Preparation tips for a “SHINE” consultation
By Margie Ware
As we look back on the year 2008 and the fact that we survived yet another Medicare D open enrollment period, we always want to learn from our experiences and see where we can improve our services and abilities.
First, please call ahead if you want to speak to a SHINE (Serving the Health Information Needs of Elders) counselor. Many of the things that SHINE counselors do can be done by phone. We save face-to-face appointments for people who have complex problems or are learning about the ins and outs of the Medicare system for the first time. Second, if you have problems with seeing, understanding or coping with paperwork, consider having a family member or friend sit with you while you make your call. Some of this information is fairly complex and often two heads are better than one. If you need an appointment, you may want to bring that person with you. Third, take some time to learn some of the basic pieces of information that you will be asked to provide. Because of our tight schedule, we are unable to take walk-in appointments. This important to remember, because there have been times when elders made an enormous physical effort to get to our office only to hear that they can’t meet with anyone without an appointment.
Your Medicare Claim Number is the number on your Medicare card. It is a white card with a red stripe and blue stripe at the top. Your Medicare number is often your Social Security number with the letter “A” at the end, but not always. The other pieces of information on your Medicare card are your Effective Dates of Hospital Part A and Medical Part B. Very few people know these dates off the tops of their heads. So please have your Medicare card in front of you when you call. If we are returning a call, we are happy to wait until to retrieve your card, because it makes our work a lot easier.
Your Prescription Advantage card is blue and white and contains your Member ID information on the card. Unfortunately, it does not include what category you are in with the program. If you belong to PA, please make an effort to learn what category you are in and write the information down for future reference. It saves additional calls to the PA office and allows us to give you much more individualized answers.
Mass Health membership information can be an even more complicated topic. Three different programs are run by Mass Health, and they are using a common application and redetermination forms. Mass Health Standard is for those with very limited incomes (under 100% of the Federal Poverty level (family of one $10,400, family of two $14,000) and assets under $2,000. The “Buy-In” program is for those whose incomes are under 135% of the Federal Poverty level (FPL) and who have assets under $4,000. The Health Safety Net is 400% of the FPL and there are no asset limits. Be aware that if you have been accepted into any of these programs, you do need to fill out a redetermination form every year. Ignoring it will remove the benefits that you receive.
Your Medicare D Prescription Drug Plan (PDP) is represented by a membership card from a private insurance company. Please know the name of this company. If you know your Member Identification Number, it is even more helpful. Please do not confuse membership in a PDP with membership in Prescription Advantage. Prescription Advantage is a supplement to Medicare Part D. It does not replace it.
So the “takeaway” message for this month is:
•Call first to see if you need an appointment or whether your questions can be answered on the phone.
•Know your Medicare ID number and your effective dates of Parts A & B.
•Know whether you are a member of Prescription Advantage and what category you’re in.
•Know which Medicare Prescription Drug Plan you belong to and whether you’re financially responsible for the premium.
Armed with this critical information, our conversations will be shorter, more effective and more efficient. We have counselors available at many senior centers and in our office in Pittsfield. Please do not hesitate to call Elder Services and ask for SHINE at 499-0524 or 1-800-544-5242 if you have questions about any aspect of your health insurance coverage.
Margie Ware is Elder Services’ Regional SHINE Program Coordinator.
