Pathlights’ SHIP Counseling Helps Older Adults Make Sense of Medicare Part D Plans

Palos Heights - Medicare’s Annual Part D Enrollment Period begins today, October 15. According to a new survey, 75% of beneficiaries say that choosing a plan is confusing, and trying to decide which plan will work best for each individual is so frustrating that only 51% of people will review their options this year.

Christine Suddreth says, “People truly aren’t aware of what Medicare actually covers, which parts cover which services, and how Original Medicare – Parts A and B, Medicare Part C – also known as Medicare Advantage, Medicare Part D medication plans and Medigap plans differ. They are also not aware that Medicare C and D plan coverages change annually, so the plan you picked last year may not be the best plan for you in 2026.”

Suddreth is a Certified Senior Health Insurance Program (SHIP) counselor with Pathlights in Palos Heights. The organization, celebrating its 50th anniversary this year, provides services, supports and resources for older adults in Bremen, Lemont, Orland, Palos, Rich and Worth townships.

“I think people feel like once they get Medicare D, they can just let it ride,” says Suddreth. “They’ll say, “I’m happy with my plan and I was told to never get rid of it.” It’s okay if you’ve had a plan for years, but come to a seminar or talk to a SHIP counselor or private broker anyway, because plans are re-negotiated every year.”

Over 6 in 10 people who are enrolled in Medicare believe that the coverage is “generally the same” among Medicare Part D plans. Suddreth says that’s absolutely not the case. She explains that, for instance, a plan originally selected to cover a particular medication with just a $10 copay may have been re-negotiated and that drug will now cost the beneficiary more than $500. She adds that coverage can get so specific in each plan that a medication may be covered in tablet form, but not as a capsule.

“Although there is a cap of $2,001 maximum co-pay, if a medication is not in a plan’s formulary – meaning the acceptable drug list for that plan – it doesn’t count towards that cap; it doesn’t count towards your deductible. It’s as though you are buying it with no insurance at all.”

Suddreth points to a recent beneficiary who hadn’t checked or changed their drug plan in years. When they finally participated in Pathlights’ screening process, they saved over $7,000 by changing plans.

“Sometimes, it can be a matter of changing pharmacies. Your drug costs can be different at a pharmacy with a drive-thru, at a walk-in pharmacy, or through a mail order pharmacy. But if using a drive-thru makes more sense for your mobility needs, or if you live in a building with a public mail area, the plan with the lowest cost may not be your preferred choice. When you have the information, you can decide whether changing plans, pharmacies or delivery methods is worth it to you.”

Suddreth also encourages people who haven’t been to their doctor recently to make an appointment and go. “It’s very important that by November you know your medications for 2026. If your doctor is going to change something, you want them to do that before you complete your open enrollment screening.”

That’s another important thing Suddreth likes to point out. “A lot of people think that once they sign up for a new plan, they are locked in for the year. If, for example, you selected a plan on October 20, but on November 1, you have a health incident, or are admitted to the hospital and your healthcare providers change your drugs, as long as it’s before December 7th, you can choose a different plan for the upcoming year.”

“During the year, however, unless they qualify for a special enrollment period, you are not allowed to change plans. Once you’re in a plan after December 7th, you’re in that plan for the year.

Many people who attend the Making Sense of Medicare seminars are still working or have not yet enrolled in Medicare. The presentation provides an overview of Medicare and explains the purpose of each part. Suddreth also explains the initial enrollment period and penalties that may apply to those who enroll late.

“A lot of people retire at 65 and they're not on any type of medication at the time, so they decide not to pay the premium for Plan D. However, when they do need coverage, they will pay a lifelong penalty. It will increase their premium for life, depending on how long they waited to get into Medicare D.”

When attending any Medicare informational event, participants should not bring any medical, prescription or personal information. Suddreth brings screening forms to the Are You Ready for Medicare D Open Enrollment? seminars. “I go over the process and then I send forms home with participants so they can sit at their kitchen table and fill it out. They can get their complete prescription drug list from the pharmacist and then move forward to selecting a plan.”

When participants submit screening forms to Pathlights, SHIP counselors provide the guidance requested, make sure participants thoroughly understand what each plan pays for, and why one plan might be more advantageous than another, but in the end, the Medicare recipient makes all the decisions. “It is the person’s choice always,” stresses Suddreth.

Whether participants make an appointment with a Pathlights’ SHIP counselor or a private broker to complete the review and screening and consider their options, Suddreth says, “It’s important to work with someone who is unbiased and provides guidance without pushing you into a particular plan or company.”

Making Sense of Medicare will be held on Thursday, October 16 at 6:30 pm and Are You Ready for Medicare D Open Enrollment? will be held on Thursday, October 23 at 6:30 pm, both at the Oak Lawn Public Library. Registration is required and can be made by calling 708-422-4990. Are You Ready for Medicare D Open Enrollment? will be also be held at the Chicago Ridge Public Library on Thursday, October 23 at 10:00 am. To register for this event, please call 708-423-7753.

Medicare Open Enrollment begins October 15 and closes December 7. For more information about Pathlights’ SHIP counseling and other services, call 708-361-0219 or visit pathlights.org.

Suddreth has been leading Medicare informational seminars for nearly 5 years now, but still loves seeing “Ah ha” moments in participants. “I really like to see when a younger caregiver - there with a parent, or an aunt or uncle, or even an older sibling – understands how to make sure that the older adult gets the care they need and that they’re going to qualify for everything because they are in the correct program.”

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