With the open enrollment period starting Oct. 15, Boothbay Region Community Resource Council’s community navigator is advising Medicare recipients to check carefully before paying for supplemental plans they may not need.

Navigator Kathleen Arabasz said MaineCare and some other programs already include Medicare’s “Part B” buy-in and may make supplemental Medicare plans unnecessary. 

Arabasz cited two recent examples. In both instances, residents were buying plans they didn’t need: One for $39 a month; the other, for $100 a month.

“There are just over 90,000 people in Maine ... eligible for both MaineCare and Medicare,” said DHHS spokesperson Jackie Farwell. “MaineCare helps pay Medicare co-payments and deductibles for many people ... eligible for both forms of insurance.”

Arabasz estimated she meets at least once each week with people who are buying unneeded Medicare plans.

“It happens so regularly that I ask everyone who reaches out to us, ‘Do you have a Medicare supplement program? Do you pay a monthly premium for it?’”

And the cost is not insignificant, especially for those with limited funds. With some supplemental plans having an annual cost of more than $1,200, State Rep. Holly Stover calculated the total for the local residents who come through the navigator’s office to be around $62,000 each year. Maine Department of Professional and Financial Regulation Commissioner Anne L. Head is aware of the concerns. “As you know, there are many different issues that can come up with these coverage plans. Some people who are eligible for MaineCare can also be eligible for a Medicare Advantage plan instead, which may or may not be problematic," she told the Boothbay Register.

As for reimbursement if you don’t need the plan, that can be tricky. Arabasz has helped clients with calls to the insurance companies to cancel the unneeded plans. In some instances, the client is also reimbursed for the amount they have paid, but Arabasz said the individual “has to battle with the insurer.”    

“We get calls where we have identified this issue, and we take them on a case-by-case basis,” said Legal Services for the Elderly’s executive director, Jaye Martin.

As the state regulator, the Bureau of Insurance will help, “if, for example, the person was misled into believing they need the supplemental insurance,” Head said.

Bureau staff attorney Pamela Stutch explained there are “red flags” that serve as safeguards to prevent MaineCare recipients from being sold a supplemental insurance plan that isn’t needed. If that does happen, the person who bought the plan should file a complaint with the Bureau.

For those currently receiving or about to receive Medicare benefits, resources are available to help determine what, if any, supplemental plans might be needed.  Maine DHHS has an office of Aging and Disability Services which provides trained health insurance counselors to help with Medicare and other health insurance issues. Farwell encourages phone calls to its office. “Those considering whether to purchase Medigap insurance are encouraged to contact the State Health Insurance Assistance Program (SHIP) for assistance making the decision.”

SHIP counselors have information about programs in Maine that can help lower the cost of prescription drugs and other out-of-pocket medical expenses. Their services are free, confidential and available to older people and people who have Medicare due to a disability.

SHIP services are available by calling 1-800-262-2232. BRCRC can refer inquiries to the local SHIP counselor and can be reached by calling 350-7464 for community navigator Kathleen Arabasz or 350-1743 for navigator Hannah Corkum.

But don’t cancel a plan without checking first. MaineCare alone will not cover out-of-state medical expenses, so if the client will be traveling, it is a good idea to check first about coverage. Some programs like the “Silver Sneakers” program aren’t covered by every plan and some physicians may not be, either.

Local experts strongly advise attending the “Medicare 101” two-hour class offered in Damariscotta on the first Thursday of every month from 1 p.m. to 3 p.m.  For more information, contact Spectrum Generations at 563-1363.

“Things change – in the plans and in people’s lives,“ Arabasz said. “So it’s a good idea to go to the Medicare 101 seminar every few years and bring a relative with you.” To arrange transportation, call 633-4357.