As the client departs, ceding his seat in a full waiting room, Mr. Riccardi says: “Do not leave the pharmacy without your medications. Call me if you can’t.”

This is high season for Medicare madness. Advertisements for insurance companies saturate the media; recruiting vans park outside senior citizen centers. Through the end of December, recipients may choose among dozens of prescription plans. In January, enrollment begins for private Medicare plans.

If only it were that simple. In addition, a recipient may weigh the advisability of supplementary coverage and charity programs; master the fine print of loopholes, deductibles and co-pays; track shifting rosters of physicians, therapies and medications; and try to anticipate new frailties in the coming year. Dental work? Wheelchair? Oxygen tank?

Image Credit... Ruby Washington/The New York Times

Health insurance counselors like Mr. Riccardi, who travels to senior centers around New York City, help the elderly to understand coverage options and to escape the financial and medical vises that may be gripping them. Hospitals and senior centers often employ these caseworkers, nonprofit groups like the Medicare Rights Center have hot lines, and every state has a health insurance counseling program (www.shiptalk.org).

All day long, clients meet with Mr. Riccardi, a tall, slender man who grew up in Syracuse and learned Spanish while studying modern dance in Cuba and Mexico. He set aside that uncertain career to trouble-shoot for the elderly and to pursue a degree in social work. His clients this day are, for the most part, the retired working poor  factory workers, seamstresses, truck drivers. But for many, especially those who struggle with spoken English, the paperwork from hospitals, insurers and collection agencies, written in bureaucratic English, is beyond them. They do not understand the nuances of their plans; they pull cards from their wallets that are expired, redundant or conflicting.

“Do you answer the phone?” Mr. Riccardi says with a jesting smile to a tiny woman with frosty hair, as he sorts her envelopes. She has old bills from Medicare, collection notices, coordination of benefits snarls and new bills. Her husband, a retired hotel guard who now has Alzheimer’s, is in a nursing home; her daughter is fighting colon cancer. She herself is not in great shape, but at least she is physically and mentally able to reach out to a Mr. Riccardi.