OIC Answers Episode 2 transcript
Aaron VanTuyl
Welcome to the second episode of OIC Answers, a podcast from the Washington State Office of the Insurance Commissioner. I'm your host, Aaron VanTuyl, communications manager with the OIC’s Public Affairs Office. And with me, as always, is my co-host, Matt Baide, who is also with our public affairs office. Matt, how are things?
Matt Baide
Things are good. feels like we just did this. It's great to be back.
Aaron VanTuyl
That's the magic of podcasting. On this podcast, we will go on some of our favorite colleagues from the OIC and ask them questions about what they do or their particular area of expertise and use that to provide useful info about some aspect of insurance. Our agency protects consumers and regulates the industry, which ranges from setting rules for insurers and taking legal action against companies that don't follow the rules, to approving rate changes, to answering questions and working on behalf of people who are having problems with an insurance company. A big part of our work on behalf of consumers comes through the statewide Health Insurance Benefits Advisors, which is a mouthful, so we'll be calling it SHIBA from here on out. And SHIBA is celebrating 45 years this year. And our guest, once again, is Tim Smolen, the SHIBA program manager. Tim, welcome back.
Tim Smolen
Thank you. Good to be here.
Aaron VanTuyl
So we are discussing SHIBA on this episode. We have previously covered everything you need to know about Medicare. Well, maybe not everything.
Tim Smolen
Nothing left to say there.
Aaron VanTuyl
No, nothing at all. All the questions have been answered. So regarding SHIBA, can you give us a just kind of a high level view of what the program is and what it does?
Tim Smolen
Sure. Happy to. And Matt, thanks for being here again. So, SHIBA. As you said, it's a bit of a mouthful. We call our program Statewide Health Insurance Benefits Advisors. There are 54 programs in the states and territories that are recognized as senior health insurance assistance programs or programs. And so you could find us, for instance, in the back of your Medicare and you handbook as a trusted outlet for unbiased, confidential help in your community.
Aaron VanTuyl
Okay. how long have you been working with SHIBA?
Tim Smolen
Well, that's a funny story. I've been, three years as the program manager, but I started my career in state government 20 years ago, working, as a person that trained SHIBA volunteers. So it's lovely to be back again.
Aaron VanTuyl
Okay. And tell us a little bit about the volunteers. How many do you have in the program?
Tim Smolen
Well, we need more. We don't have enough. And it's, it's a challenging, program in the way that most people become volunteers around the time that they become, eligible for Medicare at age 65. And so, as you can imagine, there's a bit of a shelf life for SHIBA volunteer. So right now, we have about 250 volunteers working locally in the community, and we're always looking for more people to come and join us.
Aaron VanTuyl
And, what are the volunteers like? What gets them to what gets them in the door and what keeps them there?
Tim Smolen
Yeah. So, you know, not to, not to reduce it to kind of profiling or stereotypes, but, you know, it's people that like solving puzzles. They like being continuous learners. They like helping people. We get a lot of people who came to it because they had a pretty miserable experience on their own getting started in Medicare, and they don't want to have somebody else have that, kind of going through the Whitewater experience.
Aaron VanTuyl
Okay. And tell me a little bit about the just the volume of work the SHIBA program does. How many calls do you guys get on average? I don't know how you'd break that down. Like per year, per day or like what? Give us some idea of what kind of work we're talking about.
Tim Smolen
Yeah, well, you know, there's a study aspect of it, right? In the way that people are turning 65 every day or moving here to Washington state or moving around the state. It's a lot of the transitions that happen in people's lives where they become eligible for Medicaid coverage or lose Medicaid coverage or get moved off the health benefits exchange.
Tim Smolen
So, you know, there's always that across the year. you know, work as people have these life transitions, but we absolutely have a surge of work around the Medicare open enrollment period in the fall, that seven weeks between October 15th and December 7th, we do about half of our volume of work there. So all in across the year, we do 20 or 30,000 incoming phone calls.
Aaron VanTuyl
Okay. Do you get repeat callers or are older issue solved with just one, one phone call?
Tim Smolen
Lots of repeat callers, in two ways. So we're going to get the repeat callers because one appointment is not enough to solve the complexity of the problems that you have. And we also have repeat callers in the way that they had such a good experience a year or two ago that they call back. And oftentimes they're asking for the same volunteer by name, or they're just reaching out to that volunteer directly. That helped them two years ago, and that was great. And they retained his number. And they just call him back directly because they want to be reassured about the next changes.
Aaron VanTuyl
So what does this SHIBA call look like? Do you just call the number and somebody automatically picks up and is ready to answer questions? Or do you kind of go through maybe not a screening process but get kind of filtered to people near you?
Tim Smolen
Yeah, that's the idea. The program started, 45 years ago, and in fact, it was initiated by a small group of volunteers up in, Skagit County, and the Insurance Commissioner's office adopted them. So we were the first in the nation, SHIP program. And, the idea still is that it wants to be local people helping local people, sort of neighbor to neighbor counseling. So if you call the (800) 562-6900 number, we're going to ask where you're calling from. You're going to say, you know, I'm calling from Edmonds and we're going to say, that's great. We've got a dynamic group of volunteers that work out of the Edmonds Senior Center. And, we'll take some basic information from you. Your phone number, email, if you like that. And we'll schedule an appointment for you. Typically, we'll see you in a couple of days. we can do that on the phone. We can do zoom. We can do, in-person visitation.
Aaron VanTuyl
Okay. And these volunteers, how, how knowledgeable are they about Medicare? And what kind of advice can they give?
Tim Smolen
Yeah, well, they're excellent. And, and that's a common concern that people have if is, if they say, like, they're just volunteers, you know, how knowledgeable, can they be? But they take a lot of pride in being great at it. They are great at it. We provide extensive training for them. And then there's also peer to peer mentoring that happens. So it takes 6 to 12 months for a person, starting out to become pretty proficient and, and work independently. But they're highly trained and highly competent.
Aaron VanTuyl
And, what, you just mentioned the program. It started in Skagit County, about 45 years ago. What, how much is it changed or grown since then?
Tim Smolen
Yeah. Well, I mean, it's changed a lot. You know, the Medicare program has changed a lot across that time. I would say, the complexity of the cases absolutely has been the biggest change. You know, we're helping more people now that are leading more marginal lives. You know, unfortunately, you know, the, the Medicare program started as part of Lyndon Johnson's Great Society programs, and it wasn't really intended to, you know, help more people who are older avoid poverty.
Tim Smolen
But we've seen that trend really regressed now. So more and more seniors are, you know, living in poverty and more and more of them are our clients. So we're serving a lot of the people through volunteerism that aren't well served by agents or brokers or their own HR departments. As you know, companies cut back on retiree benefits. And more and more people are qualifying for public assistance. So, the complexity of the cases has really, probably changed dramatically. So it's both a challenge and an opportunity in that way.
Aaron VanTuyl
What, one thing I was wondering who is making the calls. Do you often get calls of people calling on behalf of an older family member, or is it usually the Medicare recipient themselves making the call?
Tim Smolen
Yeah, that's a great question. Both of those happen routinely. you know, there are lots of, multigenerational households now, right? A lot of younger people are moving their parents in with them or moving in with their parents.
Aaron VanTuyl
Don't let my parents hear that.
Tim Smolen
And some of it is just the complexity, right? people are reaching out to their kids for, a second opinion, or it's, advocates. So we're getting a lot of transfers from other social service agencies or health agencies. You may have started out at your local area Agency on Aging because you're connected to the family caregiver support program. And they're making a handoff, to us, but they want to continue to stay involved.
Aaron VanTuyl
Okay. Has there been any change in the types of calls over the years? Is there anything more recently that's been a bigger issue?
Tim Smolen
Yeah, for sure. I mean, what we what we see right now, and of course this relates to my earlier observation about the Medicare open enrollment period is right now, you know, nationwide, about half of folks are enrolled in Medicare Advantage plans compared to original Medicare. And that has just been kind of galloping forward. And, you know, especially in the past few years, there's just been very aggressive marketing. So you will have seen John Smith on TV or Jimmy Walker on TV, you know, hawking these Medicare Advantage plans. people are rightly skeptical about that. and the promises of extra benefits, through Medicare Advantage plans, especially for low-income people. So you'll hear about, rental assistance or, food benefit. And so it, you know, the calls are definitely tilting towards, Medicare Advantage plans. And, you know, how much can I rely on these promises? And, is this behavior in terms of marketing unethical?
Aaron VanTuyl
What have I not asked that you would like to talk about? As far as the SHIBA program goes, I'm sure I haven't covered everything.
Tim Smolen
Yeah, well, it's a great interview, and thank you. You know, I guess the main thing, you know, back to your question about the changes in the program. Of course, the Medicare program, has changed substantially in 45 years. We had the advent of managed care programs and then Medicare Part D, the prescription drug benefit. Medicare has improved quite a lot in terms of preventive care benefits. And so, you know, educating people about those opportunities for things like vaccinations and, wellness care. But the other significant change beyond the changes in the Medicare program is just the changes in technology. And so, you know, this is, both a blessing and a curse, right? We have more people who are more comfortable with technology, but we've also created a bit of a digital divide where, you know, you got kind of haves and have nots. So, definitely the volunteers, nowadays are more proficient and comfortable with technology, and a lot of the systems really require that. It's, you know, it's not a practical reality to walk into your Social Security office and get an appointment. You're going to do that online these days.
Aaron VanTuyl
Okay. Do you have any questions, Matt?
Matt Baide
Are in-person services available in every county and are they close by, if they're not like Garfield or Ferry counties?
Tim Smolen
Yeah. So that's a great question. So outreach and assistance in rural areas is a is a big challenge for us. And it's a big part of our push towards equity. You know, on a per person or a, you know, a case cost basis, it's more expensive to, kind of stand up that same local presence. But we're very committed to that. So partly that's us working directly, Matt. And some of that is us just doing a better job of finding good local partners and kind of training them up. So, you know, you mentioned like, you know, for work out in Dayton and, you know, in places like that or up in, Ferry County, up in Colville. Then it's working with our friends at Rural Resources or down in, you know, the southeast Washington, the Washington, Idaho Volunteer Center. So trying as much as we can continue to recruit volunteers in those places, but where we can't kind of, fostering some partnerships.
Matt Baide
And you mentioned 50% is during that Medicare open enrollment period when there's that Medicare open enrollment, is it just kind of sparse calls and still kind of doing the same thing, or is it a little bit different when that's not Medicare open enrollment time?
Tim Smolen
Yeah, it's not as busy for sure. Right. And so, a lot of that, sort of downtime is where we're really looking at ways to improve for the next year, right. Where you got that kind of like wash, rinse, repeat cycle. So we're trying to always get better. You know, we're, you know, six months away from next open enrollment are talking about how we get better, learning from our past experiences. And there is still just a steady flow of work, because, as I said, those people that are aging in, or other transitions. So, there's never a shortage of work.
Matt Baide
Is there anything planned for the 45-year anniversary?
Aaron VanTuyl
Is there like, what are we…
Tim Smolen
Yeah, we, yeah, it's like a wedding, you know, we put away, we put away a piece of cake from year 1, and we're going to bring it out again for year 45. And, you know, sort of a cake time capsule. You know, we have a terrific communications consultant, Donna Wells, who works in the public affairs office, and she's working on a series of, local programs to promote the 45th. So please watch for us on social media and the OIC website. And if you have a chance to come out and meet with a volunteer, you'll probably see our branding on that as well.
Aaron VanTuyl
A couple quick questions to wrap things up. How could I reach out to SHIBA if I was so inclined?
Tim Smolen
Yeah. So, you know, most of the work to us comes through the 1-800-562-6900 number. But back to our observation about technology. Lots of people are going to find us that insurance.wa.gov. And you can type in Medicare or SHIBA there. or we have a list of our local partner agencies as, as Matt referred. You can look us up on the web and then find if, if we don't have a local, SHIBA volunteer will refer you to a local partner agency and, do that through the website.
Aaron VanTuyl
Okay, and then how would I go about volunteering?
Tim Smolen
Yeah. So being a volunteer is, pretty straightforward. You're going to reach out to us either through the web or the phone, and we're going to connect you to a volunteer application and a volunteer coordinator in your local area. We work with 16, around the state, 16 different not for profit, organizations. These are senior centers, community action councils, area agencies on aging. And, we'll get you connected to, dynamic volunteer coordinator who help you out.
Aaron VanTuyl
All right. Tim, thank you so much for joining us.
Tim Smolen
My pleasure. Thanks, Aaron. Thank you. Matt. Thank you.
Aaron VanTuyl
This has been OIC answers. You can follow the OIC on social media. We've got Twitter, Facebook, Instagram and Threads accounts and of course visit insurance.wa.gov to learn more about our work.