County aging office: Medicare counseling demand surges; staff warn program at capacity

Erica Wyman, director of the Cayuga County Office for the Aging, told the Legislature that the county’s Medicare counseling program (ICAP) is seeing a marked increase in demand and complexity and that staffing and training needs are straining the office.

Wyman said the program offers three core services: monthly group “Medicare 101” classes, confidential one-on-one counseling and an annual enrollment assistance period from October through December. Nicole Sadoras, the county’s ICAP coordinator, demonstrated how counselors use a folder of client information, drug lists and the Medicare.gov tools to compare dozens of plans and to screen for savings programs.

Why it matters: County staff said decisions by Medicare Advantage and Part D plans change annually, so many Medicare-eligible residents rely on free, local counseling to pick coverage they can afford and that will cover their prescriptions. Counselors also screen low-income residents for Medicare Savings Programs and other benefit programs that can reduce premiums and drug prices.

Wyman and Sadoras described the program’s process and limits. The group class introduces basic choices; individuals then schedule private appointments where staff enter medication lists and income to screen for savings and to find the most cost-effective plan. Sadoras said the number of available Medicare Advantage and Part D plans has grown (she cited about 26 plans currently on a two-sided worksheet for the county) and that pharmacy pricing differences and prior-authorization rules can make plan comparisons time-consuming.

Sadoras gave a specific example from an enrollment appointment: a client’s prescribed medication (Victoza, discussed by name in the presentation) was not covered by many plans and would have resulted in thousands of dollars of out-of-pocket costs for the year until staff worked through prior authorizations or alternative therapies with that client’s provider. ‘‘Sometimes that initial comparison shows a medication will be $10,000 or $12,000 for the year,’’ Sadoras said; she explained counselors then work with providers on prior authorizations or check for lower-cost equivalents and pharmacy price differentials to reduce costs.

Staffing and training constraints: Wyman said ICAP counseling requires substantial training (she noted the state coordinator training requirement) and that the county currently has one full-time staff member primarily assigned to ICAP, plus part-time support. She said the county referenced grant funding for some services (WIC was described elsewhere in the meeting as fully grant-funded) and that ICAP counseling itself is supported by the county’s Office for the Aging in coordination with the New York State Office for the Aging.

Discussion and next steps: Legislators asked questions about where demand was rising and how the county screens for savings programs; Wyman said the office routinely refers callers outside the county to the state when internal capacity is exceeded, which is not ideal because some plans are locally specific. Wyman said staff would return to the Legislature with options for handling the continuing increase in demand, including potential staffing, volunteer training barriers and funding scenarios.

Ending: County staff said the ICAP service remains free to residents and is increasingly relied on to prevent large prescription or premium costs for Medicare beneficiaries; the office will report back with concrete staffing or program recommendations.