Aging Matters: Navigating Medicare open enrollment

SHINE counselor Barry Gibbons assists two consumers with a review of Medicare options.
SHINE counselor Barry Gibbons assists two consumers with a review of Medicare options.
Photo by Ronnie Lovler

It’s busier than usual on Tuesday mornings during this time of year at the Senior Recreation Center on the outskirts of Gainesville. That’s because volunteers from Elder Options’ SHINE (Serving Health Insurance Needs of Elders) program are on site to help seniors navigate the ins and outs of Medicare options.

Medicare’s open enrollment period kicked off Oct. 15 and continues through Dec. 7 for those age 65 and above. There are many ways to look at plans and make decisions, including doing it on your own or with the assistance of an insurance agent or broker who has a product to sell—creating a potentially confusing situation for many seniors.

Keith and Peggy Stedman retired to Gainesville a few years ago and signed up to work as SHINE volunteers because they wanted to help their chronological peers figure out their health insurance needs.

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Consumers don’t need an appointment necessarily when they seek SHINE assistance at the Senior Center.
Photo by Ronnie Lovler Consumers don’t need an appointment necessarily when they seek SHINE assistance at the Senior Center. They can sign in on a sheet in the hallway.

“Medicare is complex,” Keith Stedman said. “People approach us with a high anxiety level. People come in and they are lost. We are the only group of volunteers authorized to provide one-on-one Medicare counseling.”

SHINE volunteers say they are uniquely positioned because they have no skin in the game and can focus on what’s best for each senior.

“It’s great to have a volunteer opportunity where we’re helping people,” Peggy Stedman said. “We explain what Medicare is, which options they have, and allow them to review and determine which option is best for them.”

SHINE’s website underscores the fact that they offer eligible consumers free, personalized, unbiased, and confidential Medicare counseling. SHINE, a free program supported Florida Department of Elder Affairs and Elder Options, provides counselors who have no affiliation with any insurance companies or agencies and neither sell nor recommend insurance of any type.

Diana Tonnessen, 66, is one of those helped by a SHINE volunteer during the current enrollment period and she said was grateful for the assistance.

“As you start going through all the mailings and leaflets and flyers and you see all these ads on TV… most of these people are not Medicare employees,” she said. “They are employees of insurance companies.”

Tonnessen said the mountain of information available about Medicare is enough to “make your head spin.”

“When I heard about the SHINE program, I felt more confident that a volunteer trained in this information would be able to help me navigate all that material without bias and without the financial incentive on their end,” Tonnessen said.

Elder Options’ SHINE team has 68 volunteers and four staff members as members of the team who assist Medicare beneficiaries, their families, and caregivers. 

Cheryl Harris, SHINE liaison at Elder Options said there are generally two paths that people can follow when they select Medicare coverage: traditional Medicare with or without a Medigap policy or supplement, or an Advantage Plans that is administered by a private insurance company.

Those who opt for traditional Medicare will also have to purchase a separate drug plan. Some Advantage plans provide drug coverage.

Harris laid out some of the pros and cons of each pathway.

SHINE counselor Peggy Stedman assists a consumer with reviewing her Medicare options.
Photo by Ronnie Lovler SHINE counselor Peggy Stedman assists a consumer with reviewing her Medicare options.

“If someone wants maximum flexibility with their health care to be able to go to any provider in the United States who is enrolled in Medicare, that is going to be original Medicare,” she said. “If you have that Medigap policy, it works hand in glove with original Medicare. That gives maximum flexibility. Downside is that’s going to cost.”

Many Advantage plans have no monthly premium but have less flexibility and more demands to stay in network.

“The downside is you may need to stay within a network of providers,” Harris said. “Another downside is the number of pre-authorizations that may be required.”

The best will vary between individuals.

“There’s no right or wrong answer,” said Harris. “Advantage plans have positives and they have negatives. Having an original Medicare plan with a Medigap policy also has positives and negatives.”

SHINE volunteers go through extensive training before they begin assisting Medicare consumers, Harris said. The process includes online training and in-person training and a volunteer must pass a Level 2 background screening.

“Then a new volunteer will shadow and mentor with an experienced counselor,” Harris said. “[There is also] role reversal where the new volunteer takes the lead but goes out with backup. Nobody gets sent out on their own until they are ready.”

Elder Options’ SHINE program offers services in 16 counties in North Central Florida, including Alachua, Hamilton, Suwanee, Lafayette, Columbia, Union, Bradford, Gilchrist, Putnam, Dixie, Levy, Marion, Citrus, Hernando, Sumter, and Lake counties.

By going to the SHINE website at consumers can find counseling sites in their counties and determine when volunteers will be there. Or you can call 1-800-96-ELDER or 1-800-963-5357.

Editor’s note: This is part of Mainstreet’s ongoing Aging Matters series. It was independently reported by Ronnie Lovler and underwritten by Elder Options. Some reporting was made possible by Lovler’s acceptance as a fellow into the 2022 Age Boom Academy, a program of the Columbia Journalism School, the Robert N. Butler Columbia Aging Center, and the Columbia Mailman School of Public Health.         

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Jenny Dearinger

Great article! Medicare can be very difficult to decipher, to figure out what’s the right program for you. It’s nice to be reminded about the dates for open enrollment and it’s nice to know there is a recource to go to if you are confused.