The enrollment period for Medicare began Oct. 15 and lasts until Dec. 7. But this year, there are fewer options for Medicare Advantage plans, requiring more work for many patients and healthcare providers during and after enrollment.

Major insurance carriers like Anthem and Martin’s Point have pulled out of Medicare Advantage in New Hampshire. Aetna has also pulled out of most counties in the state while some counties, like Coos, only have two options for seniors.

According to the New Hampshire Insurance Department, 77,000 seniors are affected by these Medicare Advantage changes.

At an information session this week at the Concord Public Library, Tim Harrigan, a state-licensed, private Medicare plan advisor, walked Medicare enrollees through the process of signing up for the program. Harrigan offers services to seniors for free, and is paid by most insurance carriers that serve Medicare Advantage plans.

One thing Harrigan teaches enrollees is how to navigate the many calls a person might receive once they’re eligible for Medicare, including from scammers.

“Medicare will never, ever call you ever, unless you reached out to them, and they’re getting back to you,” Harrigan told the group at Concord Public Library. “The Social Security Administration will never, ever call you unless you reached out to them, and they’re getting back to you with a response.”

Harrigan says it’s best for seniors to reach out to their local Social Security office, rather than using a 1-800 number from a third party, especially if they can’t confirm who they are speaking to.

A spokesperson for the New Hampshire Insurance department encouraged patients to call Medicare directly at 1-800-Medicare or contact ServiceLink, New Hampshire’s State Health Insurance Assistance Program (SHIP) for free counselors that can help them navigate enrollment.

During this current enrollment period, Harrigan said he’s been working everyday from 8 a.m. to 8 p.m. trying to get people enrolled. The biggest concern he’s seen so far is that seniors are losing their current plans starting next year. He worries that some might not be able to access some of the region’s top hospitals, as they have in the past.

“If you live in northern or western New Hampshire, there’s really only one option, and that’s an HMO plan where the local doctors are not in the network,” Harrigan said. “For example, Dartmouth-Hitchcock isn’t in the network with that company. So the only network facilities they’ll be able to access are in Concord,” which may be further for patients to travel.

At the information session, a number of people said they are losing their current Medicare Advantage plans, and must choose from limited options, or have had to change plans for multiple years in a row.

Jim Culhane, president and CEO of Lake Sunapee Region VNA & Hospice, said they are bracing for the impact Medicare Advantage changes will have on seniors who receive their services, and on their own operations.

“If you change insurance on January 1, and you were having services with us on December 30, and you’re having services that continue well after the first of the year, our job is to make that largely seamless,” Culhane said. “But that seamlessness takes a lot of work behind the scenes to ensure a person doesn’t have a break in care at the start of the new year.”

Culhane said that work requires “a lot of hours and a lot of people behind the scenes that are completing certain documentation, changing documentation, creating new schedules and so on.”

Culhane said navigating Medicare — whether people are choosing Part D supplemental insurance or enrolling in Medicare Advantage — can be complicated because insurance companies might offer one benefit at the cost of another.

“The devil’s in the details, and consumers rarely have the opportunity to explore what those details are, and frequently buy products that may or may not be ideal for them,” Culhane said.

After January 1, Culhane said Lake Sunapee Region VNA & Hospice may see patients who have new coverage that doesn’t cover their prior treatment plans, meaning providers may have to adapt those plans if patients can’t afford to pay out of pocket.

“Whereas one insurance may say, ‘yes, they can have eight physical therapy visits,’ another insurance will say, ‘no, we’re only going to approve four physical therapy visits,’ ” he said.

Culhane said coverage changes could reduce the availability of in-home support or other outpatient care, for example, which could reduce patient safety at home, and lead to rehospitalization.

“It’s a very expensive outcome when an individual goes back to the hospital and it’s certainly not what the patient would like,” Culhane said. “When we develop a plan of care and say an individual needs a certain number of nursing visits or physical therapy or occupational therapy visits in order to remain home, we do so under the philosophy of trying to prevent someone from needing to go back to the hospital.”

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