SHINE program is here to help Cape Cod residents enroll in Medicare

Beverly Travis, 76, had a chance to meet SHINE counselors while working for the Visiting Nurse Association, several years ago. Inspired by the work they do, Travis started her own journey as a SHINE counselor at Bourne, five years ago. For her, it is a enjoyable and incredibly rewarding experience to be able to provide clients with real assistance.

Navigating the health insurance system, especially Medicare can be time consuming and confusing. Medicare has an open enrollment period that starts on Sunday and ends on Dec. 7.

For Cape Codders and other Bay State residents, the federally funded SHINE program is available to help with navigating this complex system.

What is SHINE?

SHINE stands for "Serving the Health Insurance Needs of Everyone," a program that provides free health insurance information and counseling to all Massachusetts residents with Medicare and their caregivers.

People who have Medicare, or who are about to become eligible, can meet with a counselor to learn about their benefits and options. Counselors usually review programs that help people with limited income to pay health care costs.

SHINE started in the state in 1992. Early on, the Chatham Council on Aging had a small SHINE program that moved to the Yarmouth Council on Aging before Barnstable County took over in 2014.

“We provide free, unbiased counseling related to Medicare and health insurance options for those who are 65 and older, as well as anyone under 65 who have disabilities,” said Kristina Whiton-O'Brien, Barnstable County's SHINE program manager.

Who can benefit from the SHINE program?

The SHINE program is strictly for Medicare beneficiaries; however, a counselor can screen for eligibility for some programs as Mass Health, Medicaid eligibility for programs that can help pick up some costs.

“These are mostly savings programs that can supplement and help people pay for premiums or copays or coinsurance, and it can all be a little bit confusing,” said Whiton-O’Brien.

That’s where SHINE counselors come in.

Who are the SHINE counselors?

“We have about 70 volunteers who are located across Cape Cod and the Islands and the majority of our volunteers are people who are living in the community,” said Whiton-O'Brien.

Most of the counselors are retired and looking to give back to the community.

“Many people feel like Medicare is very confusing and then, once they finally understand it, they realize that it's a unique set of skills and knowledge they really want to help others with,” she said.

Counselors volunteer anywhere between three and 15 hours per week, at the senior center or at a Council on Aging office in their town. Once a volunteer applies to be a counselor, they attend a 40-hour training program. After the training, they have to take a certification test.

Once they pass, they can start their mentoring sessions with someone at the Council on Aging where they live during summer and then they're typically ready to start working as counselors by September, which is just in time for open enrollment.

It's an unpaid volunteer position throughout the year. A small percentage of the counselors are from organizations like elder services, hospitals and other community organizations that have their staff trained as a SHINE counselor as well.

"Every SHINE counselor would say that they love their job and the people we help are gracious and grateful," said Joanne Crowley, 73, a SHINE counselor, based in Chatham.

Crowley signed up for SHINE training eight years ago, after seeing an advertisement at the paper. Since then, she has been loving her 'outstanding and priceless' job as a SHINE counselor.

Understanding the basics of Medicare system is helpful before enrolling.

Medicare has four parts.

Part A pays for in-patient hospital care, skilled nursing, and home health care and there’s no monthly premium for those who paid in for at least 10 years through paycheck deductions.

Part B covers outpatient medical services, such as visits to doctors and emergency rooms, tests, and procedures. The patient will be billed quarterly for Medicare premiums until they start receiving Social Security. The premiums are then deducted from the Social Security check.

Parts A and B are called basic or original Medicare, covering 80 percent of medical costs.

Patients also have the option of buying a wide range of Medicare Advantage plans from Medicare-approved private insurers under Medicare Part C, which was intended to provide more efficiencies and cost savings to retirees.

Those who opt for Advantage plans get their hospital and medical insurance — and often other benefits such as medicines, eyeglasses, or dental coverage — through plans administered by health maintenance or preferred provider organizations.

Members must still pay their Part B premiums, even though doctors’ visits are covered through their Advantage plans.

Medicare Part D allows beneficiaries to purchase prescription drug plans, also from private insurers. These plans also carry premiums.

The best time to enroll for Medicare is during the open enrollment period.

People can sign up for Medicare as early as three months before the month they turn 65, or as late as three months after.

During the open enrollment period, clients can switch from basic Medicare to Medicare Advantage, or vice versa, or buy or change prescription drug plans.

If someone is still covered by their employer or spouse’s insurance, they can delay enrolling without penalty. However, everyone should enroll in Medicare Part A even if they’re still on an employer’s plan because it sets them up in the Medicare system. And because of the contributions throughout their work life, there’s no premium for hospital coverage.

Since there’s no premium for Part A, there’s no penalty for missing the Medicare enrollment deadline. But if anyone is late to enroll in Part B, which covers doctors’ visits and tests, they are subjected to a late penalty premium for the rest of their life of 10 percent for each year of the delay.

On a similar rule, missing the deadline for Medicare Part D, prescription drug coverage, has a late penalty premium of 1% monthly, amounting to 12% for the first year. Again, if someone’s still getting their insurance through work, they can delay enrollment without incurring a fine.

For Cape Codders, enrolling can be even more difficult.

Since there are only certain plans that are available on the Cape and Islands, compared to other parts of the state, for Cape Codders options can be limited.

“That’s why during the seven-week period of open enrollment, people can come in and check their Part D drug plans and typically what happens is those premiums can go up because the price of drugs is always fluctuating,” said Whiton-O'Brien.

The Medicare Advantage Plans change year to year and it is important to come in and check the premium costs every year to make sure that they are covered.

According to Crowley, most clients are concerned with fluctuating drug prices, lack of dental coverage via Medicare and lack of primary care providers on the Cape.

“People can get confused because there are a lot of advertisements of different plans and incentives around,” said Whiton-O’Brien. “It's important for people to double check to see if those plans have doctor networks here on the Cape. They can always reach out to us or book an appointment at the County office, we are here to help.”

Rasheek Tabassum Mujib writes about healthcare and education. Reach her at rmujib@capecodonline.com.

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This article originally appeared on Cape Cod Times: SHINE program helps Cape Codders enroll in Medicare services.