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SHINE: Serving the Health Insurance Needs of Everyone

Lorraine York EdbergLorraine York-Edberg, Western Mass. Regional SHINE Program DirectorIf you’re interested in healthcare and looking for a volunteer opportunity, consider signing up to become a SHINE counselor with LifePath. The 2020 Spring Training is coming up in April, and there is no better time to get started.

SHINE, Serving Health Insurance Needs of Everyone, is a program that provides free, confidential and unbiased health insurance counseling for all Medicare beneficiaries. Volunteers in the LifePath SHINE program serve communities in all of Franklin County as well as the North Quabbin region of Worcester County and parts of Hampden and Hampshire counties.

The 2020 Spring Training is set to take place at LifePath in Greenfield from 10 a.m. to 3 p.m., with a break for lunch, beginning on April 2. Participants will meet weekdays for 11 sessions. A graduation celebration will take place in June.

SHINE counselors work one-on-one with individuals in their own communities providing information, counseling and assistance on Medicare, Medigap, Medicare Advantage Plans, Medicare Prescription Drug Coverage, Public Benefits, One Care Plans, and more. Those interested in becoming counselors should be comfortable working with a population consisting primarily of elders and persons with behavioral health challenges and physical disabilities.

SHINE Counselor Larry Bezio enjoys the volunteer work the program offers, adding that he finds “personal satisfaction to be able to help someone” and “good socialization” with other counselors.

Counselors benefit from ongoing monthly meetings, allowing them to stay up-to-date with new healthcare policies and programs, which are always changing. This year’s training is vast and comprehensive, and will address changes that have taken place in the past year.

The 2020 Spring Training is set to take place at LifePath in Greenfield from 10 a.m. to 3 p.m., with a break for lunch, beginning on April 2. Participants will meet weekdays for 11 sessions. A graduation celebration will take place in June.

If you are interested, want to learn more, or wish to sign up, contact me, Lorraine York-Edberg, Western Regional SHINE Program Director, at 413-773-5555 x2275 or 978-544-2259 x2275, or via email at This email address is being protected from spambots. You need JavaScript enabled to view it.. For more information about the SHINE Program and other programs at LifePath, visit LifePathMA.org.

The SHINE program, Serving the Health Information Needs of Everyone, provides free, confidential, and unbiased health insurance counseling for Medicare beneficiaries. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555.

Lorraine York-Edberg, SHINE Regional Program DirectorLorraine York-Edberg, SHINE Regional Program DirectorAccording to a Press Release from the Governor’s Office, 40,000 more Medicare Beneficiaries across the state of Massachusetts will be eligible for the Medicare Savings Program. Starting January 1, 2020, income eligibility expanded for the MSP program from 135% to 165% of the Federal Poverty Level, and the asset limit doubled.

Starting January 1, 2020, income eligibility expanded for the MSP program from 135% to 165% of the Federal Poverty Level, and the asset limit doubled.

This is GREAT news for those who are newly eligible! It will increase the quality of life for many by directly increasing their income and adding significant benefits towards medications.

If you qualify, these programs will pay your monthly Part B premium ($144.60) and in some cases your Part A and B deductibles, co-pays and Part A premium (if you have one).

See If You Qualify

If your income and assets are at or below the amounts listed here, you may qualify for help from one of the Medicare Savings Programs.

Income and Asset Limits Effective Jan. 1, 2020
  Income/Month Assets
Single $1,738 $15,720
Married $2,346 $23,600
Prescription Drug Co-Payments with Extra Help Effective Jan. 1, 2020
  Per 30-Day Supply
Generic $3.60
Brand Name $8.95

And Better Still…

If you qualify for any Medicare Savings programs, you will also automatically qualify for a full subsidy under the Medicare Part D Low Income Subsidy (LIS), which is also known as "Extra Help." This program in many cases pays the monthly premiums for your Medicare Prescription Drug plan, provided you are enrolled in a qualified plan. The LIS will also assist with covering drugs at low cost and assist during the Part D deductible and coverage gap.

Additionally these programs are not subject to estate recovery since January of 2010, so the state will NOT place a lien on your property to recover benefits following your death.

To apply, it is an easy, one page application, and simple to fill out. To get this application you can contact MassHealth at 1-800-841-2900 and request the Medicare Buy-In application and they can send it to you. Applications are also available online. We also have applications available here at the regional SHINE office upon request. If you need assistance filling it out we are happy to help.

-This article is based on a news release from the Governor’s Press Office and Outreach Materials developed from the Massachusetts Executive Office of Elder Affairs.

The SHINE program, Serving the Health Insurance Needs of Everyone, provides confidential and unbiased health insurance counseling for Medicare beneficiaries. This is a free service, though contributions are welcome and will go a long way to help support this vital program. For further assistance with any Medicare issue, you can make a SHINE appointment. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555, or contact your local council on aging.

Lorraine York-Edberg, SHINE Regional Program DirectorLorraine York-Edberg, SHINE Regional Program DirectorThe Centers for Medicare and Medicaid announced the Medicare Part A and B premiums and deductibles for 2020.

The standard monthly premium for Medicare Part B in 2020 will be $144.60, up from $135.50 in 2019, an increase of $9.10. The cost of this premium is normally taken out of your Social Security direct deposit. If you are not collecting Social Security yet, you will be billed the additional amount starting in 2020.

Social Security benefits are increasing by just 1.6% in 2020, which is about $16 for every thousand dollars received from Social Security. However, the 6.7% increase in Medicare Part B, will reduce the amount of increase you receive.

Medicare beneficiaries whose individual income is above $87,000 annually or a couple’s joint income above $174,000 annually will pay an increased amount for their Part B and Part D, called an income-related monthly adjustment amount, also known as “IRMAA.” The Federal government bases the 2020 adjustments on the beneficiaries’ 2018 Federal Income taxes. You may request a new initial determination by contacting your local Social Security office if you believe your IRMAA is incorrect. The monthly Part B premium for those who are enrolled helps pay for doctors' services, x-rays and tests, outpatient hospital care, ambulance service, medical supplies, and other medical equipment. 

The 2020 Part B annual deductible will be $198 for all people with Medicare, an increase of $13 from 2019. The Part B deductible is annual; once you have incurred $198 of expenses for Medicare-covered services in any year, the Part B deductible does not apply to any further covered services you receive for the rest of the year.

Social Security benefits are increasing by just 1.6% in 2020, which is about $16 for every thousand dollars received from Social Security.

Medicare Part A (Hospital Insurance) helps pay for hospital care, skilled nursing care, home health care, hospice care, and other services. The Part A deductible will increase from $1,364 to $1,408 for beneficiaries with Medicare only. The Part A deductible is the beneficiary’s only cost for up to 60 days of Medicare-covered inpatient hospital services. The 61st to the 90th day has increased from $341 to $352 a day, and beyond the 90th day has increased from $682 to $704 a day. For beneficiaries who have a Medigap plan to supplement Medicare, often most of these costs are covered by their supplemental insurance.

The skilled nursing facility coinsurance will increase from $170.50 to $176.00 for the 21st to the 100th day. Medicare Part A covers the first 20 days in a skilled nursing facility, after a three day qualifying stay in a hospital.

Many Medicare beneficiaries purchase additional insurance to cover the gaps of Medicare to help reduce out-of-pocket expenses including Medicare Supplemental Plans or Medicare Advantage Plans.  

This article is based on a news release from the Centers for Medicare and Medicaid Services.

The SHINE program, Serving the Health Insurance Needs of Everyone, provides confidential, and unbiased health insurance counseling for Medicare beneficiaries. This is a free service, though contributions are welcome and will go a long way to help support this vital program. For further assistance with any Medicare issue, you can make a SHINE appointment. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555, or contact your local council on aging.

Lorraine York-EdbergLorraine York-Edberg, SHINE Regional Program Director

What is a supplemental benefit?

A supplemental benefit is an item or service covered by a Medicare Advantage Plan that is not covered by Original Medicare. These benefits do not need to be provided by Medicare providers or at Medicare-certified facilities. Instead, to receive these items or services, you need to follow your plan’s rules. Some commonly offered supplemental benefits are dental care, vision care, hearing aids, and gym membership. Medicare Advantage supplemental benefits are not to be confused with Medicare supplemental insurance, also known as a Medigap policy. Medigaps are health insurance policies that pay for some Original Medicare out-of-pocket costs.

Changes to supplemental benefits in 2020

Beginning in 2020, Medicare Advantage Plans can begin covering supplemental benefits that are not primarily health-related for beneficiaries who have chronic illnesses. These benefits should address environmental factors that may affect the health, functioning, quality of life, and risk levels of beneficiaries with chronic conditions. Some examples of the new benefits are meal delivery, transportation for non-medical needs, and home air cleaners.

Some examples of the new benefits are meal delivery, transportation for non-medical needs, and home air cleaners.

In order to be eligible for this new category of supplemental benefits, you must be considered chronically ill.

  • Have at least one medically complex chronic condition that is life-threatening or significantly limits your health or function
  • Have a high risk of hospitalization or other negative health outcomes, and
  • Require intensive care coordination

If you meet these criteria, a Medicare Advantage Plan may offer you one of these new benefits if it has a reasonable expectation of improving or maintaining your health or function. Medicare Advantage Plans will be able to create sets of supplemental benefits for people with specific chronic illnesses, which means not every member of a Medicare Advantage Plan will have access to the same set of supplemental benefits.

Example in Western Massachusetts: One of our plans offers meals to members discharged from an inpatient stay at a hospital, within 30 days. This benefit includes 28 fully prepared meals delivered to the members’ homes at no cost. This benefit is unlimited and offered after every inpatient discharge.

Who can I call if I have further questions?

If you have Original Medicare, call 1-800-MEDICARE to learn more about what services are or are not covered under Original Medicare.

Call your Medicare Advantage Plan to learn about its costs and coverage rules for supplemental benefits. If you are thinking about enrolling in a new Medicare Advantage Plan, call the plan first to confirm that you understand the costs and coverage.

If you need help understanding your benefits or filing an appeal, contact your State Health Insurance Assistance Program also known as SHINE in Massachusetts.

Portions of this article have been written in cooperation with The Medicare Rights Center.

The SHINE program, Serving the Health Insurance Needs of Everyone, provides confidential and unbiased health insurance counseling for Medicare beneficiaries. This is a free service, though contributions are welcome and will go a long way to help support this vital program. For further assistance with any Medicare issue, you can make a SHINE appointment. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555, or contact your local council on aging.

Lorraine York-EdbergLorraine York-Edberg, SHINE Regional Program Director

On August 27, 2019, Centers for Medicare and Medicaid Services (CMS) made a change to the current Medicare Plan Finder. They launched a new redesigned “mobile friendly” version to meet the needs of the growing number of tech savvy Medicare beneficiaries. It allows you to shop and compare Medicare Prescription Drug Plans and Medicare Advantage Plans to find the best Drug Plan options to meet your needs.

The redesigned Plan Finder can be accessed through “My Medicare Portal,” so the first step to access the Medicare Plan Finder is to create an account through the MyMedicare.gov website. A SHINE program in the eastern part of Massachusetts created a YouTube video to show you how to create an account with ease.

This account creation is necessary for all Medicare beneficiaries to review and compare the 2020 Medicare Prescription Drug Plans and Medicare Advantage Plans during the upcoming annual open enrollment period from October 15th to December 7th.

As SHINE counselors prepare for open enrollment, we encourage you to create an account prior to meeting with your SHINE counselor for your review of the 2020 plans. This only takes a few minutes to set up and you may already have one, as Medicare invited you to start one when you first became eligible for Medicare. If not – no problem, it’s easy to make changes to your account and recreate it without ever needing an email address. SHINE counselors will be able to assist you if you have trouble or have no access to a computer or handheld device like a tablet or a smartphone.

Man visiting the MyMedicare.gov websiteAfter spending time exploring the MyMedicare.gov website, I have found it to be helpful for many things, including the ability to:

“It allows you to shop and compare Medicare Prescription Drug Plans and Medicare Advantage Plans to find the best Drug Plan options to meet your needs.”

  • Track original Medicare claims and your Part B deductible status.
  • See what Medicare coverage you have.
  • Sign up to get your “Medicare Summary Notices.”
  • Print an official copy of your Medicare card.
  • Manage your personal information (like drugs you take, your pharmacy, medical conditions, allergies and implanted devices).
  • Sign up for your “Medicare & You” handbook electronically.

Remember, it is time to review your Medicare Prescription Drug Coverage, “Your Annual Insurance Check-Up” to:

  • Make sure your plan continues to cover your medications.
  • Check your plan for any restrictions like quantity limits, prior authorization or step therapy.
  • Check any mail you received from your plan to make sure they continue to be available in Massachusetts, or if you have been re-assigned to a new plan.

Review and save all letters from your plan!

During the Medicare Open Enrollment (October 15 - December 7), you will have an opportunity to change your coverage for next year. You can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you are already in a Medicare Advantage Plan, you can use the Open Enrollment to switch back to Original Medicare with a Medicare Prescription Drug Plan.

State-certified SHINE (Medicare) counselors can help you understand your plan changes, as well as other options you may have. Call early to get a SHINE appointment (1-800-498-4232) during open enrollment!

All the ways to get the help you need:

  • Visit MyMedicare.gov to use the Medicare Plan Finder.
  • Look at your most recent “Medicare and You” handbook to see plans in your area; 2020 books were mailed in late September.
  • Call 1-800-MEDICARE (1-800-633-4227) and say, “Agent.” Help is available 24 hours a day, including weekends.
  • Contact your local SHINE program.
  • Attend a local presentation regarding the annual Open Enrollment period.

The SHINE program, Serving the Health Insurance Needs of Everyone, provides confidential, and unbiased health insurance counseling for Medicare beneficiaries. This is a free service, though contributions are welcome and will go a long way to help support this vital program. For further assistance with any Medicare issue, you can make a SHINE appointment. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555, or contact your local council on aging.