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Wesley Family Services: Helping People Understand Their Medicare and Other Health Insurance Benefits
By Daniel Casciato

As a 501(c)(3) organization, Wesley Family Services provides a diverse range of quality healthcare and therapeutic support services to more than 30,000 individuals throughout Western Pennsylvania annually. The organization operates more than 50 healthcare and therapeutic programs, has outpatient facilities in five counties, one elementary/middle school in Upper St. Clair Township and one high school in Whitehall Borough, 19 single-family homes for adults with intellectual and developmental disabilities, and provides educational support services to 50 school districts throughout the region.

“Our mission is to empower children, adults, and families by providing transformational care and meeting their individual needs throughout the lifespan,” says Jody Dickey, Allegheny County APPRISE Coordinator, Wesley Family Services.

One of the programs that Wesley Family Services manages in the region is the APPRISE program, Pennsylvania’s State Health Insurance Assistance Program (SHIP) which is overseen by the PA Department of Aging. There is an APPRISE program available for every county in PA. APPRISE is a free and confidential service that helps Medicare beneficiaries, their families or caregivers understand Medicare and other associated health insurance benefits so they can make informed decisions about their health care options.

“Certified counselors work with Medicare beneficiaries individually to determine their health care needs and preferences, compare health insurance options, screen for financial assistance programs, and assist in enrolling in Medicare and health coverage that fits their lifestyle and budget,” says Dickey. “In Allegheny County the APPRISE program is operated by Wesley Family Services in partnership with the Allegheny County Area Agency on Aging.”
 
Through the APPRISE program, the most common questions and concerns they tend to hear break down into four categories:

  1. An individual is new to Medicare and would like more information about Medicare, how Medicare coordinates with other coverage they may have, selecting Part D (prescription drug) coverage, and the pros and cons of delaying enrollment into Medicare.
  2. An individual needs help paying for Medicare or prescription drugs. APPRISE counselors can screen the individual for financial assistance programs they may be eligible for and help them apply.
  3. An individual has a service or coordination issue with their Medicare, Medicare Advantage plan or prescription coverage. APPRISE counselors can assist the person by helping to identify the problem, the most effective course of action, and can assist with that process (for example, filing an appeal) if appropriate. APPRISE counselors can also make referrals to other agencies for issues that lie outside our scope of expertise, for example SNAP benefits.
  4. During the Medicare Annual Open Enrollment Period of October 15th through December 7th APPRISE counselors help Medicare beneficiaries with plan changes and help them compare their existing health plan to the new health plans available for the upcoming year.

There is no fee for APPRISE counseling services, notes Dickey.

“As long as an individual resides in Allegheny County, we are able to schedule an appointment and help them with any Medicare related questions they may have,” she says. “Additionally, anyone wishing to support the Allegheny County APPRISE program may make a tax-deductible donation to Wesley Family Services.”
 
The APPRISE program is open to any individual who is soon to be eligible for Medicare, currently a Medicare beneficiary, and any family members, caregivers, etc. that are helping the Medicare beneficiary.
 
A consultation can be for a variety of reasons, but the most common is a consultation to select a health plan or compare a current health plan the individual has to what is becoming available. To maximize the safety of both beneficiaries and counselors, the Allegheny County APPRISE program is conducting counseling sessions by phone or video-conferencing at this time. To prepare for an appointment about selecting an insurance product, a person will need to bring their Medicare card if they have Medicare, any other insurance cards, a list of any medications they currently take to ensure the medications are covered, and a list of their providers and hospitals, to ensure their preferred providers are in-network.

“The counselor will discuss and compare the options and benefits between different health plan types so the Medicare beneficiary can make an informed decision based on their needs and budget,” says Dickey. “Every beneficiary is screened for financial assistance programs, and if they seem to qualify, the applications are completed during the appointment. The appointments take about an hour and the APPRISE program can provide a summary of all the plan information reviewed during the session by email or postal mail.”

For additional information on all of Wesley Family Services’ programs and services, visit www.wfspa.org. For details on the APPRISE program, call (412) 661-1438 or email AP-PRISE@wfspa.org.



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