Blog Post

Get help navigating Medicare

Joanne Burke (left), manager of the Apprise program at Einstein Medical Center Philadelphia, counsels a client new to Medicare. (Photo by Paola Nogueras)

Whether you are new to Medicare or are already enrolled and pondering changes to one or more of your plans, the decisions you make are critical to your health and finances. The good news is, you don’t have to navigate Medicare’s complexities alone. Trained Apprise counselors can provide you with free personalized counseling to help you make informed choices.

A federal program administered in Philadelphia by Philadelphia Corporation for Aging (PCA), the Apprise health insurance counseling program is available to Pennsylvanians 65 and older, as well as adults under 65 who are eligible for Medicare due to disability. Professional and volunteer counselors can answer your questions and provide you with objective, easy-to-understand information about Medicare eligibility and enrollment and counsel you on Medicare Advantage, Medicare Supplement (Medigap) and drug prescription plans. They can also screen you for eligibility for financial assistance programs that can help you pay for Medicare premiums, deductibles, co-pays and prescription drugs. In addition, counselors are available to assist caregivers, professionals and others with questions.

“We work individually and confidentially with you to determine your individual healthcare needs and preferences, compare health insurance options, and obtain Medicare and supplemental coverage that fits your lifestyle and budget,” said Joanne Burke, manager for the Apprise program at Einstein Medical Center Philadelphia in the city’s Olney section.

“There is no selling. Counselors do not make endorsements,” said Christine McBennett, who manages the Apprise program at the Mayor’s Commission on Aging in Center City. “We assist you in finding the best option.”

Initial enrollment

Those seeking counseling through Apprise can expect individualized advice. “Many people come to us when they are planning to retire or before their initial enrollment to get help understanding the basics of Medicare and the implications of the choices available,” McBennett said. “Each person’s situation is unique, and even if the question is common, the answer is specific to that person’s situation.”

While Apprise counselors provide information about Medicare, McBennett noted, they do not enroll people in the program; enrollment is done by Social Security.

Even for those who have already selected their Medicare coverage, an Apprise consultation can provide reassurance. “Many people feel better when they know they have done their due diligence and have not missed anything that could save them money or limit their access to health care,” McBennett said.

Open enrollment

The October 15 through December 7 annual Medicare open enrollment period is prime time to visit your local Apprise office. Both Medicare prescription drug plans and Medicare Advantage plans (Medicare plans offered by private insurance companies) change from year to year, and it’s always wise to ensure that your current plan is the best one for the year ahead, McBennett said. She advises coming to your Apprise appointment prepared: “Try to bring your Medicare card, a list of your prescription drugs, the names and addresses of any doctors you want to continue to see, and a list of questions you have.”

 Help year-round

While the Medicare open enrollment period is their busiest time, Apprise staff and volunteers provide services year-round. In addition to counseling new and prospective Medicare enrollees, they also screen people for Medicaid, the federal/state health insurance program for low-income and disabled individuals; the Low Income Subsidy (LIS, also known as Extra Help) program, which provides assistance with prescription costs; and the Medicare Savings Program, which can help with out-of-pockets costs for Medicare Part B. Part B covers medically necessary services like doctors’ visits and hospital outpatient services. Applications to enroll in Medicaid through the Pennsylvania Department of Human Services (DHS) and in Extra Help and the Medicare Savings Program, both through Social Security, can be filed with those agencies at any time.

Apprise counselors also can help screen you for financial assistance programs such as the Pharmaceutical Assistance Contract for the Elderly (PACE and PACENET) programs for Pennsylvania seniors whose income does not meet Extra Help guidelines, as well as the federal Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps).

In addition, Apprise counselors can help you to understand the potential benefits of long-term care insurance and discuss policy options with you. And if you disagree with a coverage or payment decision made by Medicare, Apprise can help you understand the Medicare appeal process.

For more information:

  • Apprise – Mayor’s Commission on Aging: 100 S. Broad Street, 4th Floor, Suite 400; 215-686-8462; Covered ZIP codes: 19102, 19103, 19104, 19105, 19106, 19107, 19112, 19121, 19122, 19123, 19125, 19127, 19130, 19131, 19132, 19133, 19134, 19137, 19139, 19138, 19142, 19143, 19145, 19146, 19147, 19148, 19151, 19153
  • Apprise – Einstein Medical Center: 5501 Old York Road; 215-456-7600; Covered ZIP codes: 19111, 19114, 19115, 19116, 19119, 19120, 19124, 19126, 19128, 19135, 19136, 19138, 19140, 19141, 19144, 19149, 19150, 19152, 19154
  • Statewide Apprise Helpline (toll-free in Pennsylvania): 1-800-783-7067
  • The Center for Advocacy for the Rights & Interests of the Elderly (CARIE): presentations about Medicare year-round; counseling during open enrollment. 215-545-5728.

In addition to health insurance counseling, the Apprise program offers presentations about Medicare and opportunities for volunteers. Contact your local office (see above) to learn more.

CAPTION: Joanne Burke (left), manager of the Apprise program at Einstein Medical Center Philadelphia, counsels a client new to Medicare. (Photo by Paola Nogueras)