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How Floridians can unwind Medicaid and untangle Medicare

Stethoscope on a layer of US currency.
A stethoscope on layer of US currency.

Florida Matters looks at how to navigate open enrollment for Medicare. And we explore what Medicaid 'unwinding' means for hundreds of thousands of Floridians.

It’s open enrollment for Medicare. For people who are eligible for the federal health insurance program, picking a plan and making sure it’s affordable can be a challenge, especially paying for medication when you’re on a fixed income.

On this episode, we sit down with a volunteer who’s spent the last six years guiding people through the process of signing up for Medicare.

And we explore how Medicaid unwinding has dropped hundreds of thousands of Floridians from their health insurance.

When the COVID-19 pandemic began, the federal government told states to stop determining eligibility for Medicaid, the program which provides medical and other health related services to low-income people.

It was one of several steps taken to help Americans at a time when they were struggling with the uncertainty of health concerns, job losses and other challenges brought on by the pandemic.

But when the COVID-19 emergency officially ended this spring, states went back to removing people they deemed ineligible from Medicaid rolls.

Stephanie Colombini has been reporting on Medicaid unwinding for Health News Florida.

Medicaid rolls ballooned after the start of the pandemic, Colombini tells Florida Matters, going from 3.8 million beneficiaries in January 2020 to 5.8 million people enrolled in Medicaid by April this year. That was when Florida and other states had to start redetermining eligibility for the first time in three years.

"So we've seen this process unfold the last six, seven, eight months, and over 600,000 people have lost coverage so far as the state is determining who is and isn't eligible," Colombini said.

"The problem is, are all of those people, those 600,000, actually ineligible? And that's where some concerns arise."

Some of the reasons people are losing their coverage are procedural, including things like not responding to mail, or filling out forms incorrectly. Advocates worry that some of the most vulnerable Floridians, including young people under the age of 20, may be losing access to needed health care.

A woman with red hair, a colorful shirt and glasses, smiles as she sits in front of a microphone in a recording studio
Matthew Peddie
Fran Oberne has been volunteering for SHINE for six years, helping Medicare beneficiaries enroll in the federal health insurance program.

Fran Oberne is a volunteer for SHINE, which stands for Serving Health Insurance Needs of Elders. That is a program offered by the Florida Department of Elder Affairs, which provides health insurance information for Medicare beneficiaries.

Medicare primarily covers people 65 and older, along with certain younger people with disabilities.

But navigating the program, which includes part A, part B, part D and Medicare advantage, can be confusing. Despite the barrage of TV ads for Medicare advantage, Oberne says people need to be careful when they sign up for a plan.

"If you're watching TV, and they say free, free, free, it ain't free," Oberne said.

"Nobody gives you money for nothing. If they're giving it to you with one hand, they're taking it in another place with the other hand."

If someone wants to sign up for Medicare Advantage, a volunteer like Oberne can help them decide which plan best suits them.

"In Hillsborough County alone, there are 63 Medicare Advantage plans. I am not going to go through 63 plans for every person that I help," Oberne said. "But we narrow down the focus based on questions we ask you, like the doctors that you already see, the prescriptions you already get."

Oberne says one difference for Medicare recipients next year is the cost. The monthly premium for Medicare part B is going from $164.90 to $174.70.

Some of the most common questions Oberne receives are about the cost of medications. Calls start to come in late summer and fall as people fall into the "doughnut hole" or coverage gap, which means they have reached a certain threshold of payments, they pay a higher price for medication. For brand name drugs like Eliquis or Xarelto, which are used to treat blood clots, that can leave patients thousands of dollars out of pocket.

"It's interesting, because many experienced Americans are not used to saying to their doctor, 'What else can I get instead of this?' People don't question the doctor. And really, you have to be an advocate for your own health," Oberne said.

Open enrollment for Medicare runs until Dec. 7.

"During open enrollment, it's pretty darn busy. That's our Super Bowl, only it's a six-week long process," Oberne said. "I do think that it's super important that every single person on Medicare do a health care check once a year, because your financial situation changes, your health changes, your meds or doctors change."

"You annually look at your car insurance and you annually look at your homeowner's. Wouldn't your health be just as important?"

Find more information about Medicare counseling available through SHINE by going to the website or calling 1-800-963-5337.

I am the host of WUSF’s weekly public affairs show Florida Matters, where I get to indulge my curiosity in people and explore the endlessly fascinating stories that connect this community.
Steve Newborn is a WUSF reporter and producer at WUSF covering environmental issues and politics in the Tampa Bay area.