Ezratty: SHIP counselor gives Medicare answers for Sun Cities residents

Question One: Mrs. G was in tears a few weeks ago when she called me saying, “I hope you can help me.” Mrs. G has a Medigap plan and has been pleased with it for years. However, several months ago she called 911 for a “medical emergency.” She received wonderful care from the medics but felt it would be best to have the ambulance take her to the hospital to be checked out. With the speed of light, Mrs. G was on her way to the hospital, which happened to be the one closest in proximity to her home. The other day she received a bill from the city she lives in for the outstanding amount of more than $2,000. Immediately, she called her insurance carrier, telling them there must have been a mistake. But it was not a mistake.

Answer One: The answer to the ambulance coverage may affect everyone on Medicare, whether enrolled in a Medigap or a Medicare Advantage plan. Medicare’s 2021 guidelines state Medicare will cover an ambulance for medically necessary services to the closest appropriate hospital and if transportation in any other vehicle could endanger the patient’s health. At the close of the trip, the ambulance provider submits an invoice to both Medicare and the secondary insurance carrier. If Medicare denies the request for payment, the secondary insurance, either Medigap or MAPD, is unable to pay. If you find yourself in this situation, and you think you were eligible for ambulance services and it was denied, file an appeal.

This is a reminder; If the medics took care of the medical issue and you are no longer in critical condition, do not use the ambulance service unless you are able to pay for it. Call 623-866-4214 for Medicare assistance. SHIP counseling services are always free.

Question Two: During the open enrollment season, I usually go to a community center and visit with the SHIP counselor. Due to the centers still being closed due to COVID-19 guidelines, how can I get answers to my questions about 2021 Advantage plans and about the financial thresholds for the plans? I also need to speak to someone about financial assistance for my prescription and Medicare Part B assistance.

Answer Two: Normally, I am available at the Peoria Community Center, Banner Olive Branch Senior Center and the city of Surprise Resource Center. At present, we are following health guidelines and not making face-to-face visits. I still will assist you in a different scenario — a telephonic visit. Please call me with your questions at 623-866-4214.

Editor’s Note: Roberta Ezratty is a certified State Health Insurance Assistance counselor. She will answer Medicare questions throughout the open enrollment period through Monday, Dec. 7.