Health Benefits Advocacy(the SHINE Program)

Summary
The SHINE (Serving the Health Information Needs of Elders) Program provides free health insurance information, assistance, and counseling to Medicare beneficiaries of all ages and others who have questions about insurance and public benefit programs.


Cost of service to client
Free

About the SHINE Program
HESSCO Elder Services’ SHINE Program staff and a network of certified volunteer counselors provide information about Medicare, Medigap, MassHealth, prescription drug programs, and other health assistance programs. People interested in talking with a SHINE counselor should call HESSCO Elder Services at (781) 784-4944.

To keep them abreast of the latest information, volunteer SHINE Counselors receive ongoing training and supervision from HESSCO’s SHINE Program Director.

Annual Election Period (AEP) November 15, 2008 through December 31, 2008
Once a year, Medicare allows enrollees to opt in or out of Medicare Part D and Medicare Part C, otherwise known as Medicare Advantage
Plans. Why does someone need to be aware each year of what is going on? Medicare Advantage and the Part D Plans have the option to change what they offer each year. Changes may come as a result of directives from Medicare, from previous years’ claims experience, or from a multitude of other issues. For any pending changes, a beneficiary should receive an Annual Notice of Change (ANOC). Most people will receive this document in November. People need to take the time to review changes.

2009 PRESCRIPTION ADVANTAGE PLAN CHANGES: Due to the current nationwide fiscal situation, and its impact on Massachusetts, it is necessary to impose significant budgetary restrictions on the Prescription Advantage program. These restrictions will result in changes to the assistance Prescription Advantage members receive with their co-payments. EFFECTIVE JANUARY 1, 2009, for members in categories S2, S3 and S4, Prescription Advantage will not provide co-pay assistance until members have reached the coverage gap (donut hole) with Medicare. In 2009, the coverage gap is reached when the total retail cost of a member’s covered prescription drugs is $2,700.00. Once the coverage gap is reached, Prescription Advantage co-payment assistance will begin at the same levels as 2008. For members with Creditable Coverage, co-pay assistance will also begin when the total retail cost of their covered prescription drugs is $2,700.00. Any questions about the impact of this change, call us at 781-784-4944.

Volunteer opportunities
Openings are available for volunteer SHINE Counselors. Volunteers receive training and certification from the Executive Office of Elders Affairs’ training staff. The training takes place at the HESSCO office where participants meet two days per week for a total of ten days. Following the initial training, counselors receive updates and ongoing training at monthly meetings. Counselors provide services at HESSCO’s SHINE office and/or in community settings.

Click here to access the Volunteer Application.

Thank you for taking the time to complete the volunteer application. Please mail completed application to:

HESSCO Elder Services
One Merchant Street
Sharon, Massachusetts 02067
ATTENTION: Peggy McDonough

Frequently asked questions

Q: Does the SHINE Program provide services only to Medicare beneficiaries?
A: No, we often assist family members who are trying to understand or help parents with their insurance coverage.

Q: How does a volunteer learn all the information needed to assist with such a complex topic as Medicare?
A: Volunteers complete an intensive 10-day training program that uses a variety of teaching methods, including classroom instruction, group problem-solving exercises, and case studies. They receive a comprehensive manual which becomes an ongoing resource.

Upon completion of the formal training, volunteers spend time with a mentor so they can become familiar with the types of questions and issues most commonly raised by beneficiaries. During this mentoring period, volunteers begin to provide services with the backup of a knowledgeable and experienced counselor at their side.

Volunteers have the opportunity to gain confidence in their knowledge of the material before they are asked to provide the services on their own. In addition, the regional director provides ongoing support and conducts monthly training meetings to keep counselors abreast of changes in Medicare and other insurances.

Q: What is the time commitment asked of volunteers in the SHINE Program?
A: Volunteers are required to complete the initial training, a total of ten days. The training usually runs from 10 am to 3 pm, two days per week. Training is conducted in the spring and fall each year. Following the formal training, counselors are asked to give 3-4 hours per week at a senior center, council on aging, or at the regional office. In addition, counselors are required to attend a two-hour monthly meeting.

Client snapshot
Mrs. Campbell called the SHINE office to inquire about Medicare’s coverage for home care services. She explained that her husband was in a nursing facility completing rehabilitation, but he wanted to return home. She was concerned that she would not be able to care for him at home unless she could get a significant amount of outside help.

The SHINE counselor explained to Mrs. Campbell that Medicare’s home health benefit was quite limited and would not provide all the help she needed. However, the counselor informed her of a program under MassHealth which would provide the personal care attendant services her husband required. The counselor helped her to complete the application and worked with her through the filing process with MassHealth.

Thanks to the information and assistance provided by the SHINE counselor, Mrs. Campbell was able to access the program that provided
the home care services her husband required so that he could safely return to his home, family and community.

Other helpful information
Medicare Prescription Coverage: What you need to know
This fact sheet tells about the new prescription coverage through Medicare, and explains what steps you need to take to enroll.

Click here for the fact sheet.