Volunteer Basic Training

Statewide Health Insurance Benefits Advisors Basic Training | Updated August 2021

Statewide Health Insurance Benefits Advisors Basic Training

Updated August 2021

Presenter

Presentation Notes

Note to trainers: This training may be presented as two-day or one-day as you determine appropriate based on the experience of your trainees. Suggestions below may be adjusted as needed. This training must be presented in person. Exceptions may be made if you and the volunteer coordinator deem it appropriate. Consult with the SHIBA field Supervisor or program manager if you need assistance. Suggested One-Day Basic Training Agenda 9 a.m. – 4:45 p.m. Address of B.T. Contact info: VC name, email, phone or RTC name, email phone Welcome, introductions9:00 am – 9:15 am Welcome to SHIBA9:15 am – 9:30 am Health Insurance 1019:30 am – 10:00 am Break10:00 am – 10:15 am Medicare Introduction & Enrollment Periods10:15 am – 11:30 am Original Medicare11:30 pm – 12:00 pm Lunch12:00 pm – 1:00 pm Part D1:10 pm – 2:00 pm Break2:00 pm – 2:15 pm Medigap2:15 pm – 3:00 pm Medicare Advantage Plans3:00 pm – 3:30 pm MY SHIBA, SHIBA Online3:30 pm – 3:45 pm Planning – next steps3:45 pm – 4:00 pm CMS Unique ID, Plan Finder4:00 pm – 4:30 pm Evaluation and Wrap-up4:30 pm – 4:45 pm Suggested Two-Day Basic Training Agenda Training dates: Dates Meeting time: 9:30 am – 3:30 pm Hosted at: Location and phone contact Day One Welcome to SHIBA9:30 am – 9:45 am Introductions, binder9:45 am – 10:00 am Health Insurance Terms10:00 am – 10:30 am Break10:30 am – 10:45 am Parts of Medicare and Enrollment Periods10:45 am -11:30 am Original Medicare (A and B) coverage11:30 am – 12:00 pm Lunch12:00 pm – 1:00 pm Original Medicare (A and B)1:10 pm – 1:30 pm Help Paying for Medicare1:30 pm – 2:45 pm Medicare Prescription Drug Coverage2:45 pm– 3:30 pm Day Two Review Q and A of first day9:30 am – 10:00 am Medigaps10:00 am – 10:30 am Medicare Advantage Plans10:30 am – 11:00 am Break11:00 am – 11:15 am Scenarios and SHIBA Online Data Entry (STARS)11:15 am – 11:30 am SHIP T.A. Center Online Tour – Study Up!11:30 am – 11:45 am Medicare.gov – Demo and Quiz11:45 am– 12:00 pm Lunch12:00 pm – 1:00 pm 1-800-MEDICARE & CMS Unique ID12:30 pm – 1:00 pm Evaluation and Wrap-up1:00 – 1:15 pm


Welcome to the Statewide Health Insurance Benefits Advisors (SHIBA) basic training!

As a part of introductions, please share what you would like to learn during this training.

What questions would you like to have answered?

A couple of notes: • Your trainer may adjust the following slides

depending on your level of experience and/or if this is a one- or two-day training.

• The electronic version of this training includes notes for many slides and is posted on My SHIBA. Ask your trainer for more information.

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Presenter

Presentation Notes

Trainers: You can answer questions or store them in a “parking lot” or holding area to address at the end of the training. Share with volunteers there can be different names for certain terms in Medicare. It will be helpful to make note of this as a part of training and learning to counsel clients. There is a glossary of Medicare terms in the back of the training notebook.


Basic Training table of contents

Slide # Content1-4 Welcome, introductions and acronyms5-7 Goals, references and training checklist8-12 Learning objectives and certification13-32 Advisor orientation33-36 Insurance terms and acronyms37-46 Medicare introduction47-58 Enrollment and enrollment periods59-76 Original Medicare: Parts A and B77-89 Medicare prescription drug coverage: Part D90-105 Medigaps106-119 Medicare Advantage plans: Part C120-144 Training tools, wrap up, case studies and answers

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Presenter

Presentation Notes

Trainers: Note that answers to knowledge checks and quizzes will also be included at the end of this presentation and at the end of the trainee paper packets.


Medicare training acronyms

ESRD End Stage Renal DiseaseGEP General Enrollment PeriodHMO Health Maintenance OrganizationIEP Initial Enrollment PeriodLIS Low Income Subsidy (Extra Help)LPR Legal Permanent ResidentMA Medicare Advantage (Part C)MAPD Medicare Advantage Plans with Prescription Drug CoverageMIPPA Medicare Improvements for Patients and Providers ActMSP Medicare Savings ProgramOEP Open Enrollment PeriodOIC Office of the Insurance CommissionerOM Original Medicare (Parts A & B)OTC Over-the-CounterPDP Prescription Drug PlanPFFS Private Fee-for-ServicePPO Preferred Provider OrganizationRTC Regional Training ConsultantSEP Special Enrollment PeriodSHIBA Statewide Health Insurance Benefits AdvisorsSHIP State Health Insurance Assistance ProgramSMP Senior Medicare PatrolSNP Special Needs PlansSSA Social Security AdministrationSTARS SHIP Tracking and Reporting SystemSSDI Social Security Disability InsuranceVC Volunteer Coordinator

Here’s a list of acronyms used in this presentation:

A more detailed list is included with your training materials. Training acronym lists are also available by searching “acronym” on My SHIBA at www.insurance.wa.gov/my-shiba.

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https://www.insurance.wa.gov/my-shiba



Goals for this training

• Provide you with a broad higher level overview about:o SHIBAo Medicare o Senior Medicare Patrol (SMP)

• Ensure you’re a confident candidate and have the basic training you need to move on to the SHIBA Path to Certification. The SHIBA Path includes the steps you’ll complete before you start advising clients on your own.

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Primary training references

Medicare & You 2021 (www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf) We reference this guide throughout this presentation with corresponding page numbers.

The SHIBA Volunteer Handbook (www.insurance.wa.gov/media/1548) is your guide for working in your SHIBA role.

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https://www.medicare.gov/pubs/pdf/10050-medicare-and-you.pdf

http://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf

http://www.insurance.wa.gov/media/1548

http://www.insurance.wa.gov/media/1548


Your training checklist

Medicare Advantage plans: What you need to know before you buy Medicare Part D stand-alone prescription drug plans Medicare help rainbow chart SHIBA client counseling six-step intake script

Back pocket Basic training evaluation Case studies Quizzes SHIBA volunteer coordinator’s mentoring certification checklist Path to SHIBA certification tracking sheet SHIBA STARS Beneficiary Contact Form Resource referral guide

Here’s a list of materials you’ll receive today in your 3-ring binder:Front pocket Medicare & You and a SHIBA pen Get help paying for Medicare brochure Local MA plan list (specific to county)

3-ring materials Basic advisor training packet Glossary of health care coverage and medical terms Frequently-used acronyms Your Medicare coverage choices Medicare Part A & B covered services Approved Medicare Supplement (Medigap) plans chart What you need to know about Medigaps Comparing Medicare Supplement (Medigap) and Medicare Advantage plans

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Presenter

Presentation Notes

Trainers: Here’s an abbreviated list of materials you may want to take with you or reference for training: 3-ring binder Learning aids (list) Medicare & You Quizzes Activities Authoritative resource reference list SHIBA new orientation slides SHIBA history SHIBA staff contact information Path to SHIBA certification Expectations of volunteers and SHIBA Roles Ice Breaker Desk aids All materials online STARS training PlanFinder Training My SHIBA training Signature sheets: non conflict of interest, receipt of handbook and VRPM (only if needed for Basic) Information about what’s next after today’s training Checklist of knowledge for your first ten hours of mentoring and how to be prepared for a quiz View demonstrations of medicarte.gov, STARS, SHIPTA List of acronyms Links to things like prescription drug coverage. Different plans. Med plan benefits and what they do cover. MA sup and optional. Quick access. A list of resources. Links to other items other resources such as pricing and formularies. Training packet for the next month’s SHIBA continuing education.


Basic training learning objectives

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Learning objectives

At the end of your basic training, you should be able to:• Explain SHIBA’s scope and mission.• Describe the basic framework of Medicare, including

the four parts.• Explain at least five ways a SHIBA volunteer can help

and advocate for people who need help with Medicare.

• Describe the Medicare Plan Finder, where to find it and how it can help a client.

• Explain the differences between Medicare Advantage (MA) plans and Original Medicare, and list the components of each.

Continued on next slide

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Presenter

Presentation Notes

Trainers: We want volunteers to succeed! Basic training provides the information and tools needed for the SHIBA certification exam.


Learning objectives (continued)

• Explain the importance of confidentiality and SHIBA’s expectations.

• List at least 10 authoritative Medicare resources and where to find them.

• List and describe the four main enrollment periods.

• Describe how to know if a Medicare resource is authoritative.

• Explain your boundaries within SHIBA’s scope and your role with SHIBA.


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Learning objectives (continued)

• Be able to answer basic questions about Medicare, such as:

o How and when do I enroll in Medicare?o What are the basic differences between Original

Medicare and Medicare Advantage plans?o What is a Medigap?

• Explain what you know about Medicare and what you do not yet know about Medicare.

• Describe what’ll be included in your 10 hours of mentoring.

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Certification

• After you complete basic training, you’ll take an open book exam.

• Get more information about the exam from your volunteer coordinator (VC) or regional training consultant (RTC).

• After you pass the exam and successfully complete mentoring, we’ll certify you as a SHIBA volunteer.

• This is not the end of your training, it’s the start of a rewarding journey!

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Presenter

Presentation Notes

Trainers: Taking the basic training certification exam is typically separate from the basic training dates. The mentoring checklist is on My SHIBA and includes a minimum of ten hours of client advising observation. It also includes completing basic training, passing the certification exam, demonstrating use of the database (and other administrative forms), using the OIC website, understanding how to identify SHIBA publications and training materials and also being able to access online resources such as Medicare.gov and the Medicare plan finder. All of these will be discussed during basic training!


SHIBA advisor orientation

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Volunteer advisor orientation basics

Thank you for your interest in serving as a volunteer advisor for SHIBA!

Your work and commitment will contribute to helping the lives of thousands of people across the state as they navigate their way

through Medicare.

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Presenter

Presentation Notes

Trainers: Below are some notes for this section of slides to use as reference if you like. As an example of info to include, see the SHIINE Volunteer orientation packet at http://shiine.net/images/files/Vol_Orientation_Packet_18.pdf. Introduction info Training requirements Basics training Recertification training Expense reimbursement Treasure hunt Primary websites Introduction Welcome to SHIBA! Thank you for your interest in being a volunteer for SHIBA. Your work and commitment will contribute to helping the lives of thousands of people across the state as they navigate their way through Medicare SHIBA is the Statewide Health Insurance Benefits Advisors. We are a part of the Office of the Insurance Commissioner for the state of Washington. Welcome Mission and location SHIBA provides free, unbiased information about health care coverage and access to help improve the lives of all Washington state residents. We cultivate community commitment through partnership, service and volunteering. SHIBA office staff are located in Tumwater, Seattle, and Spokane. We have sponsor offices and volunteers in nearly each of Washington’s 39 counties. Who we are Started more than 40 years ago by a group here in WA who recognized the difficulties of navigating Medicare and the need to make a difference. Volunteers are the backbone of this organization. We can‘t do the work without you. You make a difference in the lives of thousands of people each year through your commitment to counseling those who are new to Medicare, are having difficulty determining next steps, and for those who are dealing with possible Medicare-related fraud. As a SHIBA volunteer, we’ll provide you with the tools you need to make a difference in your community for only a few hours a month. � There are 14 SHIBA staff including our program manager, administrative assistant, secretary senior, program operations supervisor, field supervisor, curriculum coordinator, 5 regional training consultants, complaints coordinator, communications/marketing coordinator and grants coordinator. The staff are here to help ensure the administrative integrity of SHIBA’s operations. We also here to help you succeed as a volunteer as you work with your volunteer coordinator and other volunteers. Sponsors: SHIBA contracts with locations around the state so there is a location for volunteers to gather for counseling and training, and where the volunteer coordinator works. These are usually agencies or centers and are called sponsors. There is often and executive director and other staff on site. As a volunteer, you’ll be working primarily with the volunteer coordinator at this site who would most likely be your supervisor. You’ll also work with other volunteers and possibly other staff at this location. This is where you will meet for training – and you can meet at any location in the state for your training – with your regional training consultant and other volunteers. Training is held monthly, 10 times a year. There is no training in August or December to help accommodate vacation and holiday planning. Jobs: SHIBA volunteers may serve Medicare clients, their families and caregivers in many creative ways and in a variety of job roles. There are six types of activities most commonly conducted by SHIBA and (SMP volunteers) nationwide: Assisting with administration Distributing information Staffing exhibits Making group presentations Counseling Handling complex interactions such as fraud, errors and abuse. These are the most active roles, there may be others as needs arise. Who is a volunteer A volunteer can be anyone who is interested in committing the time it takes to counsel others about Medicare. • Screen clients’ eligibility for various health care coverage options including Medicare, Medigap, private health insurance, low-income programs and COBRA (Consolidated Omnibus Budget Reconciliation Act). • Provide clients and community members with unbiased information about Medicare and health insurance options. • Advise clients about points to think about with regard to their Medicare and health insurance options. • Educate the community about Medicare fraud identification and prevention. • Counsel and/or enroll clients in Medicare programs and plans when eligible and appropriate. • Assisting low-income clients research prescription and co-insurance options. Why this is important It’s important that SHIBA volunteers, sponsors and staff provide the same level of service across the state to ALL clients and to work within the program’s service scope. It’s also important to know when to ask for help for questions you cannot answer and when to refer a client to a colleague or another agency. Unless specifically stated, volunteer policies apply to all volunteers in all SHIBA programs and projects. This includes volunteer involvement that’s organized and managed by sponsor organizations. (VRPM Policy 1.2) Your volunteer coordinator will work with you so define the duties within a volunteer’s scope so that you have the proper training to do your volunteer work. Why we need you and how you can make a difference: Expectations Honesty Integrity Confidentiality Attend 8 of 10 monthly training sessions per year. Read your training materials. Be familiar with the VRPM, POM, and VH. Ask questions. Tools for your job and how to succeed Expectations of the VRPM Volunteer Handbook VC works with the Program Operations Manual (POM) On site training: never go to a client’s home. Work with the VC for any location that is other than the sponsor agency site. Be familiar with the tools that will help you with your work. The two most important guiding documents are the volunteer handbook and the Volunteer Risk and Program management – or VRPM – manual. The volunteer handbook covers information and SHIBA and the program, known as SHIP, the volunteer selection and certification process, the steps to becoming a certified SHIBA volunteer, supervision and performance management responsibilities, SHIBA’s scope, recognizing and celebrating the work of SHIBA volunteers, SHIBAs policies and procedures, the use of SHIBA’s website which is called My SHIBA, publications and materials, reporting of all program activities in a data system called STARS and why this is an important part of your work, the use of state resources including the extraordinary importance of confidentiality, the SHIBA news flash system, workplace safety along with other checklists and policies. Other tools that will help you in your work include things like the POM which is the guiding manual for your volunteer coordinator and sponsor, monthly training, My SHIBA, job aids, forms, external websites like SMP/ACL/SHIPTA/NCLR/Medicare/CMS. Get to know the other volunteers, participate in community awareness events, take time to do some Medicare-related reading and training outside of the monthly on-site training. There are people around to help and processes in place to help you every step of the way. Next Steps So what are your next steps? Review all your materials. Ask questions. Commit to the expectations. Communicate with your VC about any questions, concerns, or life issues you may experience that impact your time with SHIBA. Thank you!


Volunteer advisor orientation overview

1. Who we are and what we do – our mission 2. When we started – some history and funding info3. A note about SHIPs, SMPs and MIPPA4. SHIBA’s scope5. Who’s an advisor?6. Duties and work scope7. Referrals8. Volunteer roles9. Types of cases10. How we’ll help you: Staff and training11. Next steps and advisor mentoring

This section of slides will cover:

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SHIBA and our mission statement

SHIBA’s MissionSHIBA provides free, unbiased information about health care coverage and access to help improve the lives of all

Washington residents.

We cultivate community commitment through partnership, service and volunteering.

SHIBA is the Statewide Health Insurance Benefits Advisors and we’re part of the Washington state Office of the Insurance Commissioner.

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SHIBA history

• The first State Health Insurance Assistance Program (SHIP) began in our state in 1979.

• All states have a SHIP program.• SHIBA is funded by the federal government.• In Washington state, we are

also funded by the state legislature.

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http://www.bing.com/images/search?q=state+workers&qs=n&form=QBIR&pq=state+workers&sc=8-13&sp=-1&sk=


SHIBA history – how it works

• Funding comes to SHIBA through federal and state resources.

• SHIBA uses these funds to award grants to sponsors in our state to provide SHIBA services statewide.

• SHIBA provides volunteer training and education.• Each sponsor site has a volunteer coordinator who

manages the SHIBA program in their area.• These programs are mainly staffed by volunteers.

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A note about SHIPs, SMPs and MIPPA

• SHIBA is a State Health Insurance Assistance Program (SHIP).

• Senior Medicare Patrols (SMPs) empower and assist Medicare beneficiaries, their families and caregivers to prevent, detect and report health care fraud, errors and abuse.

• The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 is a piece of legislation related to Medicare.

One important provision of MIPPA was the allocation of federal funding to help low-income beneficiaries apply for programs that make Medicare affordable.

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Presenter

Presentation Notes

Trainers Grants from SHIP, SMP and MIPPA provide funding to support operations of the SHIBA program.


SHIBA’s scope: Work expectations

It’s important that SHIBA volunteer advisors, sponsors and staff provide the same level of service across the state to ALL clients and work within the program’s service scope.

It’s also important to know when to ask for help for questions you cannot answer and when to refer a client to a colleague or another agency.

Unless specifically stated, volunteer policies apply to all volunteers in all SHIBA programs and projects. This includes volunteer involvement that’s organized and managed by sponsor organizations.

For more information on SHIBA’s scope, see the SHIBA volunteer handbook pages 36-38.

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Presenter

Presentation Notes

Trainers: Take some time to talk about the purpose of the Volunteer Handbook Reference: Volunteer handbook Search https://insurance.wa.gov/my-shiba for “volunteer handbook.”


Volunteer duties & scope

Duties within a volunteer’s scope • Screen clients’ eligibility for various health care

coverage options.• Provide unbiased information about Medicare and

health insurance options. • Advise points to think about with regard to Medicare

and health insurance options.• Educate about Medicare fraud identification and

prevention. • Counsel and/or enroll in Medicare programs and

plans when eligible and appropriate. • Help low-income clients research their prescription

and co-insurance options.

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Who’s a SHIBA volunteer advisor?

Volunteer advisors are the foundation of our Statewide Health Insurance Benefits Advisors (SHIBA) program.

A SHIBA volunteer advisor can be anyone who:• Is interested in committing the time it takes to

advise and counsel others about Medicare.• Is not a licensed insurance agent.• Passes a background check.• Can bring honesty, integrity and confidentiality

to their role.

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Confidentiality

SHIBA expects and requires protecting client information.

Volunteer coordinators (VCs) and volunteers are responsible for maintaining the confidentiality of all proprietary or privileged information to which they are exposed while serving as a volunteer, whether this information involves a staff member, a volunteer, a client or others, or involves the overall business of SHIBA.


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Presenter

Presentation Notes

Trainers: If confidentiality training and signing the agreement are required, it may be done here.


Confidentiality (continued)

VCs and volunteers should take all steps necessary to safeguard the confidentiality of all SHIBA and client-related information and to prevent personal client information from falling into the possession of unauthorized people.

VCs and volunteers should only use any information collected or obtained in the course of their SHIBA work to assist the client or otherwise fulfill VC and volunteer role responsibilities.


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Confidentiality (continued)

VCs and volunteers must use secure andencrypted methods when sendingemails that contain personallyidentifiable client information.

Anyone who collects and obtains information while doing SHIBA work must not disclose that information unless clearly approved by an authorized SHIBA representative. There is zero tolerance for breaches of confidentiality in connection with work at SHIBA.

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Roles for SHIBA volunteers

There are lots of opportunities for SHIBA volunteers. Many of you will be involved with advising and counseling clients. Work with your VC to determine the training you’ll need for the role of Medicare:

• Counselor• Fraud advisor• Outreach/exhibitor• Administrative support

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For counseling advisor roles, you might receive one or more of these kind of cases:• New to Medicare.• How and when to enroll in Medicare.• How to interpret billing paperwork and appeal denials.• Questions about covered and non-covered benefits

provided by Original Medicare, Parts A & B, Medicare Advantage plans, Medigaps or Part D.

• Plans or service needs that we refer to other agencies.• Requests to use Medicare Plan Finder (on

medicare.gov) for help with getting medications covered and at lowest cost.

• Complex cases that could require a referral, such as those for billing errors and fraud.

Types of cases you might receive

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Presenter

Presentation Notes

Trainers: You might ask the volunteers what about Medicare do they find to be the most confusing? Topics might include: Part D Enrollment in Bart B Sign-up dates and enrollment periods Remind volunteers that it’s OK to say they are not sure and to provide a referral. Below are some notes for additional examples of cases and complaints if you would like to use them. These can also be used for scenarios and case study examples. Examples of Complaints Created by SHIBA complaints coordinator, October 7, 2019. Complaints can be addressed by the local sponsor to the degree that the individual is comfortable with the issue. Examples of complaints volunteers typically address: Issues regarding understanding how to interpret MSN and appealing denials Covered and non-covered benefits provided by OM A/B, MA, Supplements, Part D Preventive screening coverage Medically necessary services vs non-medically necessary procedures Optional Supplemental dental, vision, hearing, LTC, Rx medications Plans and/or service needs that we refer to other agencies [CMS, DOL, DSHS (Apple Health), CA, DOH, SS, OPM, DRS, PEBB/HCA] Misinformation given beneficiary regarding Medicare Supplement or Medicare Advantage plan enrollment that caused him/her to not enroll during her Guaranteed Issue Right Period or Initial Enrollment Period Beneficiary is being assessed a LEP for no coverage in a Part D or Part B Seeking reimbursement for immunizations or other drugs Plan Finder assistance with getting medications covered and at lowest cost Rx medication formulary exemption Inpatient vs Observation/Outpatient status and coverage Behavioral Health coverage and benefits and providers Hospital and SNF discharge appeal Balance billing dual-eligibles More complex/urgent need Complaints include: Medicare enrollment errors Provider enrollment or contracting issues Appealing denied services Medicaid client transitioning from Apple Health Managed Care plan to Medicare in need of medication. Claim denials or claims not paid correctly – This can run anywhere from beneficiary complaining about plans not paying claim(s) correctly, or, at all, to provider complaints where plan is not paying according to the fee schedule. Provider claim processing issues with the plan Out-of-network provider and facility billing issues Provider’s billing for preventative services that should be covered 100% Billing beneficiary for claim denied due to incorrect coding Third party provider networks Service denied for no or improper authorization where required by plan Medication out-of-pocket cost issues Ambulance Billing Skilled Nursing Facility Billing – Out of benefit days; notice of non-coverage Hospital Billing Durable Medical Equipment Billing Oxygen Supplies and Equipment Diabetes Supplies and Equipment CPAP Supplies and Equipment Issues regarding charges for plan premiums Supplemental coverage not per plan’s marketing Coverage for transition-related surgery Misrepresentation by Agents/Brokers/Plans/Federal Employee Marketing violations by plan representatives requesting change in enrollment Fraud, Error and Abuse


Referrals and providing more insurance help

You can also help your clients by letting them know about the OIC’s statewide toll-free Insurance Consumer Hotline at: 1-800-562-6900.

The Consumer Hotline is a free service where clients can get help with all types of insurance, such as home, auto, health, life, disability coverage, long-term care and even annuities.

Clients can also find more information at: https://www.insurance.wa.gov

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https://www.insurance.wa.gov/


How we’ll help you

• SHIBA staff include specialists in training, program management, communications, grant management, Medicare complaints and program administration.

• VCs will provide supervision, mentoring and training.• Regional training consultants will provide monthly

Medicare training and support.• Training sources include SHIBA sponsor locations

and the My SHIBA website at https://www.insurance.wa.gov/my-shiba.

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Presenter

Presentation Notes

List of SHIBA staff: Program manager Administrative assistant Field supervisor Program supervisor Training coordinator Secretary senior Communications coordinator Grants coordinator Complaints coordinator Regional training consultants Other possible information may include: Volunteer coordinators info Regional training consultants info Info about where and when to meet in person and online content SHIBA staff RACI chart




Next steps include:

• Taking the certification exam.• Mentoring (see the next slide and the Mentoring

Certification Checklist in your binder).• Knowing how to access and use the Volunteer

Handbook.• Asking for help.• Locating tools for you to succeed.• Getting to know your colleagues.• Knowing important rules.• Being recognized annually for your work.Your VC will help you on your path to certification! See your binder for the Path tracking sheet.

What are your expectations and questions?

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Advisor mentoring

Advisors receive specific on-the-job training, which provides the information and skills they need to perform their volunteer assignment.

After you complete Basic Training, the VC will set up mentoring training to provide skills and techniques for those who’ve chosen to become a counselor. You’ll receive more information on each of these as you progress through training. Some training tools may include:

• Medicare.gov and Medicare Plan Finder • STARs database• Department of Enterprise Services, Fulfillment Center • SHIP Technical Assistance Center • CMS National Training Program • Senior Medicare Patrol

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Presenter

Presentation Notes

Trainers: Mentoring includes observing a minimum of 10 hours of counseling sessions lead by an experienced volunteer See the SHIBA Volunteer Handbook and My SHIBA for more information on mentoring. https://www.insurance.wa.gov/my-shiba. The mentor checklist includes (search My SHIBA for “mentor checklist”): To be Completed by Volunteer Coordinator Date VC Initials Volunteer has completed Basic Training Volunteer has taken and passed SHIBA Certification Exam Volunteer has observed a minimum of 10 hours of counseling sessions lead by an experienced volunteer Volunteer can demonstrate using STARS (Beneficiary Contact; Group Outreach and Education, Media Outreach and Education, and Activity (timesheet information) on their own or on paper form Volunteer does not use a computer STOP HERE Volunteer is able to successfully maneuver on the OIC website Volunteer understands how to identify and order publications and training materials on MySHIBA Volunteer can access other online resources like: Medicare.gov; Medicare Plan Finder; Social Security; DSHS; HCA; etc.


Knowledge check

Q1 What are examples of the type of cases you might receive as a SHIBA advisor?

Q2 What are some examples of duties within a SHIBA advisor’s scope of work?

Q3 What is the primary purpose for protecting client confidentiality?

Q4 What is a referral number you can give to clients if they need help with Medicare?

Answers are on slide 131.

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Presenter

Presentation Notes

Knowledge check answers: Q1 What are examples of the type of cases you might receive as a SHIBA advisor? A1 Answer on slide 27. New to Medicare How and when to enroll in Medicare How to interpret billing paperwork and appeal denials Questions about covered and non-covered benefits provided by Original Medicare, Parts A & B, Medicare advantage plans, Medigaps or Part D Plans or service needs that we refer to other agencies Requests to use Medicare Plan Finder for help with getting medications covered and at lowest cost Complex cases that could require a referral, such as those for billing errors and fraud Q2 What are some examples of duties within a SHIBA advisor’s scope of work? A2 Answer on slide 21. Screen clients’ eligibility for various health care coverage options. Provide unbiased information about Medicare and health insurance options. Advise points to think about with regard to Medicare and health insurance options. Educate about Medicare fraud identification and prevention. Counsel and/or enroll in Medicare programs and plans when eligible and appropriate. Help low-income clients research their prescription and �co-insurance options. Q3 What is the primary purpose for protecting client confidentiality? A3 Answer on slide 24. To prevent personal client information from falling into the possession of unauthorized people. Q4 What is a referral number you can give to clients if they need help with Medicare? A4 Answer on slide 28. OIC’s statewide toll-free Insurance Consumer Hotline at: 1-800-562-6900.


Insurance terms and acronyms

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Health coverage and medical terms

Please reference the handout in your binder.

It is also posted on My SHIBA.

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https://www.insurance.wa.gov/sites/default/files/documents/glossry-health-coverage-medical-terms.pdf


Insurance terms activity

AppealCoinsuranceCopaymentCost SharingDeductibleESRDFormularyHealth insurance

Medically necessaryNetworkPlanPreferred providerPremiumProviderScreeningSpecialist

What is the definition of each of the following terms?

Answers are on the handout in your binder.

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Presenter

Presentation Notes

Trainers: This is an optional activity. The terms are on the Glossary of Health Coverage and Medical Terms included with the Basic training binder. You could discuss this or create an activity by printing out the definitions and perhaps do a matching activity where the trainees match the definition to the term.


Insurance acronyms

• See the list at the beginning of this slide presentation.

• Acronym lists and a glossary of terms are available on My SHIBA(https://www.insurance.wa.gov/my-shiba). Search for “acronym” or “glossary.”

• Medicare.gov also has a training glossary.

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https://www.medicare.gov/glossary/a


Medicare introduction

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Medicare 101

Medicare is our country's health insurance program for people age 65 or older, and certain people under age 65 with disabilities. The program helps with the cost of health care but it doesn‘t cover all medical expenses or the cost of most long-term care.

Clients have choices for how they get Medicare coverage. If they choose to have Original Medicare (OM) coverage, they can buy a Medicare supplement policy (Medigap) from a private insurance company to cover some of the costs that Medicare does not.


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Presenter

Presentation Notes

See document: Medicare, Explained (received 10/2/18) by Kirk Larson, Social Security Washington Public Affairs Specialist. Medicare is our country's health insurance program for people age 65 or older. The program helps with the cost of health care but it doesn’t cover all medical expenses or the cost of most long-term care. you have choices for how you get Medicare coverage. If you choose to have original Medicare coverage, you can buy a Medicare supplement policy (called Medigaps) from a private insurance company to cover some of the costs that Medicare does not. Medicare has four parts: Parts A hospital insurance, B medical insurance, C Medicare Advantage and D Medicare prescription drug coverage. If clients cant afford to pay Medicare premiums and other medical costs, they may be able to get help from their state. States offer programs for people eligible for or entitled to Medicare who have low income. Some programs may pay for Medicare premiums and some pay Medicare deductibles and coinsurance. To qualify, you must have Medicare Part A and have limited oncome and resources.


Medicare 101 (continued)

Medicare has four parts: 1. Part A is hospital insurance2. Part B is medical insurance3. Part C is Medicare Advantage4. Part D is Medicare prescription drug coverage

If clients can’t afford to pay Medicare premiums and other medical costs, they may be able to get help from their state.


39



States offer programs for people eligible for or entitled to Medicare who have low income.

Some programs may pay for Medicare premiums and some pay Medicare deductibles and coinsurance.

To qualify, they must have Medicare Part A and have limited income and resources.


40



Medicare clients have options.

We’ll start by covering the basics of each part of Medicare and later we’ll look more closely at the coverage options shown below.

41


The four parts of Medicare

42


Medicare Parts A, B and D

Medicare & You: Page 5

Here’s another way to look at three of the four parts of Medicare.

You’ll find this in your Medicare & You handbook.

43


Who is eligible for Medicare?

• Age 65 and older• Under age 65 and deemed disabled (Social Security

Disability Insurance) by the Social Security Administration (SSA)o 24-month waiting periodo No waiting period if diagnosed with ESRD or

ALS

Note: Must be a US citizen or legal permanent resident (LPR). If a client is an LPR, they must reside in the U.S. for 5 continuous years.

Medicare & You: Pages 15-17

44


Medicare card

Are clients using the new Medicare card that came out in 2020? Tell them to guard their card. Help prevent fraud!https://www.facebook.com/medicare/videos/guard-your-medicare-card/930570750674196/

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https://www.facebook.com/medicare/videos/guard-your-medicare-card/930570750674196/


Knowledge check

Q1 What are the four parts of Medicare?

Q2 Who is eligible for Medicare?

Q3 What are the residency requirements to be eligible for Medicare?


46

Presenter

Presentation Notes

Knowledge check answers: Q1What are the four parts of Medicare? A1 See slides 42 and 43 Part A is hospital insurance Part B is medical insurance Part C is Medicare Advantage Part D is Medicare prescription drug coverage Q2Who is eligible for Medicare? A2See slide 44 Age 65 and older Under age 65 and deemed disabled (Social Security Disability Insurance) by the Social Security Administration (SSA) 24-month waiting period No waiting period if diagnosed with ESRD or ALS Q3 What are the residency requirements to be eligible for Medicare? A3 See slide 44 Must be a US citizen or legal permanent resident (LPR) If a client is a LPR, they must be for 5 continuous years


Enrollment and enrollment periods

47


Some people are automatically enrolled

• Automatic enrollment for people who turn 65 and receive:o Social Security benefits and/oro Railroad Retirement Board benefits

• Automatic enrollment also occurs for people:o Under age 65 who apply to SSA for SSDI

disability benefits (SSDI is Social Security Disability Insurance). Most of those with SSDI must have received it for 24 months.

• Will receive an enrollment packet, including a Medicare card in the mail


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When enrollment is NOT automatic

• If client is not receiving Social Security Administration (SSA) retirement income, they’ll need to enroll with Social Security:

Online at www.ssa.gov Call 1-800-772-1213 Visit local SSA office

• If a client has questions about enrollment, have them contact Social Security at www.ssa.gov.


49

Presenter

Presentation Notes

Trainers: Enrollment is not always automatic. There may be questions or requests for examples such as those who live in Puerto Rico won’t automatically get Part B and must sign up for it.

http://www.ssa.gov/

https://www.ssa.gov/


Three main Medicare enrollment periods

1. Initial Enrollment Period (IEP)2. Special Enrollment Period (SEP)3. General Enrollment Period (GEP)

There’s also an Open Enrollment Period (OEP) that we’ll cover in another section.

This is just the start. The client will have more decisions to make along their path!


50


Initial Enrollment Period

When the client is first eligible to sign up for Medicare, the IEP is the 7-month window they have to sign up.

• Starts 3 months before client’s 65th birthday• Includes the client’s birthday month• Ends 3 months after client turns 65


51


Initial Enrollment Period (continued)


3 months before the month you turn age

65

Medicare starts BD

month

2 months before

the month

you turn age 65

Medicare starts BD

month

1 month before

the month you turn age 65

Medicare starts BD

month

Your birthday

(BD) month

Medicare starts next

month

1 month after you turn age

65

Medicare starts in 2 months

2 months after you turn 65

Medicare starts in 3 months

3 months after you turn 65

Medicare starts in 3

months

The later a client enrolls, the later their coverage starts. There could be up to a 3-month wait.

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Examples of Initial Enrollment Period

George will turn 65 in May. He enrolled in Medicare in February and it will start on May 1.

Sally turned 65 in May as well, but she did not enroll in Medicare until August. Sally faces no penalty, but her Medicare will not start until November.

53


Special Enrollment Period

• Special Enrollment Period (lasts 8 months)• Occurs after the Initial Enrollment Period (IEP) ends• For people covered by a group health insurance plan

based upon current employment o Their own, a spouse’s or if disabled, then a

family member’s• Can enroll in Medicare Part A and/or B

o Any time still covered by the group plano During the 8-month period that starts the

month after employment ends or the coverage ends, whichever happens first


54


Example of Special Enrollment Period

Alec’s been working for a large employer and is getting ready to retire this year. He is 68 years old and has not signed up to collect Social Security or Medicare.

Alec can sign up for Medicare at any time now, using his Special Enrollment Period (SEP). His SEP will end when he has been retired for 8 months.

55


General Enrollment Period

• General Enrollment Period (GEP)o If client missed Initial Enrollment Periodo If client missed, or is not eligible for a Special

Enrollment period (i.e. employer coverage)• Can enroll during the GEP

o January 1 – March 31 each yearo Coverage won’t start until July 1 of each yearo Possible higher premiums for Medicare Part A

and/or Part B due to late enrollment


56


Example of General Enrollment Period

He is past his Initial Enrollment Period, and it’s been more than 8 months since he was covered by activeemployer insurance, so he is past his Special Enrollment period.

Charlie will have to wait for the General Enrollment Period to enroll in Medicare.


Charlie is 68 years old. He stopped working over a year ago, and his employer doesn’t offer any retiree health coverage. He is planning to sign up for Social Security when he turns 70 to get his maximum benefit. Since he is pretty healthy, he thought he would wait until then to enroll in Medicare. Now he needs knee surgery!

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Knowledge check

Q1 What is a Medicare:• Initial enrollment period?• Special enrollment period?• General enrollment period?

Q2 When enrolling during the GEP, what penalties might incur due to late enrollment?


58

Presenter

Presentation Notes

Knowledge check answers Q1What is a Medicare: Initial enrollment period? See slide 51 When the client is first eligible to sign up for Medicare – it’s the 7-month window they have to sign up. Lasts 7 months Starts 3 months before client’s 65th birthday Includes the birthday month Ends 3 months after client turns 65 Special enrollment period? See slide 54 Special Enrollment Period (lasts 8 months) Occurs after the Initial Enrollment Period (IEP) ends For people covered by a group health insurance plan based upon current employment Their own, a spouse’s or if disabled, then a family member’s Can enroll in Medicare Part A and/or B Any time still covered by the group plan During the 8-month period that starts the month after employment ends or the coverage ends, whichever happens first General enrollment period? See slide 56 If client missed Initial Enrollment Period If client missed, or is not eligible for a Special Enrollment period (i.e. employer coverage) Can enroll during the GEP January 1 – March 31 each year Coverage won’t start until July 1 of each year Q2 When enrolling during the GEP, what are possible penalties due to late enrollment? See slide 56 Possible higher premiums for Medicare Part A and/or Part B due to late enrollment


Original MedicareParts A and B are referred to as Original Medicare (OM)

59


Original Medicare: Parts A and B


60


Original Medicare – Part A

Part A – Hospital insurance:• Inpatient hospital• Skilled nursing facility (limited)• Home health care• Hospice care• Blood


61


Medicare hospital insurance (Part A)

62


Medicare Part A (hospital insurance)

What does Part A cost in 2021?• Most people get Part A premium-free

o They or their spouse must have paid FICA taxes for at least 10 years (40 quarters)

• IF they paid into Medicare less than 10 years, they:o Can pay a premium to get Part A $471 per month (if worked fewer than

30 quarters) $259 per month (if worked 30 -39

quarters)


63

See the bottom of your blue Medicare Part A chart.


Examples of Medicare Part A

Evelyn is a widow and has contributed to Medicare for the last 20 years through her job. She’s earned 40 working quarters throughout her active work. When Evelyn enrolls in part A, it’ll be premium-free.

Vivian is single and has acquired only 35 quarters for Medicare, therefore she doesn’t qualify for premium-free Part A. Vivian will have to pay a monthly premium of $259 (in 2021) to receive Part A. Vivian can also continue to earn more quarters.

64


Original Medicare – Part B

Part B – Medical insurance:• Doctor visits• Outpatient hospital services• Tests, labs, x-rays, etc.• Durable medical equipment (DME) and supplies• Preventive services


65


Medicare medical insurance (Part B)

66

Presenter

Presentation Notes

Trainers: Be sure to have the current version of this document which is on My SHIBA.


Medicare Part B (medical insurance)

What does Part B cost?• In 2021, most people will pay $148.50 per month

o People with higher incomes could pay more• Social Security will notify clients if they

have to pay more or less than the standard premiumo The amount may change depending

on the client’s yearly income

Medicare & You: Page 23-24

67


Examples of Medicare Part B

William enrolled in Medicare in 2013. His Part B premium in 2021 is $148.50.

Natasha’s Medicare started in 2018. Her income is over $88,000 per year. Her Part B premium in 2021 is $207.90.

New Medicare premiums are announced each fall for the next calendar year. Social Security notifies individual enrollees of their premium. Factors affecting the amount include:

• Current income (higher or lower may pay more or less)• If there’s a cost-of-living adjustment to people’s Social

Security benefit in the new year

68


Does a client need Part B?

It depends. Potentially no, if:• They have coverage through active employment

o Their own job, their spouse’s job, or if disabled and under 65, then another family member’s job


69

Things to consider:• Some of the decision is based upon rules about

when Medicare would pay BEFORE the employer plan pays.

• People should check with their employer, in some cases, small employers will pay AFTER Medicare pays, even with active employment.

• Delaying Part B may mean:o Higher premiums (late enrollment penalty)o Waiting for GEPo Paying for their health care out-of-pocket


Examples of Part B coverage considerations

Maggie plans to keep working until she’s 68. She’s covered by her employer’s insurance. Maggie will sign up for Part A, but defer Part B until she stops activelyworking.

Barbara retired at age 63 and has been paying for a private insurance plan. At age 65, she will start her Medicare Parts A and B.

70


Paying for Medicare Parts A and B

In addition to Part B premiums (and sometimes Part A), client pays:

• Part A hospital deductible• Part B yearly deductible• 20% coinsurance for most services • May be other costs


71


Remember!

Medicare (generally) covers 80% of the cost for services that are “medically necessary.”

72


Example: Coverage for “medically necessary”

Sara is diagnosed with glaucoma. Medicare does not cover eye exams related to prescribing glasses (with the exception it does cover eyeglasses after cataract surgery).

Medicare does consider covering regularly scheduled eye exams to monitor Sara’s eye health as “medically necessary.”

Medically necessary Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.

73

Medicare & You: Pages 114

Presenter

Presentation Notes

Trainers: This could be an opportunity to discuss the term “medically necessary.”


Help paying for Medicare Parts A and B

There is a program to help clients pay for Medicare Parts A and B:

• It’s called the Medicare Savings Program (MSP).• Available to clients with limited income and

resources.• Find MSP at:

https://www.washingtonconnection.org/home/.


74

https://www.washingtonconnection.org/home/


Example of help paying for Medicare

Sam receives Social Security retirement of $1,000 per month, and has less than $7,000 in the bank. The Medicare Savings Program will pay his Part B premium –$148.50 per month x 12 months – saving him over $1,780 per year.

75


Knowledge check

Q1 What parts of Medicare are known as Original Medicare?

Q2 Does Part B cover hospital or medical?

Q3 What is the name of the program that can help clients pay for Medicare Parts A and B?


76

Presenter

Presentation Notes

Knowledge check answers Q1What parts of Medicare are knows as Original Medicare? A1Answer on slide 60. Part A and Part B. Q2Does Part B cover hospital or medical? A2Answer on slide 65. Medical. Q3What is the name of the program that can help clients pay for Medicare Parts A and B? A3Answer on slide 74. The Medicare Savings Program (MSP).


Medicare prescription drug coverageAlso called Part D

77


Medicare Part D


78


Medicare Part D

• Medicare prescription drug coverage (Part D) helps clients pay for both brand-name and generic drugs. Drug plans are offered by insurance companies and other private companies approved by Medicare.

• Available to all people with Medicare Parts A and/or B.

• Provided through:o Stand-alone Part D plans (PDP)o Medicare Advantage Plans (MAPD)


79

Presenter

Presentation Notes

Trainers: Only U.S. based companies approved by Medicare.


Who can enroll in Part D?

Clients must:

• Have Medicare Part A or Part B or both. • Live inside the U.S. and can’t be incarcerated.

Enrollment is not automaticfor most.


80

Presenter

Presentation Notes

Trainers: Part D late enrollment penalties https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty The late enrollment penalty is an amount that's permanently added to a Medicare drug coverage (Part D) premium. Client’s may owe a late enrollment penalty if at any time after their Initial Enrollment Period is over, there's a period of 63 or more days in a row when they don't have Medicare drug coverage or other creditable prescription drug coverage . They’ll generally have to pay the penalty for as long as you have Medicare drug coverage. See https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty. The cost of the late enrollment penalty depends on how long a client went without Part D or creditable prescription drug coverage. Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($32.74 in 2020, $33.06 in 2021) times the number of full, uncovered months they didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. The national base beneficiary premium may change each year, so their penalty amount may also change each year.


Do all clients need Part D?

It depends…

• Do they already have creditable drug coverage from another source?

• Creditable means it’s as good as Medicare Part D.o For example, through an employer plan

• Without creditable coverage, client may have:o To wait to enrollo A penalty

Medicare & You: Pages 75-76 & 79-86

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What Part D covers

• Prescription brand-name and generic drugs only.• Each plan has its own formulary (a list of covered

prescription drugs, also called a drug list). • Plans must cover a range of drugs in each category.• Coverage and rules vary by plan.

Note: Part D does not cover over-the-counter drugs.


82


Examples of Part D plan coverage

Bob was told by his doctor to take a low-dose aspirin daily. Since this is an over-the-counter (OTC) medication, Part D plans do not cover it.

Samantha takes several brand-name and generic prescriptions. The Plan Finder will help her see if there’s a plan that will cover these and if there are any coverage rules, such as:

• Quantity limits• Prior authorization• Step-therapy


83


Medicare drug plan costs

What do clients pay?• Cost varies by plan.

• Most people pay:o A monthly premiumo A yearly deductible o Copayments or coinsurance Amounts vary over the course of the year based on cost

of drugs.


84

Presenter

Presentation Notes

Trainers: This may be a place where you can discuss coverage phases.


When can clients enroll in Part D?

• During 7-month Medicare Initial Enrollment Period (IEP).

• During Open Enrollment Period (OEP).o October 15 – December 7o Coverage starts January 1

• Can possibly join at other times.o Special Enrollment Period (SEP)

Examples: Move to a new area, gain or lose employer or retiree coverage, are eligible for Extra Help/Low Income Subsidy (LIS)


85


Help paying for Part D

• “Extra Help” or “Low-income-subsidy” (LIS) is a program available to clients with limited income and resources.

• Extra Help or LIS will pay for part or all of premiums, deductible and copay for eligible clients.

• Part D penalties waived for LIS clients.• LIS enrollees can change plans more than once per

year• Find LIS applications at: www.ssa.gov.


86

http://www.ssa.gov/


Example of help paying Part D premium

Samantha receives $1,400 per month in Social Security retirement. She has less than $10,000 in savings. Extra Help could save her a lot of money. The program:

• Could help pay some or all of her Part D premium.

• Pay most or all of her deductible.• Make it so she has small drug copays.• Could allow her to change her drug plans

more than once per year.

87


How do clients choose a Part D plan?

Call SHIBA for help at 1-800-562-6900.

Research the online Plan Finder at: https://www.medicare.gov.

Contact the plan to find out if their medications are on the plan formularies and ask about costs.

Additional training is offered to SHIBA volunteers in this area – it’s the best way for clients to compare plans.

88

https://www.medicare.gov/


Knowledge check

Q1 In a word or two, what does part D cover?

Q2 When can a client enroll in Part D?

Q3 What is LIS?

Q4 What is the Medicare Plan Finder and where do you find it?


89

Presenter

Presentation Notes

Knowledge check answers: Q1In a word or two, what does part D cover? A1Answer on slide 79. Prescription drug coverage. Prescription drugs. Drug coverage. Drugs. Q2When can a client enroll in Part D? A2Answer on slide 85. During 7-month Medicare Initial Enrollment Period (IEP) During Open Enrollment Period (OEP) October 15 – December 7 Coverage starts January 1 Can possibly join at other times Special Enrollment Period (SEP) Examples: Move to a new area, gain or lose employer or retiree coverage, are eligible for Extra Help/Low Income Subsidy (LIS) Q3What is LIS? A3Answer on slide 86. “Extra Help” or “Low-income-subsidy” (LIS) is a program available to clients with limited income and resources. Extra Help or LIS will pay for part or all of premiums, deductible and copay for eligible clients. Part D penalties waived for LIS clients LIS enrollees can change plans more than once per year Find LIS applications at: www.ssa.gov Q4What is the Medicare Plan Finder and where do you find it? A4Answers on slides 83 and 88. The Plan Finder will help her see if there’s a plan that will cover these and if there are any coverage rules, such as: Quantity limits Prior authorization Step-therapy Research the online Plan Finder at: www.medicare.gov


MedigapsAlso called Medicare Supplement plans

90


Medigap (Medicare Supplement)


91


What is a Medigap plan?

• Medigaps (also called Medicare Supplement plans) are sold by private insurance companies.

• They help pay for “gaps” in Original Medicare.• Gaps include:

o Deductibles, coinsurance and copayments

• Medigaps are standardized and designated by letters A-N.


92


How to compare Medigap plans


Letters A - N

93


Example of Medigap plan

Willem has Original Medicare Parts A and B and a Medigap plan. As long as Willem’s doctor accepts Medicare and Medicare Parts A and B cover the care he gets, his Medigap will pay its part after Medicare pays. Then, if there’s anything left over, Willem will be billed for the remaining.

Medicare coordinates its payments with most Medigap plans, so the doctor or Willem most likely will not have to take any other action to get the Medigap to pay.

94


Who is eligible for a Medigap?

• Any client with both Medicare Parts A and B.• Medicare clients under age 65 have limited choices.

o There are no “guaranteed issue” protections for people under age 65 in Washington state


95


Do clients need a Medigap?

If a client is NOT covered under an employer plan (active or retired) and does not have any other source to pay for the balances after Original Medicare has paid, they may want to consider a Medigap.


96


When to enroll in a Medigap

• Clients may enroll in a Medigap any time after they enroll in Medicare Parts A & B if a company agrees to sell them one.

• Medigaps don’t have an annual Open Enrollment Period (OEP).

• Each individual gets their own one-time six-month OEP (see next slide).


97


When to enroll in a Medigap

Clients are guaranteed to get a Medigap without a written health screening: • During the six-month period that starts the first day

of the month that they’re 65 or older AND enrolled in Part B. Medicare calls this the “Medigap Open Enrollment Period.”

• If they currently have a Medigap plan B through N, they can join any Medigap plan – except Plan A.

• If they currently have Medigap Plan A they can join any Medigap Plan A


98

Presenter

Presentation Notes

Trainers: Here is a note you may share with volunteer advisors: The Office of the Insurance Commissioner has staff who can interpret and explain laws about Medigaps and health screenings. Ask your VC or RTC if you need help when advising clients. For reference: What you need to know about Medigap (Medicare Supplement) plans https://www.insurance.wa.gov/media/8737


Examples of Medigap OEP

Toby is 69 years old and just enrolled in Medicare Part B. Toby is retiring from his job, therefore he is going to use his Special Enrollment Period. His six-month Medigap Open Enrollment Period starts as soon as his Medicare Part B starts.

Samantha is 63 years old, disabled and on SSDI. She was automatically enrolled in Medicare Parts A and B because she has been on SSDI for 24 months. Her six-month Medigap Open Enrollment Period will not start until the month she turns 65.

99


Examples of Medigap enrollment rules

Lin bought a G plan with Pear Company. Lin now wants an N plan that Pear Company provides. She can call Pear Company and buy the N plan to replace her G plan.

Lee bought a G plan with Pear Company, but wants a G plan from Grape Company. He can call the Grape Company and enroll. Once his new plan activates, it is his responsibility to cancel with Pear Company.

100


Approved Medigap plans and rates

101

Presenter

Presentation Notes

Trainers: Be sure to have the current version of this document which is on My SHIBA and is updated quarterly.


Things to consider about Medigaps

• Medigaps are good nationwide.• A client should make sure the providers they use will

accept patients with Original Medicare.• Once a client buys a Medigap, it’s theirs as long as

they pay the premium.• There is portability in

Medigaps.• Plans C & F are only available to

people who were eligible for Medicare prior to Jan. 1, 2020.



102

Presenter

Presentation Notes

Trainers: You may wish to explain portability by sharing there are times when a person can switch Medigaps, along with any other associated information. For reference: What you need to know about Medigap (Medicare Supplement) plans https://www.insurance.wa.gov/sites/default/files/documents/what-you-need-to-know-medigap-plans_3.pdf


Things to consider about Medigaps (continued)

• Insurance companies can only sell the client a “standardized” plan (letters A – N).

• Medicare standardizes Medigaps:o Plans with the same letter designation all cover the

same benefits.o Different insurance companies may charge different

premiums for the exact same plan.• Medigaps sold today DO NOT pay for prescription

drugs.o Most should consider buying a drug plan (Part D)


103


How to find the right Medigap plan

Clients can call SHIBA for help at 1-800-562-6900.

Research what benefits each plan letter provides.

Compare the plan costs to what is affordable to the client.

104


Knowledge check

Q1 Which part(s) of Medicare do Medigaps help cover?

Q2 What are some examples of “gaps” that are helped with Medigap coverage?

Q3 When can a client enroll in a Medigap?

Q4 What are three (of several) things a client should consider when purchasing a Medigap?


105

Presenter

Presentation Notes

Answers to knowledge check: Q1 Which part(s) of Medicare do Medigaps help cover? A2 Answer on Slide 95 Parts A and B Q2 What are some examples of “gaps” that are helped with Medigap coverage? A2 Answer on slide 92 Deductibles, coinsurance and copayments. Q3 When can a client enroll in a Medigap? A3 Answer on slide 98. Clients are guaranteed to get a Medigap without a written health screening: During the six-month period that starts the first day of the month that they’re 65 or older AND enrolled in Part B. Medicare calls this the “Medigap Open Enrollment Period.” Q4 What are three (of several) things a client should consider when purchasing a Medigap? A4 Answers on slides 102-103 Medigaps are good nationwide A client should make sure the providers they use will accept patients with Original Medicare Once a client buys a Medigap, it’s theirs as long as they pay the premium There is portability in Medigaps Plans C & F are only available to people who were eligible for Medicare prior to Jan. 1, 2020. Insurance companies can only sell the client a “standardized” plan (letters A – N) Medicare standardizes Medigaps: Plans with the same letter designation all cover the same benefits Different insurance companies may charge different premiums for the exact same plan Medigaps sold today DO NOT pay for prescription drugs Most should consider buying a drug plan (Part D)


Medicare Advantage (MA) plansAlso called Medicare Health Plans or Part C

106


Medicare Advantage


107


Medicare Advantage (Part C)

Medicare Part C (Medicare Advantage) is another way to get Medicare coverage.

• Plans are sold by private insurance companies.• Most plans require clients use a defined provider

network.• Clients can get a coverage determination from

the plan before they get a service to find out if it’s covered and get an estimate of costs.

• Choice of plans varies depending on what county the client lives in.o Some counties don’t offer plans.


108

Presenter

Presentation Notes

Trainers: This is a chance to clarify and discuss coverage determination, if needed.


How Medicare Advantage (MA) plans work

• Provides all the same rights and protections as Original Medicare.

• Delivers Part A and B benefits, but rules can vary.• Generally must use network providers for best

coverage.• Medicare pays a private plan to provide the services.

o Client pays Part B premium and may also pay plan premium.

o An annual maximum out-of-pocket limit can protect clients from catastrophic health costs.

• Most include Part D prescription drug coverage.• May include extra benefits:

o Vision, dental, hearing and health club memberships


109


Who is eligible?

Anyone enrolled in Original Medicare Parts A and B and lives in the plan’s service area.


110


When can clients enroll in an MA plan?

• During seven-month Medicare Initial Enrollment Period (IEP).

• During Open Enrollment Period (OEP):o October 15 – December 7o Coverage starts January 1o May be able to join at other times o Special Enrollment Period (SEP)

Examples: Move to a new area, gain or lose employer or retiree coverage, are eligible for Extra Help/Low Income Subsidy (LIS)

• Depending on what county the client lives in, MA plans may not be available.


111


Examples of Medicare Advantage plan

Sally checked with her doctor’s office about Medicare and they told her they only accept three Medicare Advantage (MA) plans. They gave her the list. They do not accept Original Medicare. Sally wants to continue to see her doctor when her Medicare starts, so she will choose one of these MA plans.

Bob checked with his doctor’s office about Medicare and they told him that they only accept Original Medicare. They do not accept any MA plans. Bob wants to continue to see his doctor when his Medicare starts, so he will not enroll in an MA plan.


112


Example of Medicare Advantage plan

Morgan is 57 years old and is on Medicare because he’s disabled. He has a lot of health problems and is not able to buy a Medigap plan. Choosing an MA plan can help protect him from catastrophic health care costs.


113


What are Medicare Advantage plan costs?

Medicare pays a fixed monthly payment to the private plan for the client’s care. Clients pay:

• Part A premium (if any)• Part B premium• MA plan’s monthly premium (if any)• Copays • Coinsurance• Deductible• Non-covered services – (not calculated in

maximum out-of-pocket)

Note: “Maximum out-of-pocket” limits costs of covered care to enrollee.


114


Four most common types of MA plans

1. Health Maintenance Organization (HMO) plans2. Preferred Provider Organization (PPO) plans3. Special Needs Plans (SNPs)4. Private Fee-for-Service (PFFS) plans.

In 2021, there are no PFFs plans in WA state.


115


Things to consider about MA plans

• Medicare Advantage (MA) plans offer comprehensive coverage (including Part D coverage).

• May require a referral to see a specialist.• Doesn’t work with Medigap plans.• Not all providers are included in the MA’s network.• MA plans require clients to pay some of the cost.


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Shopping for MA plans

• Look at BOTH the health benefits and drug benefits of each plan separately.

• Clients can do this on the medicare.gov website (SHIBA volunteers may assist with this).

• Look at MA plans’ websites for summary of benefits and provider lists.o Always verify provider participation by

contacting the provider.

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Presentation Notes

Trainers: Below are additional benefits notes from page 8 of Nov. 2019 training. Medicare Advantage (MA) plans can offer some of the extra benefits that Original Medicare (OM) doesn’t cover. As of 2019 and into 2020, the benefits that plans can offer has and is expanding beyond the vision, dental, hearing and gym memberships we’ve seen in past years. Supplemental “Extra” benefits are additional services offered by MA plans that aren’t covered under Medicare Parts A, B or D, including transportation to doctor visits, covering over-the-counter drugs, adult day-care services and other supplemental services that promote beneficiary health and wellness. Many of these are called “special supplemental benefits for the chronically ill” and beneficiaries will need to meet specific health and other criteria to become eligible for these benefits. Some Extra benefits, such as dental, may include an additional premium (also known as a rider). This may create more options and more confusion for consumers. Understand that some MA plans offer extra benefits but you are not required to counsel clients on these. Refer clients to the plan. The two tip sheets at the back of the Nov. 2019 training packet will help you when you meet with clients and are asking them questions: Buying Dental Insurance Medicare Advantage Plans: What you need to know before you buy


Where do clients enroll?

• Online at www.medicare.gov• Contact a licensed agent

• Call: SHIBA at 1-800-562-6900• Call: 1-800-633-4227

(1-800-MEDICARE)• Call the plan

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http://www.medicare.gov/


We can help clients choose their path!



Training tools and wrap-up

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Office of the Insurance Commissioner

OIC (insurance.wa.gov)

There is a link for Medicare at the top of the web page.

There is a link for SHIBA volunteers at the bottomof the page.

See the next three slides for more information.

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Office of the Insurance Commissioner

OIC (insurance.wa.gov)

Be familiar with the Medicare page on the OIC website and share this information with clients.

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My SHIBA

My SHIBA (insurance.wa.gov)

Access to My SHIBA requires a password, which you may get from your trainer or volunteer coordinator.

Continued

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My SHIBA (continued)

My SHIBA (insurance.wa.gov)

The home page for My SHIBA includes links to a variety of information that you’ll need for your work.

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Plan Finder

Medicare Plan Finder (medicare.gov)

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Presentation Notes

Trainers: This is an optional slide for Plan Finder training. https://www.medicare.gov/plan-compare Visit medicare.gov and search for “plan finder.” From a web search engine (such as Bing, Google or Yahoo) search for “Medicare Plan Finder.” DO NOT click on ads. Find the link to medicare.gov.

https://www.medicare.gov/plan-compare/#/?lang=en


Test your basic Medicare knowledge

Your trainer may lead an activity for a knowledge check. This may include quizzes, scenarios or discussion time.

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Presentation Notes

Trainers: You may lead with optional quizzes, scenarios and/or discussion topics for this slide. Case studies and quizzes should be included with the basic training materials. Determine how to use the quizzes and case studies. Handouts and optional PowerPoint slides may be used. Each of the below are a part of optional SHIBA training materials. Quizzes Case studies Authoritative documents: Search My SHIBA to find current versions of documents and web pages. Medicare Advantage and Special Needs plans and prices by county (copies available from your VC) Medicare hospital insurance (Part A) and medical insurance (Part B) covered services Medicare Part D Stand-Alone prescription drug plans Approved Medicare Supplement (Medigap) plans Extra Help/LIS Co-pay Levels & Costs Cross-Agency Desk Aid Disability Basics Find a local SHIBA office (available only as a web link) Get Help paying for Medicare Guide to consumer mailings from CMS, Social Security & plans Medicare & You Medicare help rainbow chart Medicare Part D Prescription Drug Benefit Medicare's Limited Income NET Program Other State Health Insurance Information Programs (SHIP) SHIBA and PEBB Ways SHIBA volunteers can assist PEBB retirees Special Enrollment Periods for Medicare Advantage Plans and Medicare Part D Drug Plans Understanding Medicare Part C and Part D Enrollment Periods Volunteer Complaint Process Your Guide to Who Pays First Your Medicare coverage choices (copies available from your VC) Discussion: Provide a description and explanation of: Balance billing MSN EOB


Final thoughts and questions

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• What questions do you have?• Did we answer your questions from the start of

training?• Where do you hope or plan to go from here?• What can we do to help?

Contact SHIBA:

[email protected] 1-800-562-6900

www.insurance.wa.gov/my-shiba Login required

mailto:[email protected]



Primary authoritative resources

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• Medicare & You• medicare.gov• My SHIBA login required• oic.wa.gov• cms.gov• shiptacenter.org• ssa.gov• Medicare saving program• Washington healthplanfinder• SHIBA staff including your volunteer coordinator (VC) and

regional training consultant (RTC)• SHIBA Volunteer Handbook• Volunteer Risk and Program Management Handbook

(VRPM)• SHIBA Program Operations Manual• PEBB• WA Apple Health (Medicaid)• Managed Care• smpresource.org • acl.gov

https://www.medicare.gov/medicare-and-you

http://www.medicare.gov/



http://www.cms.gov/

http://www.shiptacenter.org/

http://www.ssa.gov/

https://www.dshs.wa.gov/esa/community-services-offices/medicare-savings-program

https://www.wahealthplanfinder.org/_content/Homepage.html?bmctx=B1EF2C76C22FC823F3BC4BBDAD8CA2C823B2A98DCF1D66A14F235198F62516A8&contextType=external&username=string&password=secure_string&challenge_url=https://www.wahealthplanfinder.org/_content/Homepage.html&request_id=-5111850940004639344&authn_try_count=0&locale=en_US&resource_url=https://www.wahealthplanfinder.org:443/HBEWeb/

https://www.hca.wa.gov/about-hca/public-employees-benefits-board-pebb-program

https://www.hca.wa.gov/health-care-services-supports/apple-health-medicaid-coverage

https://www.medicaid.gov/medicaid/managed-care/index.html

https://acl.gov/


Evaluation

Please take a few minutes to fill out the paper evaluation to provide your feedback on SHIBA’s basic training for new volunteer advisors.You may also send comments to [email protected] or use the online survey at www.surveymonkey.com/r/SHIBA-BasicEvaluation.

Your comments will help us in developing stronger content for our counseling program.

We appreciate your feedback!

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Trainers: There should be an evaluation in the binders. If not, please have a few on hand to pass out. Completed evaluations may be returned to the SHIBA program supervisor or SHIBA curriculum coordinator.

mailto:[email protected]

http://www.surveymonkey.com/r/SHIBA-BasicEvaluation

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Knowledge check answers

Slide 32Q1 What are examples of the type of cases you might receive as a

SHIBA advisor?A1 Answer on slide 27.

Q2 What are some examples of duties within a SHIBA advisor’s scope of work?

A2 Answer on slide 21.

Q3 What is the primary purpose for protecting client confidentiality?A3 Answer on slide 24.

Q4 What is a referral number you can give to clients if they need help with Medicare?

A4 Answer on slide 28.

Slide 46Q1 What are the four parts of Medicare?A1 See slides 42 and 43

Q2 Who is eligible for Medicare?A2 See slide 44

Q3 What are the residency requirements to be eligible for Medicare?A3 See slide 44

Continued

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Knowledge check answers (continued)

Slide 58Q1 What is a Medicare:A1 Initial enrollment period? See slide 51

Special enrollment period? See slide 54General Enrollment Period (GEP) See slide 56

Q2 When enrolling during the GEP, what are possible penalties due to late enrollment?

A2 See slide 56

Slide 76Q1 What parts of Medicare are knows as Original Medicare?A1 Answer on slide 60.

Q2 Does Part B cover hospital or medical?A2 Answer on slide 65.

Q3 What is the name of the program that can help clients pay for Medicare Parts A and B?

A3 Answer on slide 74. Continued

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Knowledge check answers (continued)

Slide 89Q1 In a word or two, what does part D cover?A1 Answer on slide 79.

Q2 When can a client enroll in Part D?A2 Answer on slide 85.

Q3 What is LIS?A3 Answer on slide 86.

Q4 What is the Medicare Plan Finder and where do you find it?A4 Answers on slides 83 and 88.

Slide 105Q1 Which part(s) of Medicare do Medigaps help cover? A1 Answer on Slide 95

Q2 What are some examples of “gaps” that are helped with Medigapcoverage?

A2 Answer on slide 92

Q3 When can a client enroll in a Medigap?A3 Answer on slide 98.

Q4 What are three (of several) things a client should consider when purchasing a Medigap?

A4 Answers on slides 102-103

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Case study answers

Case study #1: Supplementing Medicare – FredCase studies should be located in your training binder.

How should you advise Fred?1. His retiree insurance will end when he turns 65.2. His income is too high for Extra Help or MSP (screen him using the

Medicare Rainbow Chart: https://www.insurance.wa.gov/media/5711.The information from his doctors sounds like they don’t want to take plans with a defined network, such as a Medicare Advantage plan. He should double-check with his doctors to be sure.

3. If his doctors prefer Original Medicare, he might consider a Medigap plan.

4. He should be guaranteed a Medigap without a health screening (see slide 57).

5. People who have a Medigap should consider a Part D plan to cover prescriptions.

6. SHIBA can help him compare Part D plans and check to see if a plan that offers mail order would save him any money.

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Presentation Notes

Trainers: This page includes answers to the SHIBA case study that should be in the training binder.

https://www.insurance.wa.gov/media/5711


Case study answers

Case study #2: Supplementing Medicare – WilmaCase studies should be located in your training binder.

How should you advise Wilma?1. Wilma can sign up for her retiree insurance, but we can help her

compare that to buying a plan available to people with Medicare in her area.

2. Her income is too high for Extra Help or MSP (screen her using the Medicare Rainbow Chart: https://www.insurance.wa.gov/media/5711.

3. Her doctor’s office already told her they want her to choose a Medicare Advantage plan if she doesn’t take the retiree coverage.

4. SHIBA can help her compare the five Medicare Advantage plans to help her find the one that offers her the best coverage for the lowest cost.

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Case study answers

Case study #3: Supplementing Medicare – Barney and BettyCase studies should be located in your training binder.

How should you advise Barney and Betty?1. When advising a couple about Medicare, we look at each person’s

situation individually. In some cases, each person will make a different decision, and often the best plan for one member of the couple will not be the best plan for the other member.

2. Betty and Barney sound like they might qualify for Extra Help and a Medicare Savings Program. Screen them using the Medicare Rainbow Chart: https://www.insurance.wa.gov/media/5711.

3. Barney might want to sign up for a Part D or Medicare Advantage plan with prescription drug coverage. It could offer additional benefits apart from going to the VA, and he probably could find a doctor closer to home.

4. If there are any in her county, Betty might want to sign up for a Medicare Advantage plan with prescription drug coverage. If not, she’ll probably want to sign up for a Part D plan.

5. SHIBA volunteers can help Barney and Betty compare the costs of different Medicare Advantage or Medicare Part D plans, and show them what the costs would be if they’re eligible for Extra Help.

6. SHIBA volunteers can advise Barney and Betty on where and how to apply for Medicare Savings Program and Extra Help.

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Case study answers

Case study #4: Medicare enrollment periods – LucyCase studies should be located in your training binder.

When should she sign up?Lucy needs to enroll in Medicare by contacting Social Security. She can do that right away, because she’s in her Initial Enrollment Period. If she wants to, she can file to start receiving her Social Security retirement benefit at the same time.

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Case study answers

Case study #5: Medicare enrollment periods – Desi Case studies should be located in your training binder.

What does he need to do? He should double-check with his employer to find out if they require him to enroll in Medicare when he turns age 65.

Should he sign up for Medicare? If his employer says he has to, then yes. But, if they say he does not have to, he might consider delaying it until he retires, using his Special Enrollment Period.

When should he do this?• If he needs to sign up per his employer, he should sign up right away,

because he’s in his Initial Enrollment Period.• If he decides to wait, we recommend he use his Special Enrollment

Period to sign up with Social Security about two to three months before he retires. He’ll be able to select the month that his Medicare starts, so he won’t have any breaks in his coverage.

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Case study answers

Case study #6: Medicare enrollment periods – Fred and EthelCase studies should be located in your training binder.

What do we tell Ethel?• She should double-check with Fred’s employer to find out if they

require her to enroll in Medicare when she turns age 65. • If she needs to sign up per Fred’s employer, she should sign up right

away, because she is in her Initial Enrollment Period.• If she decides to wait, we recommend she uses her Special Enrollment

Period to sign up with Social Security about two to three months before Fred retires. She’ll be able to select the month that her Medicare starts, so she won’t have any breaks in her coverage.

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Case study answers

Case study #7: Medicare enrollment periods – George Case studies should be located in your training binder.

What can you tell him about this?• Most people get Medicare after they receive Social Security Disability

for two years.• He will then be automatically enrolled in Medicare Parts A & B.• If he does not know when his two years will be completed, he should

check with Social Security to find out when his Medicare starts.• He should contact SHIBA about three to four months before his

Medicare starts to get help deciding what kind of plans and coverage to enroll in.

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Case study answers

Case study #8: Medicare enrollment periods – Marie Case studies should be located in your training binder.

What can you tell her?• Since she’s not collecting Social Security Benefits, she won’t be

automatically enrolled in Medicare.• Maria has missed her Initial Enrollment Period.• Since it has been more than eight months since her ACTIVE or

CURRENT employment, she has missed her Special Enrollment Period.• She can sign up for Medicare during the General Enrollment Period.

(January1 through March 31), and her Medicare will start July 1 of that year.

• She might have a late enrollment surcharge added to her Medicare Part B premiums. Social Security can answer questions about that.

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Quiz answers: Medicare enrollment

Test your knowledge! True False1 People are always automatically signed up for Medicare. X

2For people turning age 65, their Initial Enrollment Period for Medicare is the nine (9) months around their birthday month.

X

3People with ESRD (End-Stage Renal Disease) or ALS (Lou Gehrig’s Disease) do not have to wait 24 months to start Medicare.

X

4People may defer joining Medicare after age 65 with no penalty if they have COBRA coverage from a former employer.

X

5People over age 65 may defer joining Medicare with no penalty if they have insurance through a working spouse. X

6People who miss their Medicare Parts A & B Initial Enrollment Period may have a penalty for late enrollment when they join.

X

Continued

Correct answer notes:Q2. 7 months surrounding their birthday.Q4. People only have 8 months after ACTIVE employment to use

their SEP. COBRA doesn’t count as ACTIVE employment

Quizzes should be located in your training binder.

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Presentation Notes

Trainers: This page includes answers to the SHIBA quizzes that should be in the training binder.


Quiz answers: Medicare enrollment (continued)

Test your knowledge! True False

7People who enroll in Medicare during the General Enrollment Period (January – March) will have Medicare that starts July 1.

X

8 You sign up for Medicare through the Medicare office. X9 You sign up for Medicare through Social Security. X10 You always have to go in-person to sign up for Medicare. X

11SHIBA volunteers should be able to help clients sort out complex enrollment issues. X

12BONUS: A person who has their birthday on the first day of the month starts their IEP (Initial Enrollment Period) one month early.

X

Correct answer notes:Q11. SHIBA wants volunteers to send clients with any complicated

enrollment questions to Social Security.


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Quiz answers: Who is eligible for Medicare?

Continued

Correct answer notes:Q1. Amanda is not disabled (assumption) because she states she is

healthy.Q2. Bennie is over 65 and U.S. Citizen.Q3. Kassandra hasn’t been LPR for 5 continuous years. Q4. Jim has been on SSDI for more than 24 months.Q5. Sarah is in her IEP for Medicare.

Test your knowledge! YES NO

1 Amanda is age 62 and describes herself as “healthy as a horse.” X

2 Bennie is age 83 and describes himself as “healthy as a horse.” He was born in Kentucky. X

3 Kassandra is age 83 and was born in Greece. She moved here legally two years ago to live with her son and his family. X

4Jim lives in Missouri, where he was born and raised. He went on SSDI about seven years ago after being diagnosed with multiple sclerosis.

X

5 Sarah turned age 65 yesterday. She has lived in Las Vegas her whole life. X


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Quiz answers: Who is eligible for Medicare? (continued)

Correct answer notes:Q6. Does Jesse have Medicare and Medicaid (confused)? She isn’t

eligible for Medicare, but in Washington, we might refer her to Washingtonhealthplanfinder.org.

Q7. Duc has been a LPR for more than 5 years.Q8. Mirela doesn’t have legal papers (such as LPR), so it doesn’t matter

how long she has been here.Q9. Yes, she has ESRD.Q10. It doesn’t matter how wealthy a person is to be eligible for

Medicare.

Test your knowledge! YES NO

6Jessie tells you she has heard that Medicare might help her get less expensive insurance for her and her kids. She is in her thirties and has been pretty healthy.

X

7 Duc has been living legally in the U.S. since escaping from Vietnam in the 1970’s. He is now age 65. X

8Nadya tells you that her grandmother, Mirela, has lived in this country forever, but never got any papers. Mirela is in her 70’s.

X

9 Roberta is waiting for a kidney transplant. She has been getting dialysis for over a year. X

10 Bill Gates just turned age 65 last month. X


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Documents

Volunteer Basic Training