ConfusedAs the Social Worker in the Out-patient clinics at UTMB I both look forward to and dread this time of the year.  Medicare Open Enrollment is a confusing and overwhelming time for seniors and their families.  Last year I assisted more than 120 patients review their Medicare enrollments.   I look forward to this time because our patients are able to get out of plans that do not work for them anymore.  I dread it because there are many uninformed people giving seniors advice that is not correct and sometimes the senior is stuck with the wrong plan until next year.

On October 15th Medicare Open Enrollment begins.  Any enrollment changes for 2014 must be completed by Midnight December 7th.  There is a lot of press regarding aspects of the Affordable Healthcare Act currently going into effect.  These aspects impact persons who do not have medical insurance up to age 65. Most seniors age 65 and older have Medicare.

Medicare recipients need to review their options during the Open Enrollment as new companies and plans are available depending on living location.  New drug plans are being offered.  For the next ten (10) weeks there will be numerous commercials regarding the “best” plans being marketed.  This can be a very confusing time and the number of options overwhelming.

Seniors can go on-line at and use a program to identify options available and estimated costs.  Medicare does not pay 100% of costs and many recipients have opted for Medicare Advantage Plans which cover the uncovered parts but still have co-pays.  When considering an Advantage Plan seniors need to verify that their doctors and medical care facilities are in the Plan’s network.  Out-of-Network co-pays and deductibles can be expensive.

At a minimum, seniors need to check that the drug plan they have is still the best one.  The drug plans change drugs in their formulary.  Medications are added and dropped, Tier levels change, and quantity limits or pre-approval requirements are changed.  The plan a spouse is in may not be the best one for the partner.  I helped a couple who were in the same plan and after review the wife was in the plan that best met her needs but the husband was able to save more than $500 over the year in a different plan.  Be aware of deductibles and monthly premiums, some seniors have difficulty affording the deductible the first of the year.

Participants not comfortable using a computer can call Medicare (1-800-Medicare) and receive assistance by phone.  When calling, seniors need to call in October or November as hold times in December may be very long. When they call  they need to have their Medicare card and prescriptions ready as the helper will need more than just the name of the drug.  Social Security offers assistance with cost of premiums and medications for low income seniors. Applications for this can be found  on-line or by contacting the local Social Security office.

These suggestions can help your patients to have less costly and more positive healthcare experiences.

Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room:

Our Guest Blogger is Adele Herzfeld, LMSW. She is the social worker in the UTMB Geriatric

Adele Herzfeld

Adele Herzfeld

Ambulatory Clinics.  She obtained her MSW at Stephen F Austin State University and has worked seniors in long-term care, home health, hospice and out-patient settings.  Ms. Herzfeld coordinates and assists with an educational seminar for Caregivers of persons with memory loss.  She is also an Alzheimer’s Association trained co-facilitator for the caregiver support group held at Libbie’s Place in Galveston.  Ms. Herzfeld participates in several community organizations that focus on the needs of seniors in the community.


LudditeThe United States is one of the few countries in the world that considers health care as a commodity and pays for it through the mechanism of insurance provided by private corporations. The rest of the world considers health care to be a public service. Why don’t we change?

Well, other than the inconvenient fact that our legislatures are filled with elected representatives who are supported by the very corporations that public service health care would disenfranchise, part of the reason lies in inertia.

Matthew Heineman, speaking to our rigid health care system, provides “a metaphor comparing our broken health care system with a forest fire that ignited in Mann Gulch, Mont., in 1949. Just as the health care system today lies perilously on the brink of combustion, this forest fire, which seemed harmless at first, was waiting to explode. A team of 15 smokejumpers parachuted in to contain the fire, but soon they were running for their lives to the top of a steep ridge. Their foreman, Wag Dodge, recognized that they would not make it.

With the fire barely 200 yards behind him, he came up with an ingenious solution. He took some matches out of his pocket, bent down and set fire to the grass directly in front of him. Soon after, he stepped into the middle of the newly burnt area, calling for his crew to join him. But nobody followed Wag Dodge. They ignored him, clinging to what they had been taught. The fire raged past Wag Dodge and overtook the crew, killing 13 men and burning 3,200 acres. Dodge survived, nearly unharmed.”

There is an even shorter metaphor from a Pete Seeger song from the 1960’s, Waist Deep in the Big Muddy (

One day, we will truly consider the options available for providing health care in the US. Until that day we will fritter away the years with marginal systems that are profitable for any number of entities but that really do little to increase the level of wellness and quality of life for the elderly or for anyone else really.

So, how can a real willingness to consider the options for health care that are embraced by almost everyone else be created in the minds of the people best able to effect change in the US health care system? What are the options? Who are these people? How do we get to them in an effective manner?

Join us for a real-time discussion about ideas raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room:


  1. Heineman, M. Do we want disease care or health care? Austin American Statesman, Thursday, April 4, 2013.
  2. List of countries by health insurance coverage.
  3. Universal health coverage by country.

Image Source: The Leader of the Luddites –