David Sayen, Medicare's regional administrator for California.
Related Story: Medicare Open Enrollment Now Through December 7
CAVANAUGH: We've talked a lot about the future of Medicare during this election season. But right now, San Diegans on Medicare have some choices to make. Of the open enrollment period begins this week. They can sign up for or switch their health and prescription drug plans. Joining me is my guest, David Sine, Medicare's regional administrator for California. Welcome.
SAYEN: Thanks for having me.
CAVANAUGH: How many San Diegans are on Medicare?
SAYEN: About 424,000, actually. Quite a big number.
CAVANAUGH: That is. I think most people who are not on Medicare think of the program as just one standard healthcare plan that you sign up for when you're 65. So what are the healthcare plans that can be added on or switched during open enrollment?
SAYEN: Well, there's two categories, people that are in the original program but are in one of our prescription drug programs. And this is a time you can switch prescription drug programs or join one. Then we have Medicare advantage plans which are private health plans that for the most part also include prescription drugs. You join one of those plans, and the government pays a premium for you. You may have some small premium to pay as well, and then they arrange for all your healthcare.
CAVANAUGH: Are you still on Medicare if you sign up for one of these auxiliary plans?
SAYEN: Well, if you sign up for one of the Medicare advantage plans, you're guaranteed to have all the same coverage that original Medicare covers. The difference is simply that they may have a smaller network of providers that's available to you. And they may sometimes offer additional benefits.
CAVANAUGH: What about someone who has original Medicare? During this open enrollment period, do they need to do anything?
SAYEN: If they don't have a prescription drug benefit and like their original Medicare, they won't really need to do anything. It's not really changing next year. But if you're in a drug plan or want to consider one of those Medicare advantage plan, this is the time you would look at that.
CAVANAUGH: Do most people on original Medicare supplement with the prescription drug program?
SAYEN: Well, about -- a bit over 90% of the people with Medicare have prescription drug coverage. Not all of them have it with us. But we're trying to get to those other 10% of people because they're missing a great opportunity, particularly for a person that's older or has a disability. It's a bargain to buy this plan since the government is subsidizing it for you.
CAVANAUGH: If you are on a program that has more than just original Medicare, what would be the reason to go over it at this time of year?
SAYEN: Well, there's a couple of reasons, the first is that people's health changes; you may have different needs. And the coverage of the plans changes a bit from year to year. They may change the doctors in the plan, raise their premium, and on the prescription drug side, maybe they don't cover a drug that you need that you weren't using last year, and our website would help a person figure out if they have an opportunity to save or get more convenient care by switching.
CAVANAUGH: How does someone go about finding out if there have been these little changes to the plans that they were already on or they could get a better deal with opting for another plan?
SAYEN: Well, the best way, if you have access to a computer is to use our Medicare.gov website. That's what we call our plan-finder. You can go in
With your Zip Code, it'll tell you all the plans that are available in the geography where you live, and they'll compare the plans for you based on premium, deductibles, and copayments. And we rank these plans so you can see which plans have higher overall quality in customer satisfaction.
CAVANAUGH: What do you rank them on?
SAYEN: From objective measure, quality measures that they report to us, like the rates of immunizations, the rates of people getting their flu shots, the kind of preventive services they do, and then we do customer surveys of our beneficiaries, when you went to the pharmacy, did they know who you were? Were they helpful? That kind of thing.
CAVANAUGH: You were saying the best way is to go online. What if you don't have access to a computer? How can you get any help reviewing these plans to see whether or not you should switch or you should get an additional healthcare plan?
SAYEN: Well, we have a wonderful program with voluntary advisors. We call it health insurance council advocacy. They're trained who can help you enroll in a new plan if you'd like to, and their counselling is actually free.
CAVANAUGH: And is this on the phone?
SAYEN: They can do it on the phone or in person. And to find them, they're at 1 eight hundred 6334 two two seven. That's 1-800-Medicare. And our operators, 24 hours a day, are also equipped to go through the choices with you. A lot of people like to sit down with somebody. And during this time of year, the counselors go around to different local facilities like libraries and senior centers and have hours where you can work with them.
CAVANAUGH: Oh, okay! So there's also face-to-face counseling in San Diego.
CAVANAUGH: Do the counselors try to sell you anything?
SAYEN: They're not allowed to sell you anything. They're volunteers who are working for a nonprofit agency that we in the State of California fund just for this purpose.
CAVANAUGH: I'm wondering, why does Medicare work so closely with the private insurers who are offering these supplementals to seniors? Are their big gaps in Medicare coverage that you don't -- that you have to fill with an add-on plan?
SAYEN: I think there's often some confusion between Medicare advantage and that's called meddy-gap. When you think of an add on, that's meddy-gap. People who saoriginal care who want to buy things that Medicare doesn't cover. On the other hand, the Medicare advantage enrollment is you're switching into a comprehensive plan that does everything for you, and you don't need a supplemental policy.
CAVANAUGH: I see. Okay. So I guess for the first one you're talking about that has to do with the gap, if you have a specialized health problem?
SAYEN: I wouldn't say so much. Because Medicare doesn't care about your specialized health problems. But everybody faces the hospital deductible, coinsurance, and so forth. So this lowers that for you.
CAVANAUGH: I see what you're saying. What about low-income senior who is have trouble paying their premiums for any kind of a health program or an add-on?
SAYEN: Well, for the prescription drug program, the law provides for something called extra help. It's administered by the folks at Social Security, but 1-800-Medicare can connect you to that. And for regular Medicare, the state in some cases can help people with the premiums for Medicare based upon income.
CAVANAUGH: I just want to let our listeners know that we are -- we have on our website all of the numbers and the information that you're giving out to our listeners here, KPBS.org. What kind of feedback, David, do you get from people on Medicare about the program in general? Are they pleased overall?
SAYEN: People -- beneficiaries are overwhelmingly satisfied with Medicare generally. And the providers of service like working with Medicare because the payment is dependable and predictable. If you're in original Medicare, if you need a service, you just get it, and we take care of the rest.
CAVANAUGH: Now, when does open enrollment season end?
SAYEN: Well, are that's very important. This year, the season is longer but it starts sooner and ends earlier. So it's open now and ends on December 7th. And that way we've got three weeks to get everything loaded into the computer for somebody that needs a service on January 1st.
CAVANAUGH: And I'm sorry if I was distracted before. I did want our listeners to know that we have all the numbers and information that you're giving out about where people can go to contact the Medicare support if they want to change or add onto their program on our website at KPBS.org.