Understanding Medicare part I: Looking for a plan while avoiding scams

Understanding Medicare part I: Looking for a plan while avoiding scams

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(The Dallas Examiner) – For Medicare recipients, navigating the system may seem like a foreign language – figuring out the benefits, what it covers and doesn’t cover, which doctors accept certain types of insurance and if a co-pay is required for certain services. It can be a confusing and frustrating process, especially for senior citizens and vulnerable populations. 

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For those needing to learn more about Medicare benefits and provisions, along with avoiding scams, the North Central Texas Area on Aging has provided relief. On Jan 9, the group hosted a webinar, MIDWEEK MEDICARE: Medicare Coverage Preventive Services and Top 10 Scams of 2025.

Speakers included counselors from the agency, the Better Business Bureau Education Foundation and Texas Senior Medicare Patrol.

State Health Insurance Assistance Program 

Also known as SHIP, its goal is to help people understand the costs and coverage of Medicare, compare different Medicare options, enroll or change plans and correct billing issues.

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“Currently, there are 54 SHIPs – one in every state, Puerto Rico, Guam, Washington D.C. and the U.S. Virgin Islands,” stated Felecia Warner, benefits counselor II for North Central Texas Area on Aging. “There are 2,200 local programs, 12,500 counselors and 4 million individuals we have educated. We also conducted 2.5 million counseling sessions. So it is important that we also provide services for the Senior Medicare Patrol Program, which helps Medicare beneficiaries, protect, detect and report health care fraud, errors and abuse.”

The SHIP program was established by Congress and their work is funded by the U.S. Administration for Community Living by the U.S. Department of Health and Human Services.

“We work with helping individuals understand the cost and the coverage,” Warner said. “We just finished up as of Dec. 7 with the open enrollment, and that’s generally always our busiest time, and counselors help provide unbiased information about your Medicare benefits to their families and caregivers. So we’re important research when you’re reaching out to help compare options, enroll in a plan, or even you know, just to correct things such as billing and appeal issues, which sometimes happen and can be very complicated for someone to understand. And a lot of people just give up and just let it go and pay the bill when they know it might be questionable. So we can help resolve some of those issues.”

Warner suggested that anyone needing help from the program could visit a local office, go to https://www.shiphelp.org or call 877-839-2675.

“I had a lady call from Houston. She did not know there was a local SHIP in her area there, and I was so glad to help her find that location and get services for her daughter, who is disabled,” she said. “It is very important that you can participate in that and find out, and the information you get can help with caring for your loved one or even yourself.”

Free services for older adults and family caregivers include caregiver respite, home delivered meals, in-home services and much more. For those disabled at all ages and their caretakers, free services include help accessing in-home and other long care services, help with receiving COVID-19 vaccines and caregivers also receive short-term respite.

“When you’re just at home and you have a question and you don’t know exactly who to call, you can call us at 1-800-272-3921,” Warner emphasized. “We can help you get the services that you need. We can help you contact the agencies that can provide caregiver, respite, home delivered meals and again, much more. So we have a great volunteer program. I was a volunteer for a very long time, and I enjoyed it. We know how our volunteers are an essential part of our mission and our vision. Here at the Area Agency on Aging, we serve 14 counties, and our efforts are enhanced by our volunteers. They really care, and they increase our reach, and they’re visible because they’re out in the community and they’re very efficient and highly trained.”

Watch out for scams

She also warned senior citizens and their loved ones about being a target for scammers.

“Seniors have a bullseye on their backs, and there are scams everywhere. And I think the more people we have out in the community to talk about this issue, the more we can save our seniors from financial ruin regarding some of the scams out there.” Warner said.

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The program is in need of more volunteers to help spread the word out and inform Medicare recipients of their rights and how to avoid abuse.

“Volunteers get to choose. You get to choose what suits you best, and the training is awesome. It gives an individual confidence. And you’re enhancing your skills that you’ve already learned in the workplace,” she said. “Second, which is communication and listening, which is so important, and relationship building, also understanding what you already have now. You have respect for the older community members and compassion and so compassion also for our disabled population. So you have that, and it’s really quite rewarding.”

Medicare plan, coverage and eligibility

“This information can save your life or the life of your loved one,” Warner said. “Preventive services may prevent or detect illness at an early stage, and this is very important when treatment is likely to work best, Medicare Part B covers preventive services like screening exams and yearly wellness visits, the lab tests and the immunizations to help prevent, find and manage medical problems. But again, you must have, of course, Medicare Part B for Medicare to cover those services.”

She stated those with original Medicare pay nothing for most preventive services if they get them again, the services are from a doctor or other provider who accepts an assignment.

An assignment is an agreement by the doctor to be paid directly by Medicare to accept the Medicare approved amount as full payment of the covered services, and not to bill you for any other services that Medicare takes care of.

“So that’s important, you won’t receive a bill if you take advantage of your preventive services, even if you have a Medicare Advantage plan. That also goes with that again, you must stay in network. And you’ll hear that term over again, you must stay in network if you have a Medicare Advantage plan. So another thing to think about, if your doctor performs other tests, additional tests or services during this time that aren’t covered under the preventive benefits,” Warner explained. “Always check with your provider to make sure the services related to your preventive service appointment are covered by Medicare. So remember, we’re watching our dollars. So we’ll go to the website and see what’s covered. The goal is to detect health problems early, determine the most effective treatments and prevent certain diseases.”

Preventive services include things such as labs, shots, exams and screens. They also include health monitoring and counseling and education to help one take care of their own health, to help a person to stay healthy and active.

For those that are new to Medicare, a Medicare preventive visit is provided and includes an initial preventive physical examination.

“It’s a great way to start to get up to date information on important screenings and vaccines and to review your medical history,” Warner said. “It is very important that you get the initial screening because it is only offered one time within the first 12 months of getting Medicare Part B.”

Warner said that during one’s preventive visit, a doctor or health care provider will perform services such as reviewing medical history, social history related to health, taking a blood pressure reading, checking height, weight and body mass index. They will also perform a simple vision test, review potential risk factors for depression, review functional ability and level of safety, which means an assessment of your hearing ability in order to perform activities of daily risk of living and home safety.

The brief is generally information about the patient’s health, tests results, a list of screenings and preventive services needed.

“You’ll get advice on how to help you prevent disease, improve your health and stay well,” Warner concluded. “And your doctor will give you, of course, a brief. It they don’t offer it; you should ask for the brief.”

Understanding Medicare is a series of articles about participants’ responsibilities, resources, benefits, etc. plus how to spot scams.

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