PA MEDI Medicare Counseling (Formerly APPRISE) in Pennsylvania

If someone told you to "call APPRISE" about a Medicare question, the Pennsylvania program you want is now called PA MEDI, and it's free.1 PA MEDI Medicare counseling is Pennsylvania's State Health Insurance Assistance Program (SHIP), a statewide service run by the Pennsylvania Department of Aging whose counseling is free, confidential, and delivered by certified counselors through Pennsylvania's 52 local Area Agencies on Aging.2

In This Guide

• What Is PA MEDI Medicare Counseling, and What Happened to APPRISE?
• What Can a PA MEDI Medicare Counselor Help You With?
• Can PA MEDI Help You Pay for Medicare?
• Can PA MEDI Help With an Appeal, a Bill, or a Plan You Regret?
• How Do You Reach PA MEDI in Your County?
• What Will PA MEDI Not Do?
• Who Are PA MEDI Counselors?
• What If You Have Both Medicare and Medicaid?
• Frequently Asked Questions
• Learn More

What Is PA MEDI Medicare Counseling, and What Happened to APPRISE?

APPRISE is the old name for PA MEDI, Pennsylvania's free Medicare counseling program. Cumberland County, Pennsylvania titles its Medicare counseling page "PA MEDI / Medicare Counseling (Formerly APPRISE)," and a public comment recorded in the Pennsylvania Department of Human Services' (DHS) Community HealthChoices (CHC) waiver application notes that APPRISE was renamed PA MEDI.1 So if a doctor's office, a pharmacist, or an old brochure sends you to APPRISE, PA MEDI is where that advice now leads.

PA MEDI stands for Pennsylvania Medicare Education and Decision Insight. Cumberland County describes PA MEDI as the State Health Insurance Assistance Program (SHIP) for all Medicare beneficiaries in Pennsylvania, created by the Pennsylvania Department of Aging to help Pennsylvanians understand their Medicare and related health insurance benefits and make sound decisions about what is best for them.1 The Centers for Medicare & Medicaid Services (CMS) contacts directory lists PA MEDI as the SHIP for Pennsylvania, with the toll-free number (800) 783-7067.3

The program itself is not new. The Pennsylvania Department of Aging says PA MEDI is part of the nationwide network of State Health Insurance Assistance Programs, and that Pennsylvania's SHIP has provided Medicare assistance and information to Medicare-eligible individuals since 1995.2 You can read how SHIPs work across the country in our guide to free Medicare counseling through your SHIP, and how local Area Agencies on Aging fit into senior services more broadly.

PA MEDI isn't only for the person on Medicare. PA MEDI provides objective help and information for those on Medicare, their families, and caregivers, so an adult child helping a parent is part of the audience PA MEDI serves.2 For a wider view of Pennsylvania's Medicare choices before you call, see our Pennsylvania Medicare plans and coverage guide.

What Can a PA MEDI Medicare Counselor Help You With?

The Pennsylvania Department of Aging lists ten subjects that PA MEDI gives free, unbiased, personalized help with.2 Those subjects are:

• Original Medicare
• Medigap (Medicare supplement)
• Medicare Advantage plans
• Prescription drug plans
• Enrollment assistance
• Medicare rules, notices, and billing concerns
• Medicare financial assistance programs
• Medicare appeals
• Long-term care insurance
• Coordination of benefits

Comparing plans is often the reason people call. PA MEDI can help you compare Part C, Part D, and Medigap plan costs in your local area, and can also help you sign up for Medicare and explore your options.2 If you're weighing a Medigap policy, our Pennsylvania Medicare Supplement guide explains the state's enrollment rules.

How the help is delivered matters too. For SHIPs nationally, the federal Administration for Community Living (ACL) says that when you contact your local SHIP, a certified counselor will give you one-on-one guidance based on your unique situation and needs.2 PA MEDI also provides in-person and virtual educational presentations and events for the general public, which suits people who would rather learn the basics in a group before booking a one-on-one session.2

Can PA MEDI Help You Pay for Medicare?

Help with costs is on the Pennsylvania Department of Aging's list of PA MEDI subjects, under the name Medicare financial assistance programs.2 For SHIPs nationally, ACL lists paying for Medicare and prescriptions among the things SHIP is there to help with.2 The Department's PA MEDI page names three kinds of cost help:

• Medicare Savings Programs: Medicare Savings Programs (MSP) help with Medicare Part A and B costs, are administered by the Pennsylvania Department of Human Services, and can be applied for online, or you can call PA MEDI at 1-800-783-7067 for help.2
• Extra Help: Extra Help, also known as the Low Income Subsidy (LIS), works with any Medicare Part D prescription drug plan to lower the costs of premiums and prescription drugs, and is administered by the Social Security Administration.2
• PACE and PACENET: Pennsylvania's prescription assistance programs for older adults, PACE and PACENET, offer low-cost prescription medication to qualified residents age 65 and older and work with Medicare Part D plans and other prescription drug plans.2 PACE stands for Pharmaceutical Assistance Contract for the Elderly, and PACENET stands for Pharmaceutical Assistance Contract for the Elderly Needs Enhancement Tier.5

A past denial doesn't close the door. The Pennsylvania Department of Aging's PA MEDI page says you can reapply for Medicare Savings Programs and Extra Help even if you have been denied in the past.2

This guide doesn't list the income and resource limits for these programs. Those details live in our guides to Pennsylvania Medicare Savings Programs, Extra Help, and Pennsylvania PACE and PACENET. A PA MEDI counselor can then help you work out which of them to apply for.

Can PA MEDI Help With an Appeal, a Bill, or a Plan You Regret?

Yes, PA MEDI helps with problems as well as choices. The Pennsylvania Department of Aging's PA MEDI page describes what counselors can do for each kind of problem below.

A denied claim or service. PA MEDI certified counselors can assist you with questions and help you through the Medicare appeal process.2 For SHIPs nationally, ACL says SHIP can assist with correcting billing issues and filing complaints and appeals, and that with your permission SHIP will work with Medicare directly to help solve problems on your behalf.2 Our guide to Medicare appeals walks through the appeal levels themselves.

A confusing bill. For specific billing questions, and questions about your claims, medical records, or expenses, you can log into your secure Medicare account or call PA MEDI at 1-800-783-7067 for assistance.2

A plan you chose on bad information. If you believe you made the wrong plan choice because of inaccurate or misleading information, including information from using the Medicare Plan Finder on Medicare.gov, PA MEDI can help you throughout the year with options for making changes.2 PA MEDI's page describes this as help with options for making changes, so bring the details of what you were told when you call.

A charge that looks like fraud. If you suspect Medicare fraud or question something on your statements, PA MEDI's page says to contact your provider first and, if you need further help, contact Pennsylvania Senior Medicare Patrol at 800-356-3606.2 For signs of Medicare fraud and how to protect your Medicare number, see our guide to Medicare fraud protection.

How Do You Reach PA MEDI in Your County?

The Pennsylvania Department of Aging says that for year-round Medicare assistance you can call your local PA MEDI program or the PA MEDI Helpline.2 Either route gets you to free counseling, so pick the one that's easiest.

If a county number doesn't connect, the statewide PA MEDI Helpline at 1-800-783-7067 is the other route the Pennsylvania Department of Aging names.3 Some Pennsylvania counties share a PA MEDI number, and the table below shows each number exactly as the Pennsylvania Department of Aging prints it.4 Cumberland County's own PA MEDI page gives 717.240.6110 as its PA MEDI appointment number.4

The Pennsylvania Department of Aging's county list spells Huntingdon County as "Huntington," and the number shown for Huntingdon County is the one printed under that spelling.4

What Will PA MEDI Not Do?

PA MEDI will not try to sell you a plan. According to the Pennsylvania Department of Aging, PA MEDI does NOT sell or recommend Medicare insurance products, insurance agents, or brokers.2 For SHIPs nationally, ACL says SHIP is supported through state and federal partnerships that are not reimbursed by private health insurance plans or entities, and that SHIP is not paid per enrollment.2

A federal rule backs this up. Because PA MEDI is Pennsylvania's State Health Insurance Assistance Program, the federal SHIP law applies to it: 42 U.S.C. 1395b-4 requires each state's SHIP grant plan to provide assurances that staff members, including volunteer staff members, have no conflict of interest in providing the counseling.1,6 ACL's conflict-of-interest resource for SHIP and Senior Medicare Patrol (SMP) programs says that no person with a conflict of interest in connection with the work they will do at the SMP or SHIP, whether personal, philosophical, or financial, may serve as a volunteer.6 ACL gives one example of a person with an inherent conflict of interest: anyone who receives compensation for enrolling beneficiaries in a specific insurance plan or plans.6

If you're weighing a PA MEDI counselor against an insurance agent or broker, our comparison of SHIP counseling and insurance brokers walks through how the two differ.

Who Are PA MEDI Counselors?

PA MEDI counselors are trained, certified, and often volunteers. The Pennsylvania Department of Aging says the PA MEDI program has over 250 volunteers statewide who offer their time and talent assisting the public with important information about their Medicare health insurance benefits.2 For SHIPs nationally, ACL says SHIP counselors are members of your local community who have been screened, trained, and certified as Medicare experts, and that many are volunteers.2

A county program shows what this looks like day to day. For example, Cumberland County's PA MEDI program describes its counselors as specially trained staff and volunteers who can answer questions and give objective, easy-to-understand information about Medicare, Medicare Supplemental Insurance, Medicare Advantage Plans, Prescription Plans, and Medicaid.2 Cumberland County's PA MEDI program says that through individualized counseling it can help you understand the Medicare appeals process and assist with appeals paperwork, and can provide presentations on Medicare to your organization.2

If you're thinking about becoming one of PA MEDI's volunteers, your county's PA MEDI program in the table above is the place to ask what the role involves where you live.

What If You Have Both Medicare and Medicaid?

If you're applying for Pennsylvania's Community HealthChoices (CHC) program, a Medicare question can reach PA MEDI through a second door. The Pennsylvania Department of Human Services' CHC waiver application says the Independent Enrollment Broker is responsible for responding to questions about how CHC enrollment and benefits interrelate with Medicare coverage, and for referring applicants to the State Health Insurance Assistance Program (PA MEDI) as necessary.1

A CHC applicant's Medicare questions can therefore land with PA MEDI, whose subjects, as listed by the Pennsylvania Department of Aging, include coordination of benefits and Medicare financial assistance programs.1,2 Our guide to Community HealthChoices in Pennsylvania explains how that program works.

Learn More

Find personalized help reaching free PA MEDI Medicare counseling in your Pennsylvania county at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.