The role of APPRISE in Counseling Medicare Beneficiaries.

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Presentation transcript:

The role of APPRISE in Counseling Medicare Beneficiaries

APPRISE is… Pennsylvania’s State Health Insurance Assistance Program (SHIP) Largely federally funded Administered locally by Area Agencies on Aging (SHIP paid staff) Supported by over 700 volunteers statewide Currently serving approximately 200,000 of Pennsylvania’s 2.5 million Medicare beneficiaries SHIP SERVICES

Health Insurance Counseling Community Education Outreach APPRISE SERVICES Health Insurance Counseling Community Education Outreach

Health Insurance Counseling Community Education Outreach APPRISE SERVICES PERSONS AGE 65 AND OLDER This group makes up the largest percentage of Medicare beneficiaries Eligibility for Medicare is based on reaching age 65 and work history INDIVIDUALS WITH DISABLITIES The fastest growing Medicare group Often uninsured before qualifying for Medicare May qualify for both Medicare and Medicaid Eligibility is based on disability status CAREGIVERS AND OTHERS Spouses and other family members caring for a beneficiary. Individuals and/or advocates representing the needs of beneficiaries Who seeks out APPRISE services?

Provides unbiased, personalized counseling Interprets Medicare Rules Addresses coordination of benefits issues Enrolls eligible beneficiaries into public programs Assists with plan enrollments Assists with filing appeals How Apprise Assists Medicare Beneficiaries

Enrollment Periods Benefit periods Coverage limitations (e.g., Part A deductible) In-patient vs outpatient hospital status Medigap/Supplement Insurance SNF vs NF coverage Initial & Special Enrollment Periods Late enrollment penalties Cost Sharing IRMAA Durable Medical Equipment Retiree and COBRA coverage Enrollment Periods Part A & B coverage requirements ESRD Plan Rules Cost-Sharing Extra benefits Enrollment Periods Delayed Enrollment IRMAA Creditable coverage Employer Coverage Extra Help status Part A Part B Part C Part D Important insurance considerations

How APPRISE Assists Duals Multiple Coverages? New dual Status? Medicare Cost-Sharing? Enrollment into D-SNPs? Navigating Service Systems? Filing Appeals? Drug Coverage ?

Collaborative work with OLTL to prepare for CHC Conversed with other states to better understand SHIP role APPRISE staff serves on CHC planning workgroups Reviewed and commented on CHC documents Participated on a webinar to provide Medicare training to stakeholders OLTL staff presented information on CHC at APPRISE annual conference Conference calls are being scheduled with zone 1 local APPRISE programs to assess readiness for CHC implementation Reviewing additional training needs Identifying communication and referral processes

Summary APPRISE is a trusted resource APPRISE counselors are trained in all areas of Medicare and coordination of coverage with other insurances APPRISE services are available throughout the state APPRISE understands how Medicare beneficiaries receive coverage in both systems: Fee for Service and Managed Care APPRISE works in partnership with numerous community organizations to meet the needs of Medicare beneficiaries APPRISE has experience working with individuals dually eligible for Medicare and Medicaid

For more information about APPRISE… Call us at Visit us at Or contact your local Area Agency on Aging