Guidance through the health coverage maze

Before stumbling upon the free Medicare workshop last week, Toni Mastronarde spent three years feeling ashamed and beaten down because she couldn’t figure out her Medicare coverage and didn’t have enough money from Social Security to pay for medications and basic needs like food and heat.

She carried so much stress in her muscles, her neck could hardly turn. The 69-year-old diabetic said she had mostly gone without insulin for months, canceled appointments with specialists and only eaten beans and split pea soup – never fresh fruits or vegetables. Her apartment is always cold because she fears the cost of heat.

“I have been in the dark,” Mastronarde said, her large eyes filling with tears. “I’ve talked to a plethora of people. Every one of those people would tell me something different and none of it was comprehendible.”

She looked around the clinic at tables of volunteers helping people like her navigate the complicated Medicare and prescription drug system in addition to other health insurance issues. She shook her head in disbelief that she finally found help – Medicare with affordable drug coverage helped by her ability to qualify for a low-income subsidy.

“I came in here and these people are just like a fluffy cloud covering you with all this attention and intelligent answers that explain my situation better than anyone had,” she said. “They’ve actually straightened out my life and gotten me help.”

Mastronarde’s nightmare is almost over thanks to the monthly workshop put on by the Statewide Health Insurance Benefit Advisors. The free service is provided by the office of the state insurance commissioner and Aging and Long Term Care of Eastern Washington.

In Spokane and Whitman counties, the few staff members and more than 40 volunteers in 2014 helped 4,561 people answer Medicare questions and provide one-on-one counseling. The program provides free, non-biased advice so people can make decisions about health insurance and public health programs.

The goal is to help people:

• Understand health care coverage options and rights.

• Find affordable health care coverage.

• Evaluate and compare health insurance plans.

Nearly every county in Washington offers a similar program. In Stevens, Ferry, Lincoln and Pend Oreille counties, Rural Resources Community Action runs the SHIBA program. Most states, including Idaho, have health insurance assistance programs like SHIBA.

“There’s so much to all of this,” said Kathy Dugan, SHIBA program coordinator. “It just goes on and on and on.”

The program wouldn’t work without its dedicated volunteers, who staff the monthly workshops and weekly workshops during open Medicare enrollment season Oct. 15-Dec. 7. During those months, the team often holds Thursday workshops at the Shadle Library then travels around the area offering enrollment help at other libraries. Wednesdays the team is at the Pullman Senior Center.

Dugan said more volunteers are desperately needed, especially as more and more baby boomers turn 65 and become eligible for Medicare. Spokane Valley and Whitman County are places that especially need volunteers.

“They are the most amazing human beings on the planet,” Dugan said. “It just blows me away their level of dedication.”

Beverly Baker, 77, has volunteered as a greeter for about two years. She started after attending one of the free monthly workshops to find the drug plan that covers her more than $2,000 monthly medication bill, which is more than her income.

Baker said she isn’t computer savvy and that a stroke hindered her short-term memory, but she feels helpful welcoming people at the door and showing them how to get started with a counselor.

Raeleen Turner has volunteered for about a year. The retiree used to work in a pharmacy so she helps people enter their prescription drugs into the medicare.gov website to see which medications are covered by which plans and which pharmacies also participate. Often Washington State University pharmacy students help with prescription entries, which is helpful because the students can usually spell complicated drug names.

Turner spent nearly 20 minutes helping Kathey Johnston enter all the prescriptions for her husband, who turns 65 in May.

“They are going to help me find the best plan,” Johnston said.

The free monthly workshop is open to everyone regardless of income. Dugan said the problems are often complex but sometimes it’s as simple as helping a person find a more affordable drug plan.

That was the case with Mark Thulean, who said he was duped by an insurance agent into changing to a prescription drug plan that had too high of a deductible so he had to go without his inhalers for COPD for more than a month. He wanted to return to his previous plan that didn’t have a deductible and didn’t charge extra for him to see his doctor.

“I thought I was going to die,” Thulean said, adding that Catholic Charities helped pay the deductible for the first set of inhalers.

Dugan guided Thulean on how to switch coverage plans on the medicare.gov website. The new plan he chose doesn’t pay for doctors or services outside the network. Dugan reiterated the point over and over.

“Look me in the eye one more time before you agree to this,” Dugan said, adding that the ultimate decision is up to the client but they must understand the consequences.

Thulean laughed and agreed once again that he understood. He was appreciative for the help.

“Nobody ever explained anything like that to me before,” he said.