney on aging for Justice in Aging, a nonprofit advocacy organization: “The SHIPs help a broad range of the senior population, but it’s especially important for low-income seniors when it comes to Part D and special programs that help subsidize their expenses - that can be very confusing for people.”

In Michigan, for example, 42 percent of enrollees assisted by the SHIP are focused on enrollment in Extra Help, a program that often covers up to 75 percent of prescription drug costs. (reut.rs/2FY9KEC) But the program’s counselors spend plenty of time helping people navigate other aspects of Medicare. This year in Michigan, enrollees must choose among 24 standard prescription drug plans and 127 Medicare Advantage plans, plus another 34 plans that cover specialized needs. And 65 medigap plans.

Critics of SHIPs often argue they duplicate services available on Medicare’s 800 toll-free line, or from Social Security. “They tend to think that the Medicare toll-free line and website will give beneficiaries all the information they need on plan choices,” said Marci Phillips, NCOA’s director of public policy and advocacy.

But those resources cannot match SHIP counselors’ expertise about local health providers, or their all-important contacts with regional Social Security and Medicare staff, Goldberg said. “Walking through the online Medicare plan finder tool with someone is very difficult to do by phone - it’s much better to sit with a person, talk about their prescriptions and doctors and then make a recommendation.”

Perhaps most impressive is that all SHIP counseling is provided by well-trained volunteers. That means the federal funding is highly leveraged; NCOA reports that the program generates nearly 2 million hours of free assistance annually. In Michigan, a network of 650 volunteers is helping approximately 400,000 enrollees each year, Murphy estimates.

But they also help enrollees sort through complex claims problems and billing errors like the one faced by Jones in Detroit. She was referred to the Michigan SHIP after nearly a year making phone calls and visiting Social Security offices. The SHIP counselor knew how to sort it out by filing a special complaint tracking form to Medicare that began the process of correcting the error - the kind of thing no enrollee could reasonably be expected to do.

She says the extra $134 a month from Social Security will help, along with the expected refund. Jones worked part-time after retiring from nursing before her health worsened. Nowadays, she earns some extra income making wreaths and flower arrangements to make ends meet. “After my insurance bills and Medicare, I didn’t have any money left,” she said.