What Inland Empire residents need to know about Medicare enrollment, eligibility

Redlands Daily Facts (CA)

Oct. 23--For some senior citizens, wading through the deluge of information on Medicare coverage may be overwhelming.

With the Medicare enrollment period open until Dec. 7, Inland Empire residents just turning 65 and others looking to change their plans have many options.

"There are a lot of good options," said Scott Welsh, co-owner of Welsh Insurance Services in Redlands. "It's just finding what is best for individuals and their families."

Welsh Insurance Services has been helping seniors in Southern California "navigate the medicare maze" for 9 years.

The firm, started by Scott Welsh's wife Sarah Welsh, works with most medical groups and plans helping to match seniors to the coverage that is right for them.

"It's peace of mind that we are providing people," Scott Welsh said, "so that they know they've made a good choice and they're comfortable with the providers and the coverage that they need to access those providers."

Consider medication costs and copayments

Everybody has a different medication list, Welsh said.

"That's usually the biggest cost differential from plan to plan than almost any other service," Welsh said, "because you have your medications every month, but you may only get an MRI once a year."

Medications costs may also change, which is why Lola Ramos, program manager for the Health Insurance Counseling and Advocacy Program in San Bernardino and Riverside counties, recommends beneficiaries get help researching other plans that may carry the same drugs for less.

"A lot of people don't know where to go for help and end up paying for that medication," Ramos said. "We've talked to people who actually stopped taking pills because it's been getting so expensive."

The nonprofit, a program of the Council on Aging, offers free counseling to Medicare beneficiaries. While they do not enroll beneficiaries in Medicare plans, they do help connect them to the appropriate programs.

"What we like to do is help people save money because insurance costs can be expensive and drug costs can be very expensive," Ramos said. "The average person isn't going to take the time to research who's carrying what drug and if it changes from one tier to another."

Patients should also consider the cost for hospitalization and co-payments for services, Welsh said.

"If you're with a plan in Medicare and your copayments are going up every year, you want to ask, 'Is that really taking care of me?'" he said. "'At the end of the year did I have to pay $500 for services where there are other plans that have zero costs for the same services?'"

Consider healthcare providers and services

"You want to check that you have access to the providers, meaning doctors and specialists, you want to go to," Welsh said.

Next, Welsh advises seniors to determine what care they may need and what wellness opportunities may be available.

"There are a lot of big institutions, but the approach is very individualized and everybody's story is different," Welsh said.

Loma Linda University Health is excited to be accepting new patients during open enrollment, according to Dr. Todd Martell, vice president for clinical quality and managed care for the Loma Linda University Health Faculty Group.

"We're engaged with the community and want to provide both primary and specialty care to the residents in the Inland Empire," Martell said, adding that the hospital has expanded clinical services in the Beaumont area and access to improve care at all of its sites.

"We have over 1,000 primary care and specialty providers basically covering the whole gamut of experience needed for medical care," Martell said. "So when it comes to needs for specialty care, we don't refer out because we have the expertise in house."

Consider eligibility

Medicare eligibility starts at age 65.

"There are 10 to 12,000 people turning 65 every day in America," Welsh said. "Thirty percent of them live in California."

For those looking to enroll for the first time, Welsh said, enrollment can be done any time of the year.

"The trend we see today is many people working past 65 and they need to know how to get enrolled when they do retire," he said.

When it came time for Norman Vargas, now 69, to enroll in Medicare a few years ago, he obtained a list of plans from HICAP, then sought the assistance of a broker.

"I would say get this list," Vargas said. "This list was really helpful when I didn't know anything, or go to a broker."

A few years later, it was Vargas' wife Candice's turn to enroll. The Highland couple decided to attend a free Medicare seminar, where they met Welsh.

"He'll talk to you and find out what you need, what you want in a plan and then he can narrow it down for you," said Candice Vargas, 65. "It makes it simple."

Where to go for more information

Welsh Insurance Services

To reach Scott Welsh call 909-648-1991 or for Sarah Welsh, call 909-520-8482. Their office is at 1445 W. Redlands Blvd. in Redlands. You can also visit their website at http://welshadvantage.com/

HICAP

For more information on HICAP services in Riverside and San Bernardino counties visit their office at 9121 Haven Ave. Suite 220, Rancho Cuamonga or call 909-256-8369. Information is also available through the Council on Aging Southern California's website at http://www.coasc.org/.

Loma Linda University Health

The hospital hosts several seminars during open enrollment. Information: 877-558-6248; openenrollment.lluh.org.

Medicare

information: https://www.medicare.gov/

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