What services are provided by HIICAP?

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On May 4 the Centers for Medicare and Medicaid Services (CMS) issued a warning to keep your COVID-19 vaccination card safe because scammers are using the pandemic as a cover to steal your personal information.

Do not share a photo of your COVID-19 vaccination card on any social media. If someone calls you to buy or sell you a vaccination card, it is a scam. If you suspect COVID-19 health care fraud, report it online or call 800-HHS-TIPS (800-447-8477).

What services are provided by HIICAP? It has come to my attention that many readers of this column are new to Medicare and the help that is available to them. So, beginning this month the column will focus on the range of services that are provided by the Oneida County Health Insurance Information Counseling and Assistance Program (HIICAP). To do this I conducted a telephone interview with Joan Hyde, the Aging Services supervisor with the Oneida County Office for the Aging/Continuing Care/NY Connects. Among her duties, Hyde oversees the HIICAP program.

Hyde pointed out that one problem they face is that while the various Medicare programs are discrete, they have to work together. For example, if you are covered by Original Medicare (Parts A and B) you must also have separate a Part D drug plan. If you covered by Medicaid, with eligibility determined by the Department of Social Services, you will still need a separate Part D drug plan. So, HIICAP counselors are not only responsible for ensuring that their clients have the proper Medicare coverage but that all the programs they are enrolled in fit together properly.

What are some common questions related to Original Medicare? One common question is, What options do I need?” Hyde said, “We explain to them that to be covered by Original Medicare they have to have Parts A, B & D.”

Another very common question is, “How do you sign-up for Part B?” This usually triggers a number of questions, with the most important being “Is the client enrolled in Part B and, if not, why not? Have they been working past age 65, using Medicare Part A and using their employers’ policy to cover Part B? Were they living out of the country? Is the person low income and, if so, do they qualify for a Medicare savings program? Have they been covered by a spouse’s coverage which is no longer in effect?” Hyde went on to point out that these are only a few of the questions that counselors need to ask.

Hyde and I also talked about the fact that many people are not aware that there is a financial cost in the form of a penalty for not signing up for Part B coverage on time. Deciding to wait a few years to save money on premiums will actually cost you hundreds of dollars. The Part B penalty for late enrollment is 10 percent of the Part B premium for every 12 months you are without Part B coverage. And, this is a lifetime penalty. But you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period. If you find that you are late in enrolling in Part B, HIICAP may be able to help.

Medicare Advantage Plans. According to Hyde, “the biggest problem with Medicare Advantage Plans is a lack of network coverage in the HMO’s as well as the formularies (what drugs are covered) in their drug plans.” People will enroll in an Advantage Plan only to find out that the providers they have been using are not in the plan’s network.

Another issue, according to Hyde, is that there have been some changes in the coverage of high-cost medications.

“We do find people who are currently under some Advantage Plans and are now undergoing chemo therapy, radiation or dialysis resulting in huge co-payments. If they can return to Original Medicare, they are able to save a lot of money. But we have to find a special enrollment period to make this change. In some cases, we may be able to use the NY State Elderly Pharmaceutical Insurance Coverage (EPIC) Program,” she said. If you have an urgent question you may want to call 1-800-MEDICARE (1-800-633-4227) for immediate assistance. However, this is only a temporary change in response time. HIICAP counselors remain available Monday through Friday to help you answer all your Medicare related questions. Because of the pandemic, all counseling sessions will continue to be conducted remotely.

Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer, NY. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.

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