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Health Insurance Is Confusing and SHINE is here to Help.
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Frequently Asked Questions about Medicare D and Prescription Advantage
- What is the SHINE Program?
- What is a SHINE Counselor?
- How May a SHINE Counselor Help Me?
- Where Can I Find a SHINE Counselor?
- How Can I Become a SHINE Counselor?
- Helpful Links
- Contact SHINE
The SHINE program provides free, unbiased and up-to-date health insurance information, counseling and assistance to Medicare beneficiaries of all ages and their caregivers. The SHINE counselors help older persons (and younger disabled Medicare beneficiaries) understand their Medicare benefits and other health insurance options.
The SHINE program operates with one paid staff person and a team of committed volunteers trained and certified by the Executive Office of Elder Affairs in many areas of health insurance including Medicare, “Medigap” insurance, retiree insurance, and public benefit programs.
Community volunteers who are trained and certified by the Massachusetts Executive Office of Elder Affairs in many areas of health benefits. SHINE Counselors provide information on Medicare (Part A, Part B, and Part D), Medigap insurance, prescription drug coverage, retiree insurance plans, Medicaid and free or reduced cost health care programs.
How May a SHINE Counselor Help Me?
SHINE Counselors help Medicare beneficiaries understand their rights and benefits under Medicare and other health insurance coverage. Counselors may review present coverage, provide written comparisons of plans, protect Medicare beneficiaries from paying for bills they should not pay, and prevent paying for unnecessary duplicate coverage. Counselors also help with claim forms and applications. They will make referrals when appropriate.
Where Can I Find a SHINE Counselor?
SHINE counselors hold regularly-scheduled sessions at many Councils on Aging throughout Berkshire County and are available to serve homebound elders as well as provide telephone counseling.
For a list of local organizations participating in SHINE outreach events and a schedule for up coming SHINE meetings in your area,
To make an appointment to speak with a SHINE counselor call 413-499-0524 or 1-800-957-6557, and ask for the SHINE Program. We cannot guarantee that we will be able to assist walk-ins. Thank you for making an appointment or attending COA meetings in your area.
Frequently Asked Questions about Medicare D and Prescription Advantage
What is Medicare Part D?
Medicare Part D is a Medicare Prescription Drug benefit that is available to all Medicare Beneficiaries . Some of the costs associated with this new coverage include a monthly premium, an annual deductible, and a co-payment for each prescription.
If you decide you want Medicare Prescription Drug Coverage, enrollment begins November 15, 2007 and lasts until December 15, 2007. The earliest your coverage can begin is January 1, 2008. However, if you join the state's Prescription Advantage Program, you may join outside the open enrollment period.
Who qualifies for help with Medicare Part D premiums?
Individuals with incomes up to $15,315 per year (and liquid assets under $11,500) and couples with annual incomes up to $20,535 (and assets under $23,000). If your income or assets slightly exceed this level, you are encouraged to apply for extra financial assistance in any case, since it is often difficult to determine how the Social Security Administration will look at these figures. Please call SHINE if you need to receive an application for extra financial assistance with the Medicare D plan.
When will specific information on 2008 Medicare Part D plans become available?
In October 2007. This information will help you determine if your prescription drugs are covered in the new plans, find out which pharmacies the drug plans in your area are participating, and determine the monthly fees, deductibles and co-payments.
How do I sign up for Medicare Part D?
Open enrollment begins November 15, 2007. There are other "special enrollment periods" available for some individuals. Call SHINE to determine whether you qualify. Applications may be filed over the Internet, by phone or by mail. Individuals wishing to enroll in a Medicare D plan should click here to see a list of programs which are available for Berkshire County residents. N. B. If you are a legal resident of another state and spend a substantial (more than one month) time in Berkshire County, please contact a SHIP counselor in your home state for information. You should enroll in a Medicare D plan which will cover you in both states.
Special information for Prescription Advantage recipients:
Your Medicare Prescription Drug Plan is the primary payer for your prescription drugs. Prescription Advantage may help you with some of the costs associated with the Medicare Prescription Drug Plan you choose.
What if I have prescription drug coverage through retiree insurance from a former employer?
Your employer should notify you that your current prescription drug plan is “equal to or better than” Medicare Part D. (They may also use terms such as “creditable coverage” or “actuarially equivalent.”) If your current plan is creditable, then you do not have to sign up for a Medicare D plan. You should also make sure to keep a copy of the correspondence from your former employer.
What if I don’t have prescription drug coverage right now?
This is an excellent time to review both your Medicare and Medigap plans as well as your overall usage and payment for prescription medications. The Medicare D benefit is optional for beneficiaries; however, if you choose to access it after the initial enrollment period, you will be charged an extra premium for late enrollment. A conversation with a SHINE counselor can help outline the costs and benefits of enrolling in Medicare D so that your final decision will be an informed one.
By joining the state Prescription Advantage program, you have an opportunity to join outside the open enrollment period. Click here to access an application.
How Can I Become a SHINE Counselor?
Volunteer SHINE Counselors are the heart of this program. By becoming a state certified counselor, you will be an important member of the growing efforts to help Medicare beneficiaries understand their healthcare options. We invite you to find out more about SHINE and what you can do to help. If you would like to receive more information about becoming a SHINE volunteer, please call the SHINE program or e-mail us at shinedpt@esbci.org
Medicare www.medicare.gov
SHINE/ Prescription Advantage www.medicareoutreach.org
Social Security Administration www.ssa.gov
Elder Services of Berkshire County, Inc.
66 Wendell Avenue
Pittsfield, MA 01201
413-499-0524 or 1-800-544-5242
shinedpt@esbci.org