Are you having trouble loading this page? Click here to view a text-only version.

handoff2.jpg
couple.jpg
golf-center.jpg
handoff5.jpg

SHINE: Serving the Health Insurance Needs of Everyone

Medicare Buy-In Programs help save money

Lorraine York EdbergLorraine York-Edberg, Western Mass. Regional SHINE Program DirectorMedicare Buy-In Programs, also called Medicare Savings Programs, can assist low-income Medicare beneficiaries pay their share of the Medicare Part B premium, which is currently $121.80 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 (FPL) as follows for:
    • An individual: $1,010 monthly and less than $7,280 in assets
    • A couple: $1,355 monthly and less than $10,930 in assets
  • SLMB is at 120% FPL as follows for:
    • An individual: $1,208 monthly and less than $7,280 in assets
    • A couple: $1,622 monthly and less than $10,930 in assets
  • QI-1 is at 135% FPL as follows for:
    • An individual: $1,357 monthly and less than $7,280 in assets
    • A couple: $1,823 monthly and less than $10,930 in assets

These programs has not been 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. LIS will also assist with covering drugs during the Part D deductible and coverage gap.

If you are eligible for QMB, this program will pay for your Part A (hospital insurance) deductible and Part B annual deductible of $166 annually. Part B premium is currently $121.80 monthly, and the hospital deductible is $1,288 for each hospitalization.

If you are eligible for SLMB or Q I-1, these programs will pay for your Part B (medical insurance) premium which is currently $121.80 per month.

To apply, the easy, one-page application is simple to fill out. 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 help.

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.

Spring Training 2016 begins April 7!

Lorraine York EdbergLorraine 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 2016 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 2016 Spring Training is set to take place at LifePath from 10 a.m. to 3 p.m., with one hour for lunch, beginning on April 7th, 2016. Participants will meet weekdays for 13 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.

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.

Medicare Open Enrollment begins October 15

Lorraine York-EdbergLorraine York-EdbergIf you have Medicare, sometime during the month of September you will be receiving important information known as an Annual Notice of Change. It will be sent to you from your Prescription Drug Plan or your Medicare Advantage Plan. The mailing will explain any changes to your plan in the coming year regarding premiums, drug coverage (formulary), providers, and restrictions. It is very important to review the letter to make sure the plan still works for you. This is the time when you can join, drop, or change your insurance, and the new coverage will begin on January 1, 2016.

Important things to consider when reviewing your plan changes are: Does it still cover all your medications? Did you get a letter from your Medicare Prescription Drug Plan that your plan is changing? If you’ve been reassigned to a new plan, contact the new plan to assure it will cover your current medications. If not, you must switch before December 7, 2015. Also, if you’ve never joined a Medicare Prescription Drug Plan (Part D), 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 a chance 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 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; 2016 books will be 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 an Annual Open Enrollment Presentation.

Find a SHINE Annual Open Enrollment Presentation near you

Lorraine York-Edberg, Western Massachusetts Regional SHINE Program Director, will hold presentations on the Annual Open Enrollment at the following locations:

  • Monday, September 28, at 6 p.m.
    The Senior Center, 7 Main Street, Shelburne Falls, MA
  • Tuesday, October 6, at 11:30 a.m.
    Northfield Senior Center, 69 Main Street, Northfield, MA
  • Tuesday, October 20, at 1 p.m.
    Greenfield Council on Aging, 54 High Street, Greenfield, MA

The SHINE program, Serving the Health Insurance Needs of Everyone, provides free, confidential, and unbiased health insurance counseling for Medicare beneficiaries. 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. A complete list of local sites is available here.