SHIBA volunteers dedicated to advising Medicare decisions
Published 1:30 am Wednesday, July 19, 2017
By Michelle Frye
Homage Senior Services
Homage Senior Services (formerly Senior Services of Snohomish County) sponsors the Statewide Health Insurance Benefits Advisor Program in Snohomish and Skagit counties. The program provides free, unbiased and confidential help with Medicare and health-care choices.
Known as SHIBA, it is part of the state Office of the Insurance Commissioner’s Consumer Protection Division. The SHIBA program, or SHIP as it is called in other states, started in Washington and became the model for other state health insurance programs in the nation.
Volunteer advisers assist consumers in the following ways:
Help them assess their health care coverage needs.
Determine eligibility for health care coverage plans and programs.
Screen for income guidelines, being mindful of programs that might help them pay for Medicare and help with fraud and general complaints.
Talk to Medicare on clients’ behalf.
Provide enrollment help when clients first come onto Medicare and annually during open enrollment make referrals to other agencies and programs.
SHIBA is a noteworthy program in that it’s made possible by the dedication of volunteers who receive intensive, ongoing training provided by the Insurance Commissioner’s office and its regional training staff.
Volunteers begin by taking two days of basic training and then mentoring with a volunteer who has been with the program five years or longer. New volunteers are typically mentored a minimum of three months, coming once a week for three- to four-hour shifts. They then attend monthly training meetings one day a month and then volunteer once a week. Forty-eight percent of the advisers have been with the program five years or longer and come from professional work backgrounds where they had direct contact with the public.
During Medicare’s open enrollment, Oct. 15 to Dec. 7, it isn’t uncommon for SHIBA volunteers to put in hours equivalent to a part-time job. They are out in the community almost every day providing outreach and assistance concerning changes clients can make during open enrollment. Volunteers also double-check coverage people currently have to see if it’s the best coverage, based on the doctors they see, the clinics they go to and the medications they take.
Between April 2016 and April 2017, each SHIBA volunteer attended 11 monthly training meetings and, as a group, they contributed 6,429 hours and saw 8,258 clients – 6,830 in Snohomish County and 1,428 in Skagit County. We also hosted 47 community enrollment events. Our volunteer advisers helped individuals save a little more than $1 million.
Here are recent complaints SHIBA volunteers have facilitated:
Example 1: A client with very restricted income had been making co-pays to primary care providers and specialists as well as paying bills she received from three hospitals/clinics. The volunteer adviser discovered that when the client’s insurance information was initially processed by the provider’s billing office, they neglected to list Medicaid as secondary payer and enter her Provider One number. This meant none of the referrals to other providers included this important information. As a result, her doctor’s office resubmitted her claims and reimbursed her out-of-pocket expenses for $4,750.
Example 2: A client contacted an insurance agent during Medicare open enrollment to see if she could reduce her costs. Her current coverage was a Medicare Advantage Plan. The agent was supposed to enroll her in a Medigap Plan N, but instead enrolled her only in a prescription plan. This left the client with the wrong insurance coverage. SHIBA was able to prove misrepresentation on the part of the agent, and the client was reinstated to her Medicare Advantage plan without any gaps in coverage. This was critical to the client, who had received cancer treatment in the past, and it provided great peace of mind knowing there would be a safety net for medical expenses. This client called our SHIBA adviser “her hero.”
Example 3: Great examples of cost savings to clients were evident during Medicare’s open enrollment period. In many cases, just double checking people’s benefits and prescriptions and comparing them with other plans offered in the next enrollment year delivered substantial savings to clients. Every health and prescription plan offers different drug formularies and they place medications on different tiers. In some cases, SHIBA volunteers saw that clients’ current medications weren’t even covered in the next year’s plan. There were many examples in which clients save $3,000 to $5,000 after being advised to buy their medications at different pharmacies. At least seven of our volunteers alone saw savings by checking their own benefits and changing to preferred pharmacies. One volunteer evaluated her adult son’s coverage for the next benefit year and was able to save him $10,000.
To learn more about the SHIBA program, go to www.insurance.wa.gov/shiba. Remember, in the fall you can doublecheck your benefits for the upcoming year by attending one of our open-enrollment events in communities throughout the county. Reservations for these events begin Oct. 2.
If you have questions about your Medicare coverage, suspect Medicare fraud, or if you would like to volunteer, call the SHIBA program at Homage Senior Services, 425-290-1276, or email shiba@homage.org.
