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SHINE: Serving the Health Insurance Needs of Everyone

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.

Lorraine York-EdbergLorraine York-Edberg, Western Mass. Regional Program Director

If you have Medicare, sometime during the month of August or September you will be receiving 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 will explain 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, 2020. 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 medications?

  • Did you get a letter from your Medicare Prescription Drug Plan that your plan is changing or 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, 2019, to access the medications you need without any problems.

  • Would you like to join a Medicare Prescription Drug Plan or Medicare Advantage Prescription Plan (HMO/PPO-Managed Care Plan)? Because you’ve never joined previously, you can do it during this time.

Starting October 15 through December 7, you can join, drop, or change your insurance, and the new coverage will begin on January 1, 2020.

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 to use the Medicare Plan Finder.
  • Look at your most recent “Medicare and You” handbook to see plans in your area; 2020 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.

blue stethoscopeMost 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 Initial Enrollment Period (IEP), (the seven months surrounding your 65th birthday- 3 months before, the month of, and the 3 months following).

  • 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 at www.ssa.gov

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, LifePath at 413-773-5555, or contact your local Council on Aging.

SHINE graduatesBack, Left to Right: Becky Paciorek, Buliah Mae Thomas, Laura Thorne, Leanne Dowd, Brianna Davis
Front, Left to Right: Linda Chastain, Theresa Bessette, Linda S. Talbot, SHINE Regional Program Director Lorraine York-Edberg, Carol Ball, Wanda Kelly
On Friday, June 7, 11 women graduated from the SHINE program at LifePath’s office in Greenfield. SHINE is an acronym for “Serving the Health Insurance Needs of Everyone” and that is just what these fantastic volunteers will be doing. As newly certified SHINE counselors, they 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. Lorraine York-Edberg, SHINE Regional Program Director, provided the intensive 60 hour training. “I have a greater respect for SHINE counselors because of the complexity and amount of information they have to learn,” said graduate Linda Talbot of Whately. “Lorraine is an excellent instructor, enjoyable and informative.”

Graduate Leanne Dowd of Greenfield said, “When it started, the training seemed overwhelming, but with the education from Lorraine and the materials provided, it became completely understandable.”

“She made it fun,” added graduate Wanda Kelly of Pelham.

Reasons for becoming a SHINE volunteer varied. Graduate Buliah Mae Thomas of Easthampton explained, “I’m a senior myself although I’m still working full-time. I wanted to give seniors and people with disabilities my knowledge after going through the program. I wanted them to have more knowledge than I had. I want to thank Lorraine for giving me the opportunity to be a SHINE counselor.”

“As newly certified SHINE Counselors, they 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.”

Each graduate received a rose, a datebook, and a certificate of graduation at the final class, before enjoying a potluck meal. York-Edberg said, “This was a great group of SHINE trainees. They have and will go above and beyond to assist the Medicare beneficiaries in our service area!”

If you have questions about Medicare options, you can consult with SHINE counselors over the phone or in person at your area senior center, in your home, or at another location that is convenient for you. The SHINE program (Serving the Health Insurance 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.

If you’re interested in becoming a SHINE counselor, contact Lorraine York-Edberg, Western Massachusetts Regional Director of the SHINE Program, This email address is being protected from spambots. You need JavaScript enabled to view it. or call 413-773-5555 x2275 or 978-544-2259 x2275.