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Navigating Medicare with help from local SHIP services

By Katy Deshler
Special to The PREVIEW

Medicare is complicated. It is important that you know your rights, options, deadlines, possible penalties and where to find the information you need.

Did you know that assistance is available in Pagosa Springs through the nationwide State Health Insurance Program (SHIP)?

Trained and certified Medicare navigators are available by appointment to guide you when dealing with Medicare enrollment, questions, and problems. SHIP has been available in Archuleta County at the Senior Center for more than twelve years under the auspices of Archuleta County.

Beginning April 1, SHIP services will be offered through the San Juan Basin Area Agency on Aging (AAA), again at the Senior Center. Call 264-0502 to make an appointment.

Medicare eligibility begins at 65. Three months before your birth month you can enroll in Medicare and start making decisions about your options. Some of the things you need to consider are:

• Are you eligible for Medicare Part A and Part B? Do you need both?

• Do you have a retirement plan that will work with Medicare?

• Do you want a Medicare supplement (also called Medigap)?

• Would you prefer coverage through a Medicare Advantage plan or cost plan?

• Do you want a Part D drug plan? If so, which plan would work best for you? This varies depending on drugs you take.

It is important to know enrollment deadlines to avoid penalties.

The SHIP navigators offer a Medicare 101 class every few months to help you get started and provide you with important information. The next class will be held at the Senior Center on April 22 at 10 a.m. Call 264-0502 to reserve a spot.

Generally, you can enroll in Medicare online at www.ssa.gov or by calling Social Security Administration. If you are already receiving a Social Security check you will be automatically enrolled in Part A and Part B, but will need to enroll in Part D yourself. You can also find valuable information at www.medicare.gov.

If you are already on Medicare and have a Part D drug plan, you need to review that plan each year during the open enrollment period October 15 through December 7, as plan premiums and coverage of drugs change each year. SHIP navigators are available to help during that time, or you can go to www.medicare.gov to review your plan.

If you are receiving Social Security disability, you will probably be eligible for Medicare starting 23 months after your disability begins. You will have a limited time period to enroll in a Part D drug plan without penalties and purchase a Medicare supplement policy. Call Social Security to ensure you are enrolled and follow up with an appointment with a SHIP navigator.

Are you concerned about your ability to pay your Medicare Part B and Part D premiums?

If your income falls below a certain amount you may be eligible for assistance with premiums, deductibles, and copays. SHIP navigators can help determine your eligibility, potentially enroll you in a low-income supplement and guide you to the proper channels for assistance. You can go to www.ssa.gov for further information.

What do you need to do when you are moving out of the area?

You need to report your change of address to Social Security. Check with your drug plan to make sure you are covered in the new area (and that it is the best plan for you in that area) or enroll in a different plan. If you have a Medicare Advantage Plan, contact them to find out what coverage is available in the new area and find out what other plans are available in that area. You have 63 days from the date you report your move to make these changes.

Do you have a claim you do not understand or have a problem?

Call Medicare at (800) 622-4227 for assistance or make an appointment with local Medicare navigators. If you have questions about your Medicare coverage, claims, fraud and abuse, or enrollment options, please call 264-0502 to make an appointment with a Medicare SHIP navigator. They are here to serve you, free of charge.

This story was posted on March 27, 2014.