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SHINE: Serving the Health Insurance Needs of Everyone

Are you using Medicare’s free preventive services to stay healthy?

Lorraine York Edberg headshotLorraine York-EdbergPreventative services are an easy and great way to stay healthy. Medicare has been offering free preventive services for over 20 years and has increased benefits to help prevent illness. Paying attention to your body and keeping up to date on your preventive services will help find health problems early, when treatments work best. Things like exams, lab work, screenings, monitoring and counseling are all part of the services offered. Medicare provides and pays for a number of preventive services through Part B of Medicare. Many of these services are FREE whether you have traditional Medicare or a Medicare Advantage plan, like an HMO or PPO.

Free services include:

Welcome to Medicare preventive visit

Medicare covers a one-time preventive visit within the first 12 months that you have Medicare Part B.

Wellness visit

All Medicare beneficiaries are eligible for an annual preventive wellness visit. Not to be confused with full physical examinations, these are prevention-focused visits to provide an overview of your health and medical risk factors and serve as a baseline for future care. 

Colorectal cancer screening

The fecal occult blood test, flexible sigmoidoscopy or colonoscopy is available to all beneficiaries age 50 or older.

Mammograms

All women with Medicare ages 40 and older can get a free breast cancer screening mammogram every year.

Pap tests and pelvic exams

These cervical and vaginal cancer screenings are available every two years, or once a year for those at high risk.

Prostate cancer screenings

Annual PSA (prostate-specific antigen) blood tests are available to all male beneficiaries age 50 and older.

Cardiovascular screenings

Free blood tests to check cholesterol, lipid and triglyceride levels are offered every five years to all Medicare recipients.

Diabetes

Screening is available twice a year for those at risk.

Bone mass measurements

This osteoporosis test is available every two years to those at risk, or more often if medically necessary.

Abdominal aortic aneurysm screening

To check for bulging blood vessels, this test is available to men, if they are at risk due to a family history or men ages 65 to 75 who have ever smoked.

Vaccinations

An annual flu shot, a vaccination against pneumonia and the hepatitis B vaccine are all free to all beneficiaries.

In addition, Medicare also offers free smoking cessation counseling, medical nutrition therapy to help beneficiaries with diabetes or kidney disease, depression screenings, alcohol screening and counseling, obesity screening and counseling, annual cardiovascular risk reduction visits, sexually transmitted infection screening and counseling, and HIV screenings.

Click here for a complete list of free preventive services. We have the most updated copies of the “Guide to Medicare’s Preventive Services” available at our regional office and would be happy to mail a copy to those who are interested. Please contact us at the number below to get your copy.

The SHINE program (Serving Health Information Needs of Everyone…on Medicare) 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 or contact your local council on aging.

Medicare Buy-In Programs help save money

Lorraine York Edberg headshotLorraine York EdbergMedicare Buy-In Programs, also called Medicare Savings Programs, can assist low-income Medicare beneficiaries pay their share of the standard Medicare Part B premium, which is currently $134 monthly. Medicare Beneficiaries may be eligible for different Buy-In Programs based on their income and assets. The three programs are called QMB (Qualified Medicare Beneficiary), SLMB (Specified Low Income Medicare Beneficiary), and QI-1 (Qualified Individuals).

Eligibility guidelines for these programs are as follows:

  • QMB is at 100% Federal Poverty Level as follows for an:
    • Individual $1,032 monthly and less than $7,560 in assets
    • Couple $1,392 monthly and less than $11,340 in assets
  • SLMB is at 120 % Federal Poverty Level as follows for an:
    • Individual $1,234 monthly and less than $7,560 in assets
    • Couple $1,666 monthly and less than $11,340 in assets
  • QI-1 is at 135% federal Poverty Level as follows for an:
    • Individual $1,386 monthly and less than $7,560 in assets
    • Couple $1,872 monthly and less than $11,340 in assets

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.

AND BETTER STILL…

If you qualify for any of the three 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 will pay the monthly premiums for your Part D plan, provided you are enrolled in a qualified plan. The LIS will also assist with covering drugs during the Part D deductible and coverage gap.

If you are eligible as a Qualified Medicare Beneficiary (QMB), this program will pay for your Part A (Hospital insurance) deductible and Part B deductible of $183 annually. The 2018 Part B standard premium is currently $134 monthly and the hospital deductible is $1340 for each hospitalization.

If you are eligible as a Specified Low Income Medicare Beneficiary (SLMB) or the Qualified Individual Medicare Beneficiary (QI-1), this program will pay for your Part B (Medical insurance) premium.

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. We also have applications available here at the regional SHINE office upon request. If you need assistance filling it out, we are happy to assist.

The SHINE (Serving Health Insurance Needs of Everyone…on Medicare) Program 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 or contact your local council on aging.

Ten things to know about your new Medicare card

Medicare is mailing new Medicare cards starting in April 2018. Medicare has a mailing strategy in place, and Massachusetts beneficiaries will be receiving their new cards after June of 2018. Here are ten things to know about your new Medicare card:

  1. Mailing takes time: Your card may arrive at a different time than your friend’s or neighbor’s.
  2. Destroy your old Medicare card: Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.
  3. Guard your card: Only give your new Medicare Number to doctors, pharmacists, other healthcare providers, your insurers, or people you trust to work with Medicare on your behalf.
  4. Your Medicare Number is unique: Your card has a new number instead of your Social Security Number. This new number is unique to you.
  5. Your new card is paper: Paper cards are easier for many providers to use and copy, and they save taxpayers a lot of money. Plus, you can print your own replacement card if you need one!
  6. Keep your new card with you: Carry your new card and show it to your health care providers when you need care.
  7. Your doctor knows it’s coming: Doctors, other health care facilities and providers will ask for your new Medicare card when you need care.
  8. You can find your number: If you forget your new card, you, your doctor or other health care provider may be able to look up your Medicare Number online.
  9. Keep your Medicare Advantage Card: If you’re in a Medicare Advantage Plan (like an HMO or PPO), your Medicare Advantage Plan ID card is your main card for Medicare – you should still keep and use it whenever you need care. However, you also may be asked to show your new Med-icare card, so you should carry this card too.
  10. Help is available: If you don’t get your new Medicare card by April 2019, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

This article was based on information released from Medicare in January of 2018.

Trained SHINE (Serving Health Insurance Needs of Everyone…on Medicare) volunteers can help you! The SHINE program provides free, confidential and unbiased health insurance counseling for Medicare beneficiaries. To reach a trained and certified counselor in your area, contact the Region-al Office at 1-800-498-4232 or 413-773-5555 or contact your local Council on Aging.

Can I still change my Medicare Plan?

Lorraine York Edberg headshotLorraine York-EdbergThe 2017 Medicare Open Enrollment period ended on December 7, but some people may still be allowed to change plans.

For those with a Medicare Advantage Plan: Between January 1 and February 14, you can leave your plan and switch to Original Medicare, but you cannot switch to another Medicare Advantage Plan. If you drop your Medicare Advantage plan during this period, you will be able to join a Medicare Prescription Drug Plan to add drug coverage. Your Original Medicare coverage and your prescription drug coverage will begin the first day of the month after your enrollment. You may also add a supplement (Medigap) at this time. This could be very helpful for those who missed the Annual Open Enrollment Period and wish to make a change.

Additionally, for those who are dually eligible for Medicare and MassHealth or those with Prescription Advantage, the state of Massachusetts Prescription Assistance Program or Medicare beneficiaries eligible for Low Income Subsidy program administered through Social Security, also known as “Extra Help,” a program that assists with drug plan premiums and lowering the costs of prescription drugs:

  • You can change your plan anytime during the year.
  • Those who are dual eligible or have “Extra Help” can change every month.
  • Those with Prescription Advantage members can do this only once each year.

For those of you that found your medications were not covered under your current plan this year, you may still have some options. You should make an appointment to review your circumstances with a trained SHINE counselor.

Trained SHINE (Serving Health Insurance Needs of Everyone… on Medicare) volunteers can help you! The SHINE program, Serving 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 or contact your local Council on Aging. For other SHINE related matters, call 1-800-AGE-INFO (1-800-243-4636), then press or say 3. Once you get the SHINE answering machine, leave your name and number. A volunteer will call you back, as soon as possible.

Medicare Part B premiums, deductibles and coinsurance for 2018

Lorraine York Edberg headshotLorraine York-EdbergOn November 17, 2017, the Centers for Medicare and Medicaid announced the Part A and B premiums and deductibles for 2018.

These figures are based on the Social Security Cost of Living increase of 2% for 2018 which equates to $20 monthly for every $1000 received.

The standard monthly premium for Part B enrollees will be $134 monthly, the same amount it was in 2017.

In 2017, the Medicare “hold harmless” provision protected 70% of Medicare beneficiaries from increases in their Part B Premium. That protection does not allow the Part B premium to increase greater than the dollar increase in their Social Security check.

In 2018, 30% of all Part B enrollees who are not subject to the “hold harmless” provision will pay the full premium of $134 per month. An estimated 42% of all Part B enrollees are subject to the hold harmless provision in 2018, but will pay the full monthly premium of $134, because the increase in their Social Security benefit will be greater than or equal to an increase in their Part B premiums up to the full 2018 amount. Of all Part B enrollees, 28% are subject to the hold harmless provision in 2018 and will pay less than the full monthly premium of $134, because the increase in their Social Security benefit will not be large enough to cover the full Part B premium increase.

However, the hold harmless rule also does not protect high-income Medicare beneficiaries whose individual income is above $85,000 or a couple’s joint income above $170,000. These beneficiaries 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 2018 adjustments on the beneficiaries’ 2016 Federal Income taxes. You may request a new initial determination through Social Security if believe your IRMAA is incorrect by contacting your local Social Security office. Some other beneficiaries will be paying higher Part B premiums if they are on Medicare Part B, but not yet collecting their Social Security benefit.

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 2018 Part B deductible will be $183 for all people with Medicare, the same as the annual deductible in 2017. The Part B deductible is annual; once you have incurred $183 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.

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 $1,316 to $1,340. 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 $329 to $335 a day, and beyond the 90th day has increased from $658 to $670 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 increased from $164.50 to $167.50 for the 21st to the 100th day. Medicare 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.

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… with Medicare, 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 or contact your local council on aging.