SHINE: Serving the Health Insurance Needs of Everyone
- Written by Janis Merrell, Editor of The Good Life
On June 9, 2022, six people celebrated their graduation from the SHINE program, with five attending a luncheon at LifePath’s office in Greenfield. Each graduate received a single rose along with their certificate of graduation. SHINE is an acronym for “Serving the Health Insurance Needs of Everyone.” As newly certified SHINE counselors, these volunteers will work in their own communities to provide free and unbiased health insurance information, education, and assistance services to Medicare beneficiaries and adults with disabilities.
“SHINE volunteers are an essential resource in the community because they offer a clear, objective, and unbiased view of the Medicare marketplace and show beneficiaries all of their health care choices. They are keenly aware of the important factors that must be considered when choosing any plan, including hospital and provider coverage, prescription drug costs, and plan affordability. SHINE volunteers also offer free screening for several public benefits programs that can often result in significant savings for consumers. These dedicated individuals have a strong commitment to protecting beneficiaries and ensuring they are getting the best health coverage available to them for the lowest overall cost,” said Kathy Grant, SHINE Program Assistant Director at the Executive Office of Elder Affairs, who traveled from Boston to attend the event.
SHINE graduate Lynn Hills, GBA, explained, “I chose to become a SHINE counselor because it felt like the next step for me. In doing Group Employee Benefits for many years, I consistently see the fear and panic in our retirees as they become Medicare eligible. I am excited to assist them along the way and hopefully take away some of their fear and make the transition as easy as possible.”
SHINE graduate Juan Concepcion said, “It's not an easy certification process, there is a lot to learn, but at the end it is very rewarding to be able to assist people with the many options that are available to them, with all the Medicare options, and to help them select what would benefit them.”
Lorraine York-Edberg, SHINE Regional Program Director, who provided the intensive 60 hour training, remarked, “This was a great group of dedicated and competent SHINE trainees. They will be very helpful to Medicare beneficiaries in our service area!”
Both Hills and Concepcion expressed praise for York-Edberg. Hills said, “The training was very organized and Lorraine was so informative and helpful, she made it interesting and fun. There was definitely a lot more information to learn then I had imagined, but we had a fantastic class with great interaction, which definitely helped me retain more.”
Concepcion added, “I want to express my deepest, sincere gratitude to Lorraine. She is an excellent trainer—very caring, very sympathetic, and takes her time to make sure you have understood all that has been given to you. She goes above and beyond.”
- Written by Lorraine York-Edberg, SHINE Regional Program Director
Are you turning 65? Have you been disabled for 24 months? If so, you may be eligible for Medicare. Medicare is the federal health insurance program that helps with the cost of health care, but it is not comprehensive; it does not cover all medical expenses or the cost of long-term care.
Different parts of Medicare help cover specific services:
Part A- Hospital Insurance
Part B- Medical Insurance
Part D- Prescription Drug Coverage
Who is eligible?
Individuals who are 65 years or older and U.S. citizens or lawfully permitted residents for 5 years are eligible. Medicare is also available to certain people who are under 65 who receive Social Security Disability benefits for 24 months and to people who have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s Disease, or End Stage Renal Disease (ESRD).
Most people are eligible for Part A, if they have paid into Medicare taxes long enough through their own or a spouse’s or ex-spouse’s work record.
How do you enroll? Social Security handles enrollment into Medicare Parts A and B. If you are not receiving Social Security benefits, you will need to enroll by physically going to a local Social Security office, by making an appointment to enroll over the phone, or online at www.ssa.gov. Make sure you do this early, as our local Social Security office is very busy!
If you already receive benefits from Social Security, you will automatically receive Medicare A and B a few months before you turn 65. If you are under 65 and receiving Social Security Disability benefits, you will receive it before your 25th month of disability.
There are several enrollment periods to be aware of if you do not have Medicare. First, the Initial Enrollment Period (IEP), is the period of time that surrounds your 65th birthday, including the three months before your birthday, the month of your birthday, and the three months following your birthday. Most people sign up for Medicare at this time, unless they are continuing to work and/or are covered under a spouse’s work through an Employer Group Health Plan. The Initial Enrollment Period for a person who is receiving benefits through Social Security Disability begins three months before their 25th month of disability payments, includes the 25th month, and ends 3 months after.
Next is the Special Enrollment Period (SEP). It is the opportunity to enroll in Medicare outside the Initial Enrollment Period or General Enrollment Period for people who didn’t enroll in Medicare when first eligible, because they or their spouse are still working and have employer-sponsored Group Health Plan coverage based on their employment. This Employer Coverage allows them to defer Medicare Part B until they retire. So, if you are over 65 and you have health insurance through a job and are still working, you can sign up for Part A and Part B any time as long as you have Group Health Plan coverage through your or your spouse’s employment.
One important note regarding the SEP is that employer coverage for retirees, or through COBRA, doesn’t count as current employment, so individuals with these types of coverage don’t qualify for a SEP to enroll in Medicare.
The last period is the General Enrollment Period (GEP). This period is for individuals who miss their IEP, and allows you to sign up. Medicare’s GEP lasts January 1–March 31, with coverage starting July 1.
There are a few things to understand about penalties. If you enroll late, the Part B penalty is a surcharge added to your monthly Part B premium for life. The Part B late enrollment penalty is calculated as 10% of the current Part B premium for every 12 month period you were not enrolled and did not have employer coverage through current employment.
If you do not have Part D coverage, even if you take no prescription drugs, you can incur a lifetime penalty. If you enroll late, the Part D penalty is calculated as 1% of the national base beneficiary premium for each month you were not enrolled in a Part D plan and did not have creditable coverage. That is 33 cents a month in 2022.
It makes your head spin, right? So many rules to know and we have not even discussed additional coverage!
Because Medicare is not all-inclusive, most people purchase additional coverage, including Medigap Supplemental Plans (aka Medicare Supplemental Plans), Medicare Advantage Plans (Part C), Prescription Drug Coverage (Part D), Retiree Plans, and Veterans’ Benefits.
This is where SHINE Counselors come in handy. We have free, detailed information and knowledge to assist you in making the best decision, based on your financial situation, your medical insurance needs (based on your health conditions), and your comfort with the coverage you choose.
Additionally there are a few very helpful handouts I recommend for someone turning 65 or becoming eligible for Medicare:
These publications are available through the SHINE webpage, or you can simply call the SHINE Program directly and request we mail or email them to you.
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.
- Written by Lorraine York-Edberg, SHINE Regional Program Director
2022 Medicare Part B Premiums, Deductibles, and Coinsurance
The Centers for Medicare and Medicaid (CMS) released the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs on November 12, 2021.
The standard monthly premium for Medicare Part B in 2022 will be $170.10, up from $148.50 in 2021, an increase of $21.60. This larger than usual increase is due to the rising cost of healthcare utilization combined with several other factors. 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 2022.
The standard monthly premium for Medicare Part B in 2022 will be $170.10, up from $148.50 in 2021, an increase of $21.60.
Social Security benefits are increasing by 5.9% in 2022, which is about $59 for every thousand dollars received from Social Security. This is the largest cost of living increase in 39 years. However, the 15.9% increase in Medicare Part B will reduce the amount of increase you receive. Medicare beneficiaries whose individual income is above $91,000 annually or a couple’s joint income that is above $182,000 annually will pay an increased amount for their Part B and Part D, called an income-related monthly adjustment amount, also known as “IRMAA.” This affects 7% of people with Medicare Part B. The federal government bases the 2022 adjustments on the beneficiaries’ 2020 federal income taxes. If you believe your IRMAA is incorrect, you may request a new initial determination by contacting your local Social Security office. This is especially important if your income has changed after 2020 due to various reasons—for instance, you have retired.
The monthly Part B premium helps pay for doctors' services, x-rays and tests, outpatient hospital care, ambulance service, medical supplies, and other medical equipment. The 2022 Part B annual deductible will be $233 for all people with Medicare, an increase of $30 from 2021. The Part B deductible is annual; once you have incurred $233 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 $1,484 to $1,556 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 $371 to $389 a day, and beyond the 90th day, it has increased from $742 to $778 a day. For beneficiaries who have a Medigap Supplement 1 or 1 A plan, these costs are covered by that supplemental insurance coverage.
The skilled nursing facility coinsurance increased from $185.50 to $194.50 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.
Medicare Advantage Open Enrollment Period Starts January 1, 2022
Did you know that if you are unhappy with your Medicare Advantage Plan, you have options?
The Medicare Advantage Open Enrollment Period (MA OEP) occurs each year from January 1 through March 31. You can only use this enrollment period if you have a Medicare Advantage Plan on January 1. Changes made during this period take effect the first of the month following the month you enroll. For example, if you switch to a new Medicare Advantage Plan in February, your new coverage begins March 1. Unlike Fall Open Enrollment period, you can only make a single change during the MA OEP.
It’s important to understand and be confident in your Medicare coverage choices. If you have a Medicare Advantage Plan and want to change your plan, check out your options today. Remember, the MA OEP ends March 31.
Changes that can be made during this period include switching to:
- a different MA plan with drug coverage;
- a different MA plan without drug coverage;
- Original Medicare and a Part D plan; or
- Original Medicare without a Part D plan.
In Massachusetts you may also add Medigap coverage to your Original Medicare during this time.
People who want to leave their Medicare Advantage plan and enroll in Original Medicare, can access Medigap policies, also known as supplemental plans. We are fortunate in the state of Massachusetts, as our insurers in this state offer continuous open enrollment.
Medigap policies are health insurance policies that work with Original Medicare and pay part or all of certain remaining costs such as deductibles, coinsurance, and copayments after Original Medicare pays first.
The SHINE program, (Serving Health Information Needs of Everyone…on Medicare), provides free, 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, certified counselor in your area, please contact the Regional Office at 800-498-4232 or 413-773-5555, or contact your local Council on Aging.
This article is based on the November 12 news release from the Centers for Medicare and Medicaid Services.
- Written by Janis Merrell, Editor of The Good Life
This past July, seven people celebrated their graduation from the SHINE program while enjoying a luncheon at LifePath’s office in Greenfield. Each graduate received a bouquet along with their certificate of graduation. SHINE is an acronym for “Serving the Health Insurance Needs of Everyone.” As newly certified SHINE counselors, these volunteers will work in their own communities to provide free and unbiased health insurance information, education, and assistance services to Medicare beneficiaries and adults with disabilities.
As newly certified SHINE counselors, these volunteers will work in their own communities to provide free and unbiased health insurance information, education, and assistance services to Medicare beneficiaries and adults with disabilities.
According to SHINE graduate Amanda Joao, “It’s such important work” and “will make such a difference” for her to have this training in her position as Shelburne Senior Center Director.
Graduate Diana Soler, who will be offering SHINE counseling at the Amherst John P. Musante Health Center, says she is looking forward to “helping elders in the Latino community gain access to Medicare by overcoming any language barriers.”
Lorraine York-Edberg, SHINE Regional Program Director, provided the intensive 60-hour training. “This was a great group of dedicated and concerned SHINE trainees,” she said. “They will be very helpful to Medicare beneficiaries in our service area!”
- Written by Lorraine York-Edberg, Western Mass. Regional SHINE Program Director
Initial Enrollment Period (IEP) (the seven months surrounding your 65th birthday: 3 months before, the month of, and the 3 months following).Most people become eligible for Medicare when they turn 65. Your Medicare enrollment steps will differ depending on whether or not you are collecting retirement benefits when you enter your
- If you are receiving Social Security retirement benefits or Railroad Retirement benefits, you should be automatically enrolled in both Medicare Part A and Part B.
- If you are not receiving Social Security retirement benefits or Railroad Retirement benefits, you will need to actively enroll in Medicare by contacting the Social Security Administration.
If you are eligible for automatic enrollment, you should not have to contact anyone. You should receive a package in the mail three months before your coverage starts with your new Medicare card. There will also be a letter explaining how Medicare works and that you were automatically enrolled in both Parts A and B. If you get Social Security retirement benefits, your package and card will come from the Social Security Administration (SSA). If you get Railroad Retirement benefits, your package and card will come from the Railroad Retirement Board.
Typically, you should not turn down Part B unless you have insurance based on your or your spouse’s current work (job-based insurance).
Typically, you should not turn down Part B unless you have insurance based on your or your spouse’s current work (job-based insurance). If you do not have job-based insurance and you turn down Part B, you may incur a premium penalty if you need to sign up for Medicare coverage in the future. Also, if your job-based insurance will pay secondary after you become eligible for Medicare, you should consider enrolling in Medicare in order to have primary coverage and pay less for your care.
If you are 65 but are not receiving Social Security retirement benefits or Railroad Retirement benefits, you will need to actively enroll in Medicare.
Signing Up for Medicare
Follow the steps below if you need to actively enroll in Medicare.
If you decide to enroll in Medicare during your Initial Enrollment Period, you can sign up for Parts A and/or B by:
- Visiting your local Social Security office.
- Calling Social Security at 800-772-1213.
- Mailing a signed and dated letter to Social Security that includes your name, Social Security number, and the date you would like to be enrolled in Medicare.
- Or, by applying online.
If you are eligible for Railroad Retirement benefits, enroll in Medicare by calling the Railroad Retirement Board (RRB) or contacting your local RRB field office.
Keep proof of when you tried to enroll in Medicare, to protect yourself from incurring a Part B premium penalty if your application is lost.
- Take down the names of any representatives you speak to, along with the time and date of the conversation.
- If you enroll through the mail, use certified mail and request a return receipt.
- If you enroll at your local Social Security office, ask for a written receipt.
- If you apply online, print out and save your confirmation page.
This article is made available to you with permission from the Medicare Rights Center in Washington DC. The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.
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.