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SHINE: Serving the Health Insurance Needs of Everyone

Medicare Open Enrollment is open and ends on December 7

Lorraine York Edberg headshotLorraine York-EdbergIf you have a Medicare, sometime during the month of September you should have received important information known as an Annual Notice of Change from your Prescription Drug Plan or your Medicare Advantage Plan HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). The mailing explains any changes to your plan in the coming year regarding premiums, drug coverage changes (formulary), providers, and restrictions. It is very important to review the information to make sure the plan still works for you.

Starting October 15 through December 7, you can join, drop, or change your insurance, and the new coverage will begin on January 1, 2019. I like to call this time of year “Your Annual Insurance Checkup,” because it is a time when you can evaluate your current plan and decide if you want to make changes. If your current plan continues to meet your needs, then you may want to keep it. It is also a time when you may want to shop around for a new plan to help you save money, decrease or increase coverage.

Important things to consider when reviewing your plan changes are:

  • Does it still cover all your medications?
  • Are there any restrictions on your medication like quantity limits, prior authorization or step therapy that would make it difficult to access your needed medications?
  • Did you get a letter from your Medicare Prescription Drug Plan that your plan is changing or is no longer available in Massachusetts?
  • Have you been reassigned to a new plan? If so, contact the new plan to assure it will cover your current medications. If not, you should join a new plan before December 7, 2018, to access the medications you need without any problems.
  • Would you like to join a Medicare Prescription Drug Plan or Medicare Advantage Prescription Plan? Because [JR1] you’ve never joined previously, you can do it during this time.

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!

Ways to get the help you need:

  • Visit www.medicare.gov/find-a-plan to use the Medicare Plan Finder.
  • Look at your most recent “Medicare and You” handbook to see plans in your area; 2019 books will be mailed 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.

2013 new SHINE logo 1Massachusetts has finished mailing new Medicare cards

Your new card will have a new Medicare Number that's unique to you, instead of your Social Security Number. This will help to protect your identity.

When you have your new Medicare card, destroy your old Medicare card and start using your new card right away. Your new Medicare Number is a unique combination of numbers and letters. Your new number uses numbers 0 thru 9. The letters S, L, O, I, B, and Z are never used.

What if you didn’t get your new Medicare card?

Your new Medicare card should have arrived in the mail by now. If you didn’t get it, here’s what to do:

  • Remember that your new Medicare card will come in a plain white envelope from the Department of Health and Human Services.
  • If the card didn’t arrive, call 1-800-MEDICARE. Medicare call center representatives can check the status and help you get your new card.

In the meantime, use your current Medicare card to get health care services.

Watch out for scams

Medicare will never call you uninvited and ask you to give out personal or private information to get your new Medicare Number and card.

Scam artists may try to get personal information (like your current Medicare Number) by contacting you about your new card.

If someone asks you for your information or for money, or threatens to cancel your health benefits if you don't share your personal information, hang up and call 1-800-MEDICARE (1-800-633-4227).

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.

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.