The Medicare beneficiary appeared to have excellent health-care benefits – both Medicare and Medicaid. But he was being denied a medical procedure because part of the bill wasn’t being paid.
To get help, he made an appointment with a Senior Health Insurance Benefits Assistance counselor.
The monthly procedure, done in a doctor’s office, cost several thousand dollars each time. Medicare would pay its 80%, but the state’s Medicaid system showed that another insurer should pay its share first. Because Medicaid was refusing to pay, the man couldn’t get the medical treatment he needed.
The counselor elevated the problem to the SHIBA state office in Salem, from which state officials worked out what presumably was a computer-coding issue. The billing issue resolved, the man subsequently reported that he was again scheduled for the pain-relieving procedure.
If you would like to make an appointment with a SHIBA counselor, or to ask a question to be answered here, please see the end of this column.
Q: I am going to start my Medicare in a few months, and will make a SHIBA appointment before I do. In the meantime, though, I want to do a little Medicare homework. Can you recommend a reliable source?
Yes, an excellent source is the 2021 Oregon Guide to Medicare Insurance Plans, a comprehensive booklet. Besides the table of contents, toward the back it has an index and glossary. Or to have a hard copy mailed to you call the Salem or Dallas office of Northwest Senior and Disability Services.
Medicare.gov has vast amounts of user-friendly information. For a deep dive into Medicare, log on to MedicareInteractive.org. If instead you find yourself with only a question or two, call the SHIBA hotline during normal weekday business hours at 800-722-4134 (don’t enter your ZIP Code, just stay in the line).
Q: An insurance agent gave me premium quotes for several Plan N Medigap insurance policies. The monthly premiums vary by $100 or more. What do I get if I pay the higher premium?
The short answer is nothing. Within a Medigap letter designation such as Plan N, the coverage that the policies deliver is identical. The reason for the dramatic diversity of prices is most likely that a company with higher prices has a higher claims experience and therefore charges more.
Q: I recently worked with a SHIBA counselor to apply for “extra help” paying for my prescription drugs. But when we completed the application, I forgot to declare a small pension that I receive. Could my oversight give me trouble with the IRS?
No. When you apply for that benefit, Social Security confirms your income by checking your income with the Internal Revenue Service. If the income you declared with the IRS qualifies you for extra help, also known as Low Income Subsidy, then you will receive a letter declaring you eligible; if not, you will receive a letter of denial. On an application for a Medicare benefit such as you submitted, it is not uncommon for someone to forget something.
Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected] To schedule a free SHIBA phone appointment with a volunteer Medicare counselor, call 800-722-4134.
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