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If George Montoya doesn’t take his medication daily there are life-threatening ramifications. When he arrived at his pharmacy to pick up his prescription and was told that it wasn’t covered by his insurance, Montoya started to panic.
“If I don’t have it within 24 hours, I’m dead,” he said.
Grappling with insurance plans
Montoya, who recently turned 65, had a benign pituitary tumor removed in the early 1980s. As a result, he’s on medication to help his heart, liver and thyroid function properly. He recently switched from Medicaid to Medicare. Medicaid no longer paid for his medications, and his Medicare prescription drug plan through an insurer became troublesome at the pharmacy.
The issue that day was that Montoya recently moved. He had not noticed that that his bill hadn’t arrived at his new home in Estes Park. Because he hadn’t paid his premium, his prescription insurance was canceled. Without it, his lifesaving medication was going to cost him a few hundred dollars.
“I’m 100 percent disabled on a meager income,” Montoya said.
Montoya is a pastor and has volunteered for the past two decades at many area ministries, from prisons to outreach programs. This time, though, he needed help.
“I had to go home that day without my prescriptions,” he said. “I looked to see what I had left and had only a few days’ worth. I got into prayer right away, and the Lord brought me Kim.”
After a phone call or two, Montoya found Kim Ferro, community health coordinator with UCHealth in northern Colorado.
Medicare help and assistance program
UCHealth Community Health Improvement is a designated site for the State Health Insurance Assistance Program, or SHIP, in Larimer and Weld counties. Through the UCHealth Aspen Club, counselors assist people, free of charge, with their Medicare benefits and help to objectively answer questions.
Montoya left a message with the office.
“His call sounded so desperate, and I was thinking how I had to call this gentleman right back. But I think in his panic, he forgot to leave his number,” Ferro said.
After a bit of searching, Ferro was able to find Montoya’s number and spoke to him on the phone. As a SHIP counselor, she was able to log into Medicare and discuss with him his plans and coverage. And with a bit of investigative work, she got him the help he needed.
Back on track
“I think it was heaven-sent,” Montoya said. “I was in prayer, and she came through on the phone. We need more people like Kim (Ferro) out there.”
Ferro sees all sorts of similar situations.
“This is a real typical example, and these people are in absolute panic,” she said. “This was early October, so I told George I would call him back after October 15 when open enrollment (for Medicare) began so we could make sure he was in the most cost– effective plan for him for the following calendar year.”
Open enrollment assistance
“We did end up changing his plan to save him money,” Ferro said. “Drug plans change from year to year, including, premiums, deductibles and formularies. Personal prescribed medications also change throughout the year — nothing about Medicare is one-size-fits-all. We don’t want to assume one plan is best for all. We want to choose a plan based on their medications, health needs and personal budget. It’s that individualized care that we provide.”
UCHealth Aspen Club offers community members one-on-one appointments with counselors trained through the state. Appointments take place over the phone or in person.
New to Medicare?
If new to Medicare, Ferro suggests one should start with a Medicare 101 class, a 90-minute, one-time presentation offered monthly January through October at UCHealth locations in Fort Collins, Loveland, Greeley and Estes Park.
“For those who are coming up to the 65-year age, the Medicare 101 class should be their first step,” she said. “We go over all the basic information and many frequently asked questions.”
During the annual open enrollment period from Oct. 15 to Dec. 7, people can set appointments to review their prescription and Medicare Advantage plans.
“Many times people don’t know where to begin and what questions to ask,” Ferro said. “That’s where our one-on-one appointments help. We can help to contact Medicare and other agencies, along with the consumer, and ask the right questions. We’ve done this before and can help figure out where to begin.”