As a former government employee who worked across different sectors for nearly 30 years, Bob Earnest brings his heart, his soul and a true calling to public service to his work.
Today, as a volunteer for the Multnomah County’s Senior Health Insurance Benefits Assistance (SHIBA) program, he offers free, unbiased information and assistance to community members trying to understand their Medicare options.
“We work to demystify the complexities of Medicare and Medicaid,” said Earnest. “I enjoy listening to people's stories and helping them navigate the system; it's something I've done all my life.”
The team usually sees a surge in appointments during the open enrollment period. This year was no exception, as the available appointment slots were quickly filled soon after they were announced. Those still seeking support with open enrollment can call the County’s Aging and Disability Resource Connection at 503-988-3646 or email them at adrc@multco.us.
Even after the annual Medicare open enrollment period is over, beneficiaries who are already enrolled in a Medicare Advantage plan can make some important changes. The Medicare Advantage Open Enrollment Period (MA OEP) is January 1–March 31 each year.
During this period, Medicare beneficiaries with a Medicare Advantage plan can:
- Switch to a different Medicare Advantage Plan
- Drop their Medicare Advantage Plan and return to Original Medicare
These changes take effect on the first day of the month after the plan receives your request.
“The process can be perplexing, especially as people face a mountain of choices,” said the Department of County Human Services’ Carisa Dickson, who heads up the SHIBA program.
Dickson has also devoted her career to helping people who need help with Medicare and Medicaid. And her role with SHIBA goes even further as a program specialist for the Senior Medicare Patrol, a service that empowers and assists Medicare beneficiaries, their families and their caregivers to prevent, detect and report health care fraud, errors and abuse.
Choosing the right Medicare plan can be daunting. Basic Medicare, with its 20% coinsurance fee and no out-of-pocket maximum, can leave beneficiaries exposed to significant costs.
“It's a rocketship ride to the moon,” Earnest says, referring to the potential for sky-high medical bills. Medicare Advantage plans, offered by private insurance companies, can help limit costs. But they also come with their own set of complexities, including networks, formularies and varying premiums.
Walking through those complexities is where Earnest and Dickson can step in.
“It's crucial to open your mail. So often people come in and see us and bring us unopened mail, Earnest said. “But even once mail is opened, Medicare beneficiaries can still become inundated with confusing notices and plan changes. If you're overwhelmed, don't hesitate to call us."
Dickson added that “if a plan is changing, individuals need to actively seek out that information. While people might be notified through the annual notice of change document, it's crucial to read your mail carefully and be vigilant.”
It’s especially important to seek out Medicare information this time of year. Dickson suggests looking at various formularies linked at the medicare.gov website, which she notes is designed to not be intimidating for users.
While medicare.gov is a great source for reliable information, Dickson warned that it shouldn’t be confused with the medicare.com website, which is run by “a private insurer, not a government site.”
The official medicare.gov website allows users to compare plans, check drug formularies and better understand coverage. The website’s "Is It Covered" search tool shows what services are covered, although it may not show the exact costs. Users may still need to investigate further to find cost specifics, although the site often provides coverage percentages.
SHIBA volunteers help people understand these nuances. They can explain the differences between Medicare Advantage and Medigap supplemental plans and highlight changes in coverage. If someone is prescribed a new necessary medication mid-year but it’s not on the formulary, SHIBA can even help them appeal to their plan administrator.
“We can't make choices for you,” Earnest clarifies, “but we can empower you with the information you need to make informed decisions.”
In October, Senator Ron Wyden hosted an event and press conference at the Community for Positive Aging (formerly Hollywood Senior Center) in Northeast Portland, coinciding with the launch of open enrollment. He was joined by Dickson and other SHIBA coordinators during the event, as he outlined ongoing efforts to improve and reform health insurance for seniors.
“Companies, some looking for a fast buck, can’t sell your information again and again and again,” said Wyden. “And they can’t sell plans that look like tax forms. The plans also can’t advertise benefits that they don’t make available in our area.”
As part of reform efforts Wyden also shared efforts to address insurance prior authorizations.
"I'm constantly hearing that seniors, and others, are finding these plans use a 'deny first' system: Red tape delays and denials of care,” said Wyden.
While progress is being made, there’s still more work to do. Beyond comparing plans, SHIBA also educates beneficiaries about Medicare fraud through its Senior Medicare Patrol program.
Beyond comparing plans, SHIBA also educates beneficiaries about Medicare fraud through its Senior Medicare Patrol program.
“Trust your gut,” Earnest advises. “If something doesn't feel right, reach out. No one from Medicare will ever call you and ask for your Medicare number.”
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