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NC SHIIP Program Revealed

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Elder Law Report 070
NC SHIIP Program Revealed

You know I was in the military, I was in the Navy and today I heard I was going to discuss the SHIIP program today, and I thought I might be getting shipped out again and be leaving for another 6 months. That’s not at all what the SHIIP Program is. I talked with Melinda Houser with the Lincoln County Extension Center Service who is a family councilor and coordinator for the SHIIP Program, and also Valerie Spearman who is a volunteer councilor since 2003 with the Lincoln County Extension Service.

These programs exist as I understand it, in all communities in North Carolina, not just Lincoln County. We cover 16 counties and very proud to do so and want to make sure we speak to Lincoln County but also relate that to the rest of western NC as well. So the SHIIP Program, tell me about it.

SHIIP’s been around since 1986 and North Carolina was one of the first states and also a showman for the SHIIP Program cause a lot of states model their program after North Carolina, and it’s one of the top ones, it’s been recognized so many times.

It stands for Senior Health Insurance Information Program.

We have open enrollment beginning October 15th through December 7th and it is full speed ahead, 9 until 3 everyday.

We have a satellite office down in Denver, it’s a Christian ministry. We set up an office down there so we can reach the people in the eastern part of the county. One thing that is so interesting is how much money they have saved citizens of Lincoln County. They’ve saved thousands of dollars. It was over four hundred thousand dollars ($400,000) last year.

Explain it to me. I know it’s insurance, I know it involves seniors and is it health insurance, is it a Medicaid supplement?

It’s strictly prescription drug cost.

What happens is we had 22 I think different plans for North Carolina eligible participants and a lot of times the prescription drug plans will drop a Medication or go up on the cost of the prescription drug plan, so what we do is put in all their medications and try to find the lowest cost prescription drug plan for them for the year. So if your drug costs $500 and your plan has dropped that particular drug, if you didn’t change plans you would be paying $500 dollars for the cost of that particular drug. So we may be able to change it to one that would cost $15 dollars for the cost of that same drug.

And you can do that because you’re plugged into all the information.

Yes, Medicare has an online system for us, so we go online and we give people options, but we do not tell you which plan you should use. We give you the information, and typically focus on the top 3 lowest cost plans for the individual, and we view those with them. A lot of times they may not want to go with a particular plan because each particular drug plan is associated with our pharmacies, and there’s preferred pharmacies and then just your normal pharmacy that covers the Part D plan. If you go to a preferred pharmacy you can save more money. So some people don’t want to change to the particular pharmacy that was with that plan so they may choose to pay a little bit more. Or there may be a plan that has a deductible of $360 dollars that they don’t want so they may pay a little bit more to keep from having to pay that particular deductible, because January, February, March, people don’t have a lot of money cause they spent all their money at Christmas time, so they want a plan that doesn’t hit them up front for the $360 dollars. So they may not always choose the lowest cost plan but we do help them find the plans that will save them the most money.

Another issue that I think is relevant to talk about is, a lot of people think well I’m not sick, I don’t take medication, I don’t need a drug plan, and I say what if you have a heart attack or a stroke tomorrow what are you going to do? And so people don’t and they have to pay a penalty. They have to pay a penalty from now on?

It never goes away and it’s around 3 cents, 3.7 cents I think per day until you take a plan, and that penalty will never go away, the lowest will be added to the lowest premium cost.

So you get penalized, it costs more in an emergency when you need it than from planning ahead right?

If you do not take out a plan, between November and December if you do not select a plan, in January if you suddenly get cancer god forbid, you can’t just go get a plan. You cannot enroll until November of the year then it will be effective for the next year. So it’s not easy to get a plan to help you, it’s better to be preventive. Be proactive towards the cost of your prescription drugs, because when you sign up the plans aren’t that expensive. $18.75 was the lowest cost and we have some that go up to $88 dollars per month but I seldom sign anybody up for those plans. It’s just because the plans that cost more doesn’t mean it’s the best plan for you. Each person is different, if your neighbor is paying $18 dollars and we’re telling you the lowest cost plan for you is $33 dollars, your neighbor is not taking the same medication your taking. Everything is based on the particular drugs you are taking at the particular time, so you maybe paying more than your neighbor or you maybe paying less than your neighbor but you will still be paying less than if you didn’t have a plan.

It sounds like were preaching the same thing. I talk all the time about thinking ahead and how it’s cheaper to have Powers of Attorney in place, General Durable Power of Attorney, Healthcare Power of Attorney and Living Will, and maybe some deed planning to protect property against a tragic situation that might happen with healthcare, and it costs much more to do that in an emergency to protect it than it does to plan ahead, it costs a fraction.

You get a lot of people like that who don’t even know there is programs out there for assistance and it’s called the Extra Help Low Income Subsidy. That’s another program we have if someone who comes in and says, well I can’t afford that for my medicine, we look at their assets and if they have any additional benefits. A lot of times people think well I must make too much money or when they look at the cost of their house or things like that but what we look at is the money that they have, and their checking account, and their IRA, if they have a pension fund, and if they qualify for assistance, then they may pay no more than a $1.35 now to $2.65 for their prescription drugs. We have other options for people to look at as well as the actual cost of their medication.

We work closely with social security, DSS, we all combine together as a coordinated program really because a lot of people go to DSS and get on some of their programs and social security and we have an in-line thank goodness with social security and DSS. We work together and are supportive on that.
What DSS does is if someone applies for Medicaid and they send them to us, in the past your prescription drugs used to be a part of Medicaid and now it’s not, it’s separated out, once you turn 65 or go on disability you may qualify.

Once you qualify it would be Medicaid.

People who might not qualify for full Medicaid might qualify for assistance with their prescription drugs, they work separately now. If you have what’s called Full Subsidy and Partial Subsidy. Full subsidy would pay for your Medicaid as well as your prescription drug plans, partial would pay for your prescription, it could pay for your part B premium which is $166 dollars this year and it will also pay all your medications. And it may pay 75% of your cost for medication, if you don’t qualify for full or partial subsidy.

This year if you’re an individual and qualified for the partial subsidy, if you didn’t qualify for Medicaid, you’ve an income limit of $1485 dollars a month. Your resource and asset limits are $13640 dollars. That does not include your home or your cars. It just includes your actual money available to you.
If you’re a married couple living together, your monthly income is then $2002 dollars and fifty cents. Your assets limit is $27250 dollars. So if you come in to seek help with us and you say you can’t afford your medication, we may then send them to the DSS, or they can talk to someone in social security, or we can fill out the application for them for the low income assistance.

And that’s really important, if you think about the things that are available, but we also have people who are on disability who are aged in their 20’s, 30’s, 40’s and they have signed up for these programs and it saves them bunches of money, because a lot of these people are married and have children and there is really a financial hardship for them.

So you know people who are trying to pay for food versus medication?

Yes, lots have come in, it’s sad. We’re trying to do everything we can and a lot of times even if people don’t qualify for the assistance, there are other options which are available. Some of the pharmaceutical companies offer assistance on drugs, unfortunately most will not offer assistance if you’re on partial, even so we bend the line and try an find those companies for them. A lot of times I’ll send them back to their doctor, cause the doctors don’t really know what the patient is paying for the medication, and just say look, I can’t afford this medicine is there a program out there that will pay for it, and most of the doctors were aware of this. One in particular is the people who are diabetics. Some of the diabetic insulin shots are covered 100% once you go into the gap, and the doctors know this and can help them with that, paying for their meds and get it covered free for the entire year.

Another is Helping Hands, occasionally you can get Helping Hands to help with your drug costs.

I’ll print out what the actual cost of the drugs are and I’ll say, go to your doctor and let them know what you’re having to pay. Is there another drug out there that might be a lower cost for you that would do the same thing.

Another drug, more generic, something that can do the same job only cheaper. That sounds like a great program and I’m thinking the community in Lincoln County are extremely blessed to have you.

We have 5 councilors and they are all busy and have done a great job, we’re one of the top counties in North Carolina as far as what they have accomplished, reaching people and saving money. There are a few people that can’t be helped, we’ve had one or two with a situation, there’s nothing worse.

I’ve heard of the SHIIP Program but I wasn’t familiar with it in depth, and that’s something we do on the elder law report is bring information that really may not be advertised in the community as much as needed for the public and for seniors.

So you have 5 councilors there and I know the Lincoln County Extension Service is extremely active in the senior community. How many years?

The Part D part started in 2006 that’s when the prescription drug program came into effect was 2006. We’ve been very involved since then.

The sad thing is it changes so much and people don’t know what’s happening, that‘s the reason we have this program to inform people about the drug benefit change.

Any benefits program changes, for instance you just gave a lot of information about a Medicaid Benefits Program. I do Medicaid Crisis Planning for families all the time but it’s a totally separate program okay than what you’re dealing with. Even the word Medicaid can encompass so many different programs it is unreal.

People are embarrassed about that sometimes but they shouldn’t be embarrassed about this.

So let’s talk about that for a second alright. You’re entire life you pay taxes, sometimes up to 45 to 50 cents on the dollar, if you look at property taxes, income taxes, any kind of sales tax you’re paying, and you’re working hard for this money in all types of industry in Cleveland or Lincoln County or somewhere in western North Carolina, or wherever you may be.

So you take that little 45 to 50 cents on the dollar that you’re left with and try and accumulate things during your life and then, this is what I call the middle class trap, because if you’re really super poor you’re going to get benefits, and you understand that I think, you don’t love that but, if you’re rich, you’re going to plan for that, you don’t need it, you’re going to legally protect yourself. But as a hard working middle class American you feel guilty to go access a benefit, that’s what I see many times but they don’t understand that they pay for that benefit, you created it with your tax dollars. Now it may have dwindled because of, not your fault but dwindling social security, those things are misappropriated or re-appropriated by the powers at be all the time, that money is moved around for different reasons. But it should be there for seniors. You created that pot of money by all your hard work and through all that money you were missing in your pay checks all your life. To access these programs, you talked about asset limits for married and single people, I deal with asset limits for people going into a nursing home or assisted living, at that point you’re asked to spend down all the money you worked so hard for, or that little bit of money you were able to scrounge out of your paycheck, before you can access the benefit you paid for, it makes me mad.

That’s their system, that’s the system we struggle with and then on top of that there’s guilt by the people who need to access it because of their hard working mentality and don’t want to freeload right, so they don’t access it .

I’ll probably get hate mail because of this but bring it on.

I try to put people at ease and the way I do that is by saying, hey my mother in law was on Medicaid in South Carolina. I don’t see any stigma to being on Medicaid because a lot of times you can’t live on their social security, for $400-$500 dollars a month, you can’t live on that.

That’s the food versus prescription drugs,

Right, and one thing we have done in the Christian Ministries who told me if you come in and somebody tells you they’re having to choose between medicine and food, we’ll bring you boxes of food up there they keep in the offices to give to them. It’s Lincoln Christian Ministry. We work closely with them so people don’t leave hungry. A guy that I helped, he said you’d be surprised how many ways you can make Ramon noodles.

We have hungry people in our county. We want to help people anyway we can, we’ve tried to work closely with social security, DSS, Christian Ministry, all of the local areas just to find help for people. There’s just so many in need, we’re passionate about this.

One thing I want to mention is Fraud, we emphasize that too and I want to share something with you on this.

Examples of fraud and abuse is happening everywhere, and we’re talking about people being billed by the hospital or by doctors, billing for services, supplies and equipment that were not provided, this can happen. I want to mention you get a Medicare summary that comes in and people need to look at that Medicare summary and see because we’ve had people charged for things that didn’t even happen in a hospital, or go to a doctors office and find things you’re being charged for, and people are human they make mistakes we know that but people need to be aware of that.

Another thing is having fraudsters calling Medicare beneficiaries and asking for their Medicare number, people getting phone calls from people for their information and some people have been robbed for thousands of dollars.

People give their information over the phone, their Medicare number and whatever. People have been taken and in our county, I know that for a fact. I have turned in 3 different fraud cases to the department of insurance, so these people need to be aware of this, it’s happening in our county, it’s happening in all counties because people are out for money for whatever they can get, drug money or whatever.

So this is happening to people and one thing I want you to remember is, don’t give out your Medicare number to anyone who asks, only your doctor or other Medicare providers should need it. Another thing is don’t give your Medicare number to telephone calls I mentioned that, or door to door salespeople.

We have a case happening in Denver City two years ago. Two people came to this lady’s door and said they wanted to talk about her insurance, and this one man detained the lady about insurance, the other went through the house and just robbed her blind. She wasn’t aware of what was going on with it, and then they left and that was it. They took all kinds of things from the house. So, people are not supposed to knock on your door and say I’ve got this particular insurance program I’d like to talk to you about, Medicare or whatever, no, that’s a problem, it shouldn’t happen but it is happening. I want to emphasize this over and over.

I meant to add we have other programs, we have 4H which is youth and leadership and then I do a program on nutrition and other stuff too. I have another organized group ECA (Extension Community Association) and there’ll be lots of projects in the community for different organizations and we teach a lot of different classes.

We did one yesterday on nutrition, and we did a potato garden with herbs, there is all kinds of things going on that you might be interested in. In the meantime we have a grant for this program-ship. I have a grant that I operate every year. It’s proper insurance, it’s not a lot of money but with our supplies we do education programs, we did a Medicare program not long ago, and had about 75 people there. We go to churches and do our programs and do special supplies with this grant money, it’s only about $3000 dollars which isn’t a lot of money for one year so.

Well, I thank you for the noble work you’re doing. I appreciate it, and if anyone wants to get in touch with you to learn more about the Lincoln County Extension Service, you offer much more than the SHIIP program, all kinds of activities and classes and other things that you can get involved in there, and you have raving fans that come there all the time I know, I’ve been interactive with some of them but how can they get in touch with you?

Okay, we have a phone number, it‘s 704-736-8461.

If you don’t live close to downtown Lincoln County or to Denver, there’s a SHIIP number through the North Carolina Department of Insurance, it’s 1-855-408-1212 and they can give you the name and location of the nearest SHIIP office for you, or they can actually answer your questions there too.

Well thank you so much.

Every community has something similar, a 5 year extension service, your senior services SHIIP Program, councilors who you can talk to about how you can save money on your prescription drugs and how they can help you or a loved one.

This has been the elder law report, I’ve had a lot of fun learning today along with you.

I’m Greg McIntyre, the elder law guy and Elder law attorney with McIntyre Elder Law. If you have any other questions or need any other information about this information or other planning services, you can call our office that’s McIntyre Elder Law on 704-259-7040.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

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