 Hello, everyone. My name is Jane Katman. I'm the CEO at Agewell. I'd like to welcome you to our show, Aging Matters. I'd also like to thank our sponsors, MVP Healthcare, for making our show possible every month. As you may know, Agewell is the largest area agency on aging in the state of Vermont, and we serve anyone who's over the age of 60 or under the age of 60 with a disability on long-term care Medicaid. Our goal is to make sure we provide the right kinds of wraparound services so that our clients or eligible individuals can live at home or in the setting of their choice independently. Each month on Aging Matters, we like to choose topics that are both interesting and relevant as we all age. And today, I'm delighted to welcome Sam Carlton, who is our statewide SHIP director, and SHIP stands for Statewide Health Insurance Program. Sam is also a supervisor at Agewell in the Caron Service Coordination Department. Today, Sam's going to share more information with us around the SHIP program. He's also going to do a deeper dive into Medicare and Medicaid insurance. So welcome, Sam. Thanks, Jane. Great to see you. You as well. Thank you for being here. So, Sam, before we dive into questions, maybe you can tell our viewers a little bit about your background, your experiences, and more about the roles you play at Agewell for the state. Sure. Yeah, so again, I'm Sam Carlton. I am the statewide SHIP director for Vermont, as well as a Caron Service Coordination Supervisor at Agewell. I've been with the agency nine years now. I'm a native Vermonter. I'm from an area of Vermont called Chippenhook, which is technically a hamlet, which is between West Portland and Clarendon. I grew up in a log cabin that my dad built. Wow. Yeah. That is a great place to be. So yeah, so SHIP stands for the State Health Insurance Assistance Program. There's actually a silent A in SHIP. Oh, okay. But what SHIP is, it's a federal grant that we receive, each state receives to help people deal with Medicare, help people do plan comparisons, learn about enrollment periods, help with folks who are new to Medicare, and does offer educational components as well. We offer classes throughout the year. Not during this time of year, as it's sort of our busy season, but we're picking right back up again in January. At Agewell, I also supervise the options counselors and the community health workers. Awesome. Sounds like a very broad scope. I'm not bored. No, you're not bored. And we're going to learn more about what's going on now that keeps you very not bored. So, Sam, let's dive into our topic and start with, what is Medicare and who does it serve? Sure. So Medicare is the federal health insurance program for folks who are 65 and older or who have been collecting social security disability insurance or SSDI for two years. Okay. And then there's a difference because we hear about Medicaid. So what's the difference between Medicare and Medicaid? Sure. The main difference between Medicaid and Medicare is Medicare, again, is federal for those two very discreet populations. Mm-hmm. Medicaid is a state-funded program. It comes from the federal government, but it is done through the state. And there is an eligibility criteria for Medicaid, which would be income and resource, which does not impact Medicare. Okay. So slight differences, and I know we're going to learn more about each one. So, Sam, can you tell our viewers approximately how many people are enrolled in Medicare across the United States and how many people are served by the program in Vermont? Sure. So nationally, there's about 68 million people who are on Medicare. Wow. In Vermont, it's around 160,000, which makes up a little less than a quarter of our total population as we are in older state. Mm-hmm. That is an awful lot of people. Yep. It's a big chunk of our population. Wow. So for someone who's new to Medicare, just turning 65, how do they enroll in the program or know that they're eligible? Because I know there's been circumstances where people may not enroll right away because they might be working full-time. Are there any complications or factors they should know about? So you want to contact Social Security about three months prior to your 65th birthday to let them know that you are... They also send a notification out to you as well. They send a letter, but essentially saying that you are 65 and want to enroll in Medicare and enroll in Medicare that way. Medicare has a few different parts. Mm-hmm. Medicare Part A is for hospitalization only. Medicare Part B is for outpatient. So there are circumstances where perhaps you're still working or perhaps your spouse is still working. What you'll do is enroll in Medicare Part A. Again, Social Security on the phone. And then you'll actually decline Part B. Mm-hmm. And they'll ask for creditable coverage. So you have to have creditable coverage to decline Part B. So that would be your working-age insurance or your spouse's working-age insurance. Okay. And what happens if you don't do that? So if you don't do that, you can... A couple of things can happen. Mm-hmm. You can face penalties. You can have delayed enrollments. Or depending on your circumstance, you may not be able to enroll at all. Oh, wow. Okay. So important to always make that call, right? Yep. When you turn 65. So for anyone who's already enrolled in Medicare, is there a specific time period to make changes to their current plan? Yep. We're actually in it right now. Ah. And that's called... So it's called one of two things. It's either called the annual enrollment period or more commonly open enrollment. And essentially, this is the time of year where folks have the opportunity to compare and or change their drug coverage for the upcoming year. As almost all Medicare Advantage plans in Vermont also offer drug coverage, that they're impacted this time of year as well. And so that runs between October 15th and December 7th. So as I mentioned, we're pretty much smack dab in the middle of it. Okay. So let's talk a little more about those prescriptions and prescription costs. Are there state or federal programs that can help pay for prescription costs? Yep. So there are two different programs. There's Extra Help, which is through the federal government. It's also called the Low Income Subsidy or LIS. So same program, three different possible terms for it. And essentially, there's an income eligibility as well as a resource test for LIS. And if you're eligible, the federal government will pay for your prescription drug plan coverage, premiums, and you'll pay a small co-pay at your pharmacy, a dollar or two. Okay. And in Vermont? In Vermont, there's a similar program. It's called VFARM. Oh, VFARM. Yep. And so, again, there's eligibility criteria and same thing, the state will pay for your premium or part of your premium and you will have low drug costs when you go to pick up your drugs. Okay. So VFARM and the second one was? It's Extra Help. Extra Help. LIS or the Low Income Subsidy. Okay. Perfect. Perfect. So Sam, I imagine that the Medicare beneficiaries receive all kinds of mail around the time, this time of year, or at enrollment time. How important is it that people pay close attention to their mail because we get so much junk mail too? Mm-hmm. But what should they be looking for and from whom? Yeah. So there is a lot of mail, especially for Medicare beneficiaries. They love to send mail, especially this time of year, which is not helpful. But there's a few things you should be paying attention to specifically. You should pay attention to anything from your plan, so the plan that you're currently enrolled in. Every year, your plan is required by law to send you what's called an ANOC letter. It's the annual notice of change letter. In that letter, it's going to tell you anything related to premium cost changes, drug coverage changes. So you'll want to pay attention to that. That obviously would factor largely into your decision-making, whether or not you want to keep that plan or change plans. Mm-hmm. If you receive extra help through the federal government, again, that lists. They will send a letter letting you know that perhaps the plan you were on last year is no longer going to be offered in Vermont or no longer will be covered by the low-income subsidy. So they would want to change that. And then similarly, the state of Vermont, if you're on V-Farm, will send out a letter saying that as well. That letter sometimes pink, very bright pink. Okay. So you'll know that that's what that is. Okay. I knew there was a color code in there somewhere. That's right. Exactly. All right. So I also understand there are some changes with some of these assistance programs that impact Vermonters. Can you talk about some of those changes? Yep. So we sort of alluded to it just right there that there are sometimes changes year-to-year in which plans are covered by either LIS or V-Farm. This year is no different. Although this year there are less plans specifically covered by LIS. Last year there were six LIS plans in Vermont. This year there are only three. Oh. So folks in those plans will need to make a change or the federal government will make it for them. They will auto enroll them in one of those three plans. And when that happens, their drugs may not be covered by one of those plans. So that's something they may not notice until they get to the pharmacy in January to get their medications. Oh, that's not a good thing. Right. Right. So they need to make sure they are staying up to date on all those changes. Absolutely. Okay, that's a great point. So, Sam, I was doing some reading and I know that with the Medicare program, Medicaid, Medicare, there are many losses, many billions of dollars that are lost every year. Actually, this is for the Medicare program due to errors and fraud and abuse. So we do hear about waste, fraud and abuse, certainly in our work. And it puts estimates, excuse me, of annual losses at around $65 billion. That's unbelievable really to think about that. What should people look out for when it comes to errors? What are the signs of a fraud, of Medicare fraud? Yeah, I mean, there's lots of different ways that you might catch that. One thing we hear about pretty regularly is people who are enrolled in plans without their knowledge or sort of they perhaps gave a little bit of information and that little bit of information was used by a broker or a company to enroll them in a plan. They would get mail about that. They would receive mail saying, you've been enrolled in ex-plan. So that's something they should pay attention to. Again, pay attention to your mail. Another great way to detect fraudulent stuff on your own personal account is through Medicare.gov. Okay. Medicare.gov allows you to create an account that we use during this time of year to do plan comparison for folks to figure out which plan is going to be the most cost-effective or covers all of their medications. But it also has all of your billing statements from Medicare on your profile. So you can go through that and see, you know, I went to the doctor last week. There's the statement. I didn't go to the doctor last week. What is this bill on charge to me? That would be something you would want to report. A common one is related to durable medical equipment. That's a common Medicare scam. At any scams or any fraudulent activity, anything you suspect might be going on, you should contact the senior Medicare patrol. Okay. And that has the initials SMP. That's correct. Yep. So people may know of it by SMP. And can people also contact the Attorney General's office or is that a part of the Attorney General's office? So SMP is actually a federal grant very similar to the SHIP grant. They're essentially sister grants, if you will. So you can report to the AG's office to probably the Consumer Assistance Program, the CAP office. However, if you do, they're going to send you to SMP. Okay. Because that's really where that information needs to be collected. So the federal government is aware of it, as Medicare is a federal program. Okay. So we have to be very, very mindful of waste, fraud, abuse, scams, and there is some resources out there through the SMP program to help. Okay. Great. And I think we have a graphic and a phone number that we'll be able to share later on that for folks. So, Sam, could you share a few success stories that you may have heard about through the SHIP program? Sure. Yeah. So our most recent open enrollment data, we were able to assist 2,600 beneficiaries during open enrollments, which again, October 15th, 2 December 7th. So it's a very short window. If you imagine that many people getting assisted in that amount of time. I don't know. At Agewell, last year we helped 610 Medicare beneficiaries and we tracked the cost savings of those folks and it was around, estimated, it's estimated, but $452,000. Oh my gosh. And cost savings. That is just a huge amount of money. Yep. Yeah. And another big success, I think every year we are able to onboard and retain volunteers at Agewell. We have one volunteer who this is his 12th open enrollment with us. Wow. So that's a wonderful resource we have at Agewell for folks. And it must be nice to be able to keep folks who really understand the details about these programs because they're very complicated. Absolutely. It's a huge part of the volunteer retention is that we're really retaining their knowledge as well as themselves. So every year they come in and they're just ready to go. That person we were talking about before, she comes in every year and I'm just amazed at how much she remembers and how quickly she hops back in. It just starts helping people. Wow. So Sam, have you noticed, apart from there must be year over year trends that you track or is there anything special you're noticing about those trends year over year? Well, there's an increase. I mean, I think that's the biggest trend we see every year. We're seeing it again this year. As I mentioned, I gave you the numbers of how many Medicare beneficiaries are in the state, 160,000 when we helped 2,600. So dropping the bucket if you think about it, but the more people hear about us or Social Security refers people to us, we get more calls as we're an older state and an aging state in real time. We have more boomers turning 65 every year. So this continues to be a trend we'll see moving forward. Right. Well, it gives you opportunity, as we spoke about a bit earlier, to think about what can we do differently next year to help all these manage the calls. There must be just so many calls every day. Yeah, the debrief is a very important part of the process for sure. Yeah, that's awesome. So Sam, are there ways our viewers can learn more about Medicare throughout the year? You alluded to, I think, very early in the show about maybe education or training through the SHIP program. Yeah, through the SHIP program. And I should mention that there's five SHIP offices throughout the state of Vermont. One at each area agency on aging. So your local area agency on aging is your SHIP office as well. It's a fun thing. But in terms of education, each SHIP office offers new to Medicare classes at least monthly. At Agewell, we do it bi-weekly. Starting in January, we do them via webinar. So that's one piece of education we offer. We also go out into the community and do presentations on new to Medicare, how to navigate the plan finder, hopefully doing more this year with Medicare Advantage plans and how to sort of look for what might work for folks, might not work for folks and how to sort of parse that out for themselves. We hear a lot about Medicare Advantage plans too, a lot on television, but that kind of education really helps people to understand about each program. Absolutely, yep, yep. And that's a goal of mine as a SHIP director is to offer more education, specifically on sort of those smaller bites so it's not overwhelming. There's a lot of information with Medicare. It's very easy to be overwhelmed and tune out. I can't tell you how many times I've been in a presentation and watch people's faces just glaze. Oh, so much info. And you said they were in person, do you do virtual programming too? We do virtual programming as well. We at age will have partnered with New England Federal Credit Union multiple times throughout the year and will continue to do so. And so that's great for any NAFQ members or Vermont State Employee Credit Union members as well. Once they merge, we'll be able to access that as well. Exactly, perfect. Sam, do you have any final thoughts or tips for our viewers regarding managing Medicare or Medicaid insurance? Well, Medicare, I think it's really important to create that Medicare.gov account. It tells you your coverage. A lot of people are actually confused about what coverage they have. You're in, you're out, so it tells you that. Again, it talks about, it has the billing statements. And you can do your plan comparison this time of year to look at other plans and make those changes yourselves. That's us at SHIP and we can help you do that as well. Okay, perfect. So what I've learned today is that Medicare can be challenging to navigate and there are helpful resources available to everyone out there so that you can understand your options. And I know from the feedback that I hear, because I get a lot of feedback from our communities, from people who are actually using our services that you and your team do just an amazing job. That's great. Well, it absolutely is and I think that's so important to share. Sam, thank you for taking the time to be with us today on Aging Matters and to our viewers if you need any assistance at all, especially during this open enrollment period please call Agwell or any area Agency on Aging where you may be living. As Sam said, there's five different locations, five AAAs in the state that can help and certainly open enrollment, which is a very, very busy time, continues now through December 7th so still some time to get some assistance with open enrollment and if you do need help, you can call our helpline which is 642- 5119 but above and beyond open enrollment or Medicare questions please call Agwell if you need any assistance at all. We didn't really talk about Sam's role as a supervisor in the care and service division, but I will tell you that he's in charge of information assistance and referral programs that we have so if you have a question or you have a family member Sam's team is going to be the first point of contact and they will help you navigate either other services, be able to share some options counseling am I getting that right Sam? Yep, absolutely. And options counseling may be done either on the phone or in the home and we do make home visits for those types of services so make that call. We can do a great assessment with you or your loved one or your family member and we can line up the right kinds of services to help make a difference in your life or your loved one's life. So I hope you enjoyed our show today and again we look forward to seeing you sometime on Aging Matters as we talk about more important and interesting topics for all of us to help us age well. Thank you.