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Oregon SHIBA

Oregon SHIBA. A State Health Insurance Assistance Program (a.k.a. SHIP). Agenda. SHIBA - who we are What we do Explain the Medicare program Provide insurance plan options counseling Find assistance programs Liaise with Cover Oregon for those age 65 and over Educate, advocate and resolve

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Oregon SHIBA

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  1. Oregon SHIBA A State Health Insurance Assistance Program (a.k.a. SHIP)

  2. Agenda • SHIBA - who we are • What we do • Explain the Medicare program • Provide insurance plan options counseling • Find assistance programs • Liaise with Cover Oregon for those age 65 and over • Educate, advocate and resolve • When to refer to SHIBA

  3. SHIBA – Who we are • SHIBA is an acronym for Senior Health Insurance Benefits Assistance • Nationally, we are a part of the SHIP network (State Health Insurance Assistance Programs) • We are grant-funded within the Dept of Consumer and Business Services (DCBS) • We are housed within the Oregon Insurance Div • We have 5 FTE staff at the state office

  4. SHIBA Staff Left to right: Cynthia Hylton, Donna Delikat, Tashia Sample, Ryan Adams, Dawn Shaw and Lisa Emerson Note: Tashia Sample now works in Ins Div Rates & Forms section

  5. Our Mission The mission of the SHIBA program is to ensure Medicare beneficiaries have a competent, committed and consumer-focused network of staff and certified volunteer counselors who provide accurate, understandable, objective education, personalized counseling and assistance through innovative community programs at the state and local level.

  6. SHIBA – Local Sponsors / Counselors • SHIBA funds are distributed to local agencies sponsoring the SHIBA program • Currently we have 17 sponsoring organizations providing local assistance in 32 counties • We have 286 certified volunteer counselors • Statewide, in CY2013, we had 28,935 client contacts with 16,547 counseling hours

  7. What we do – Explain Medicare • We explain the Medicare program • How to enroll • How to meet deadlines and avoid penalties • Rights and protections • What is covered and what is not covered • Rules that must be followed to obtain benefits • Costs associated with Medicare

  8. Medicare in Brief • Medicare has 4 parts: Optional for additional $105/mo. Penalties apply for delayed enrollment Premium free with work history Optional - Premiums vary Optional - Premiums vary Penalties apply for delayed enrollment

  9. What we do – Provide Counseling • We provide insurance options counseling • In 2014 there are • 33 stand-alone Medicare prescription drug plans • 78 Medicare health only or health & drug plans • 42 companies offering Medicare Supplement policies (Medigap) • 10 Medigap coverage choices • EGHP, FEHB, PERS, Retiree, VA, TFL, ChampVA, COBRA etc. that work with Medicare

  10. What we do – Find Assistance • Federal Low Income Subsidy for Prescriptions (LIS) • Based on income (up to 150% FPL) and resources • Process applications online or refer to 1-855-447-0155 Medicare Savings Connect (MSC) • Explain benefits of subsidy program • State Medicare Savings Program (MSP) • Based on income (up to 135% FPL) and resources • QMB, SMB, SMF applications through SSA referral or MSC • Referrals to local APD offices • Manufacturer Patient Assistance Programs (PAPs) • Discounts through Oregon Prescription Drug Program (OPDP)

  11. What we do – Clarify • Affordable Care Act education • Clarification on how it does / does not affect Medicare benefits and/or its beneficiaries • Liaise with Cover Oregon • Assist those age 65 and over, NOT eligible for Medicare, obtain health insurance through Cover Oregon

  12. What we do – Educate& Advocate • Conduct Medicare 101 presentations throughout the state • Educate the public on Medicare fraud, waste, abuse and error prevention, detection and reporting • Provide assistance with issue resolution – claim denials, billing errors, appeals, complaints with insurance benefits or customer service, grievances with quality of health care, etc.

  13. When to Refer to SHIBA • Medicare questions or insurance issues • Inability to afford prescription medications • Desire to review insurance options • Suspect fraudulent charges or activities • Can assist with finding low cost or free medical equipment (wheelchairs, walkers) through Senior Centers or associations

  14. When not to refer to SHIBA • Assistance with services not covered by Medicare • Glasses (not medical) • Lion’s Club may be a resource • Dental (we do have a list of dental insurance plans) • Oregon Dental Association community resources • Donated Dental programs • Hearing aids • Lion’s Club may be a resource

  15. Case Scenario • Client declined Medicare Part B due to cost • Client now wants to enroll in Part B and called SHIBA • Client was referred to local APD office • APD office said that he was not eligible for MSP because he was not enrolled in both Parts A and B • Client returned to SHIBA • SHIBA called APD office to clarify buy-in program available to client • Client WAS eligible for state assistance and Part B started sooner than July 1.

  16. Questions? • SHIBA Field Officers • Donna Delikat • 503-947-7089 • donna.delikat@state.or.us • Cynthia Hylton • 503-947-7090 • cynthia.hylton@state.or.us

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