Medicare help: It’s not one-size-fits-all

UCHealth Community Health Improvement’s Aspen Club has state-trained counselors providing Medicare help through the State Health Insurance Assistance Program.
January 24th, 2019
Women talks on the phone at her computer desk with Medicare paperwork laid out.
Kim Ferro, community health coordinator with UCHealth in northern Colorado, helps a client over the phone with their Medicare questions. Through UCHealth Aspen Club, counselors assist people, free of charge, with their Medicare benefits and help to objectively answer questions. Photo by Joel Blocker Photography, for UCHealth.

Medicare 101 presentations run monthly. Find a session near you buy clicking here and searching for “medicare 101.”

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.

 

Finding help

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.

Come celebrate 30 years with the Aspen Club at these local events

Aspen Club is celebrating 30 years with the following events. All but one is free and all will have refreshments. Aspen Club members and guests, please join us for the following:

2–4:30 p.m. Friday, May 10, Platte River Fort, east of Greeley.

Join us for a special meet-and-greet at this fun western-themed event center. Enjoy the music of Brad Fitch — one of the best John Denver tribute artists in the nation and meet Marilyn Schock, president of the new UCHealth Greeley Hospital.

 4–6 p.m. Wednesday, May 29, Sweetheart Winery, 5500 W. US 34, in Loveland.

Join us for a celebratory gathering featuring well-known local sculptor, George Walbye. George’s work is on permanent display in nationally renowned Benson Park Sculpture Garden, and his bronzes are in private collections throughout Europe, Canada and the United States.

3-5 p.m., Saturday, Aug. 3, Lincoln Center, 417 W. Magnolia, in Fort Collins.

Meet Maestro David Dworkin. After a distinguished career as a widely-hailed clarinetist and conductor, he took his passion for classical music and transitioned it into an innovative, award-winning and healthful program called, “Conductorcise.” Participants will experience a symphony performance, music history lesson and a fun “conducting” activity all rolled up into one.

 *This event also takes place in Longmont during the Boulder County Fair. Look for an update on the time, date and specific location at uchealth.org or in the Aspen Club newsletter.

5-8 p.m. Friday, Dec. 6, Lincoln Center, 417 W. Magnolia in Fort Collins. Dr. Brad Nieder is a funny speaker and clean comedian who has been described as “Jerry Seinfeld with an MD.” Have fun as you learn why laughter really is good medicine for combating stress, feeling better and living longer. There is a cost for this event as it is in conjunction with the Aspen Club’s annual holiday gala.

Aspen club offers an array of health, education and fitness programs and screenings to its members (and free membership) throughout northern Colorado. To see what you might benefit from or to sign up for an event, visit uchealth.org/aspenclub or call 970.495.8560.

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.”

About the author

Kati Blocker has always been driven to learn and explore the world around her. And every day, as a writer for UCHealth, Kati meets inspiring people, learns about life-saving technology, and gets to know the amazing people who are saving lives each day. Even better, she gets to share their stories with the world.

As a journalism major at the University of Wyoming, Kati wrote for her college newspaper. She also studied abroad in Swansea, Wales, while simultaneously writing for a Colorado metaphysical newspaper.

After college, Kati was a reporter for the Montrose Daily Press and the Telluride Watch, covering education and health care in rural Colorado, as well as city news and business.

When she's not writing, Kati is creating her own stories with her husband Joel and their two young children.