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Written by Lorraine York-Edberg, Western Mass Regional SHINE Program Director

Published: April 7, 2017

Medicare Buy-In programs help save money

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

Medicare 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. 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: $1,025 monthly and less than $7,390 in assets
  • Couple: $1,374 monthly and less than $11,090 in assets

• SLMB is at 120 % Federal Poverty Level as follows for an:
  • Individual $1,226: monthly and less than $7,390 in assets
  • Couple $1,644: monthly and less than $11,090 in assets

• QI-1 is at 135% federal Poverty Level as follows for an:
  • Individual: $1,377 monthly and less than $7,390 in assets
  • Couple: $1,847 monthly and less than $11,090 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 QMB, this program will pay for your Part A (Hospital insurance) deductible and Part B annual deductible of $183 annually. The 2017 Part B standard premium is currently $134 monthly and the hospital deductible is $1316 for each hospitalization.

If you are eligible as a SLMB or 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, which they can send 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 help.

The SHINE program, (Serving the 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.

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Written by Lorraine York-Edberg, Western Mass. Regional SHINE Program Director

Published: March 3, 2017

SHINE Volunteer Spring Training 2017 begins April 26!

SHINE Program Director Lorraine York-EdbergIf you’re interested in healthcare and looking for a volunteer opportunity, consider signing up to become a SHINE Counselor with LifePath. With the 2017 Spring Training coming up in a few weeks, there’s 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.

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 mental 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,” says Lorraine York-Edberg, Western Regional SHINE Program Director. This year’s training will address changes that have taken place in the past year.

The 2017 Spring Training is set to take place at LifePath from 10 a.m. to 3 p.m., with a break for lunch, beginning on April 26, 2017. 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 Lorraine York-Edberg, Western Regional SHINE Program Director, at 413-773-5555 x2275 or 978-544-2259 x2275 or 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.

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Written by Lorraine York-Edberg, Western Mass. Regional SHINE Program Director

Published: January 12, 2017

Special Enrollment Period into Medicare Part B with penalty waived

Lorraine York-Edberg

Did you choose not to enroll in Medicare Part B when you became eligible, because you mistakenly believed that you could continue with Marketplace coverage with subsidies?

Many people newly eligible for Medicare thought it would be cheaper to remain in the Marketplace with subsidies, rather than pay Part B premiums, but did not realize that their Medicare Part A eligibility made them ineligible for premium subsidies, also called Advance Premium Tax Credits (APTC). When they realized their mistake, they were past their initial enrollment period and could only enroll in Part B during a General Enrollment Period, often incurring Part B late enrollment penalties.

For a limited time, you can also apply for equitable relief that will give you a Special Enrollment Period to enroll in Part B. In addition, Part B late enrollment penalties will not apply.

CMS (Centers for Medicare & Medicaid Services) has mailed notices to individuals 65 and over in this situation, advising them to drop Marketplace coverage and enroll in Part B instead.

THE DEADLINE FOR APPLICATIONS IS MARCH 31, 2017.

SSA (Social Security Administration) and CMS are not publicizing this equitable relief opportunity, and it is not discussed in the notice.

Individuals who received the notice, those who have concerns about not having Marketplace subsidies even if they did not receive a notice (or lost it), or those who received misinformation about qualifying for tax credits should contact the Social Security Administration to apply for equitable relief.

Individuals should apply if they had any confusion and misunderstanding about the availability of tax credits or how their Medicare eligibility affected them.

Individuals should submit any information or documentation they have on how they learned that the subsidies would not apply and/or why they had thought they could continue subsidies. Any letters (including the notice referenced above), emails, notes from conversations, information about problems for a Late Enrollment Penalty, or other information that might be relevant should be included. For this relief, it is not necessary that the source of confusion be directly from a federal employee.

Consumers with questions should be directed to the Medicare Rights Center helpline where counselors can assist with questions. The helpline number is 1-800-333-4114. For a fact sheet regarding Equitable Relief and sample letter to Social Security, click here.

This article was written in cooperation with Justice in Aging.

More information about the SHINE program

For more help understanding your prescription drug options and other questions pertaining to Medicare, contact the SHINE (Serving the Health Insurance Needs of Everyone) program at LifePath for free, confidential, and unbiased health insurance counseling. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555. Learn more about SHINE online.

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Written by Lorraine York-Edberg

Published: July 13, 2016

Medicare’s free preventive services

Lorraine York-Edberg, Western Mass. Regional SHINE Program DirectorMedicare over the past 20 years increased the benefits to help prevent illness through preventive care services. An important goal for Medicare is to help people stay healthy by encouraging prevention.  Medicare provides and pays for a number of preventive services through Part B. Many of these services are free, whether you have traditional Medicare or a Medicare Advantage plan, like an HMO.

Some of the free services include:

• Abdominal aortic aneurysm screening
• Colorectal cancer screening (including colonoscopies)
• Mammograms
• Pap tests and pelvic exams
• Bone mass measurements
• Cardiovascular screening
• Flu and pneumonia shots
• Alcohol misuse screening and counseling
• Depression screening
• Obesity screening and counseling

There are rules that state when and how often Medicare will pay for the above services. Medicare also covers a “Welcome to Medicare” visit and “Annual Wellness Visits” in following years. However, these visits are not the same as an annual physical exam. Annual physicals are not covered by Medicare, but they are covered by Medicare Advantage plans. For a complete list of free preventive services, go to www.medicare.gov or see a SHINE counselor. 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.