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SHINE volunteers help seniors navigate health care maze

Grace and Eugene Altenhofen of St. Petersburg made a phone call to the SHINE program after struggling to understand the array of choices offered by their Medicare plans.

MELISSA LYTTLE | Times

Grace and Eugene Altenhofen of St. Petersburg made a phone call to the SHINE program after struggling to understand the array of choices offered by their Medicare plans.

ST. PETERSBURG — Like many retired people, St. Petersburg residents Grace and Eugene Altenhofen have been struggling to sort through Medicare's byzantine array of plans, choices and expenses.

The Dec. 7 deadline for picking next year's coverage is fast approaching. Television and print ads promise the world. Grace wanted to lower their expenses but was confused and wary.

Help came this week from a calming voice on the other end of a telephone.

Grace called Charles Franckle, a retired banker who volunteers with the state of Florida. They talked for 20 minutes. Grace, 86, has used an AARP drug plan for years, but when Franckle plugged her 13 prescriptions into Medicare's website, it showed that two competing plans had lower premiums and co-payments.

Eugene Altenhofen, 85, takes no drugs. Franckle found a way he could shave $25 a month by switching plans.

And yes, they could drop their AARP drug plans while still keeping AARP Medigap coverage that helps with doctor and hospital bills.

"I'm really happy with that one,'' Grace told Franckle. "I don't want to do anything wrong.''

"Don't worry,'' he reassured her. "They are not connected at all. You can go to any drug plan you want.''

Franckle, 66, works for SHINE, a state-run service that stands for Serving Health Insurance Needs of Elders. Volunteers are trained on the ins and outs of Medicare and Medicaid. Franckle has been at it for several years but says some questions are so complex he still learns new wrinkles every week.

Grace Altenhofen was delighted with his advice.

"I was so mixed up with Medicare,'' she says. "With all this stuff on TV and on the computer and coming in the mail all the time. He helped me a lot.''

SHINE volunteers in Pinellas County have helped more than 5,100 clients this year. Calls trickle in most months but accelerate into hyperdrive in October and November, when Medicare holds its annual open enrollment period.

Kathleen Van Zill, 65, of St. Petersburg calls to tell Franckle that she has a drug plan but her insulin medicine has put her in "the black hole,'' which is going to cost her a bundle.

She is referring to how Medicare structures drug plan co-payments. After plans have paid about $3,000 for drugs during a calendar year, clients face several thousands of dollars in out-of-pocket costs until coverage kicks back in. This high-cost period is often referred to as the "doughnut hole'' or in Van Zill's case, the "black hole.''

Franckle asks about her annual income, logs onto needymeds.com and finds that the drug manufacturer, Novo Nordisk, will mail her insulin for free while she is in the doughnut hole. Her doctor needs to sign the application and fax in her information.

Another caller is thinking about signing up with a Medicare Advantage HMO, because it will rebate part of her Part B premium, but she may need to travel out of state for back surgery so she can convalesce where her son lives.

Better make sure the HMO will cover that surgery outside its Florida network, Franckle warns. And talk to an executive, not just an agent who stands to earn a commission on signing her up.

Linda Kachur, 66, of St. Petersburg is just entering her second year on Medicare. A private Medicare Advantage company — Freedom Health —will rebate much of her Part B premium — which can cut her up-front costs by about $500 a year. She learned about it in a company seminar.

But as an Air Force widow, she gets Tricare for Life, military insurance that pays co-payments and deductibles for traditional, government-run Medicare, but not for private Advantage plans. It also provides good drug coverage.

Will the money she saves up front compensate for other expenses under the private plan?

She went to MacDill Air Force base and talked to people there, but "they had no clue,'' she says.

"I thought I was intelligent woman until I was faced with this. But no one can give me an answer.''

Franckle explains that with the Freedom plan, she will have to go to network doctors and get referrals before seeing specialists.

She knows that. She just wants Franckle to tell her whether to sign up with Freedom.

Yes or no?

"We are not allowed to give recommendations,'' Franckle tells her.

Kachur shifts to another tack.

"If it was your wife or your sister, what would you say.''

Franckle chuckles but won't take the bait.

In a later interview, Kachur says, Franckle was obliging but didn't really tell her anything she didn't already know. So she will stay with traditional Medicare and Tricare.

"Sometimes it's best to stick with what you've got if you really can't make a decision,'' she says. "At least with Medicare, if I go out of state, I know I can get treatment.''

Besides, she says, "if I make the wrong decision, I am stuck with it for a year.''

Stephen Nohlgren can be reached at nohlgren@sptimes.com or (727) 893-8442.

Questions about Medicare coverage?

SHINE volunteers can be reached by calling a the Florida Senior Hotline 1-800-963-5337 from 8 a.m. to 5 p.m. on weekdays. Someone will take your information and a volunteer will call you back, usually within a few days.



.FAST FACTS

Questions about Medicare coverage?

SHINE volunteers can be reached by calling the Florida Senior Hotline toll-free at 1-800-963-5337 from 8 a.m. to 5 p.m. weekdays. Someone will take your information and a volunteer will call you back.

SHINE volunteers help seniors navigate health care maze 11/24/11 [Last modified: Thursday, November 24, 2011 8:58pm]
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