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SHIP/HICAP - A Place and Guide for Medicare

Nearing age 65 and not sure when to enroll in Medicare? Have you ever received a bill from Medicare and weren't sure which course to take?

You are not alone.

Between now and 2030, an average of 10,000 U.S. Baby Boomers will turn 65 every day. Navigating the multifarious options of Medicare health insurance, including billing, is part of that transition.

SHIP/HICAP, the Health Insurance Counseling and Advocacy Program, a federal and state-sponsored, volunteer-supported program, provides free and unbiased assistance to people who need their questions about Medicare answered.

The California Department of Aging (CDA) provides oversight of the program through contracts with the local Kings/Tulare Area Agency on Aging (K/T AAA).

For more than 40 years, a team of staff members at the Kings/Tulare HICAP provide information, and often relief, to Medicare consumers on what is often referred to as the "Medicare maze."

Destiney Hernanadez, Social Worker II with HICAP, is one of those team members. During a recent counseling session with Abel Garcia, Medicare recipient and HICAP client, insurance coverage variables such as benefit coverage, billing, consumer rights, as well as coordination of Part B and Part D, were all a challenge to understand.

"I have veteran's benefits, as I am a Purple Heart recipient, so I have no issues with prescriptions, but my wife's prescription needs were high-costing," said Garcia.

Not knowing where to go, a family friend recommended he go to HICAP. And that's what he did.

"Abel lost his wife, so when he came for services, he was dealing with not only his loss but living with a disabled adult child, his grandchild, and the continuous incoming bills for Part B services his wife had received before her passing," said Hernandez.

Gradually breaking down each step, Hernandez and Garcia worked together by "reviewing bills to ensure proper payments were made by Medicare, providers were charging appropriately, previous Medicare supplements had processed payments, and applying for several financial assistance programs through the providers."

"HICAP assisted Abel in saving $6,583.62," said Hernandez.

Medicare eligibility and enrollment are basic for most people. You must be 65 years of age or older. If you are younger than 65, you may qualify for Medicare if you have End-Stage Renal Diseases (ESRD) or have been awarded Social Security Disability Insurance (SSDI).

Enrollment also requires U.S. citizenship or permanent residence, and having 40 working credits on file with the Social Security Administration (SSA). Once acquired, SSA auto-enrolls people into Medicare who already receive Social Security payments.

Most people will receive their Medicare card three months before their 65th birthday. If you're not getting Social Security payments, you have a seven-month window in which to enroll through the Social Security office or apply online.

There are two main approaches from which you must decide when enrolling in Medicare coverage: Original Medicare (Parts A/B/D) or a Medicare Advantage plan (Parts C/D). Retiree or employer coverage also factors into how Medicare coverage works.

Through Medicare Savings Programs, Medicare also provides "Extra Help," including Medi-Cal, to lower costs of Part A, Part B, and Part D. HICAP can assist with applications. HICAP goes a long way toward simplifying the Medicare expedition.

Garcia described the help Hernandez provided as, "Excellent! All the staff are friendly. The program helped me gain confidence when it came to understanding my bills and the process to pay. I felt less stressed as I saw the medical bills decrease or go away. I was able to afford my regular bills, such as house and utilities, without worrying about going into collections for overdue bills."

Although HICAP doesn't pay medical bills, counselors assist with reviewing Medicare statements and organizing bills received from providers. When necessary, HICAP counselors advocate for Medicare beneficiaries by requesting providers rebill Medicare.

Volunteers Needed

If you already have Medicare and are looking for ways to help others understand it, consider becoming a volunteer.

SHIP/HICAP needs volunteers in four areas:

Community Educators speak to groups, companies, civic, tribal, faith-based, employer and retiree organizations.

Counselors provide one-on-one assistance to beneficiaries and their families or representatives.

Senior Medicare Patrol (SMP) Liaisons educate and inform on how to protect, detect and report suspected Medicare fraud.

Special Projects Workers answer phones and assist with outreach events.

If you are interested in learning more or want to volunteer, call the local SHIP/HICAP office at (559) 713-2875 or 1-800-434-0222 for an appointment.

If you have already decided to volunteer and need more information, visit the K/T AAA at or call Blanca Alvarez, volunteer coordinator, at (559) 713-2874.


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