The Cape Cod Chronicle: Help SHINES Through
The following was written by Elizabeth Van Wye of the Cape Cod Chronicle.
January 30, 2025
If you’ve ever been offshore when a fog bank rolls in, you have an inkling about how disorienting it can be to make Medicare decisions. Thankfully, expert, unbiased help is available — for free.
For many seniors, health insurance was a benefit provided by employers during their working years. According to Kristina Whiton-O’Brien, regional director of the Serving the Health Insurance Needs of Everyone (SHINE) program, when it comes time for Medicare decisions, there are a lot of options but not all are available here.
“Older adults are bombarded with TV ads, phone calls and mail advertising all kinds of Medicare benefits,” she said. “The reality is that many of the plans we see on TV are not available to residents on Cape Cod and the Islands.”
Facing our 65th birthdays, the reality hits. If we haven’t thought of it before, now is the time to make significant healthcare choices. A first step takes place three months before your 65th birthday.
Even though Medicare coverage starts the month of your 65th birthday, you are now eligible to apply.
That date is important, Whiton-O’Brien said, because you want to be sure you are eligible for Medicare and understand your options. Serving an average of 6,000 residents a year, SHINE has been a federal, state and county government-funded free Medicare counseling service since 1985, assisting new and current Medicare beneficiaries, explaining the available options and helping seniors enroll.
Help SHINEs Through
Trained and certified volunteer SHINE counselors are located at most councils on aging across Cape Cod, as well as at the Barnstable County Office. Do you want traditional Medicare or a Medicare Advantage program? Do you need a supplemental program? What about prescription drug coverage? Making the right choices can be complicated.
To break it into parts, Medicare Part A covers hospitals and inpatient care. Part B covers inpatient doctor’s services, outpatient medical care and other services like labs. Part D is drug plan coverage and part of original Medicare. Then you can add a supplement that covers uncovered Medicare fees, if your primary provider is Medicare.
You can decide if you want original Medicare (Parts A, B, and D) or a Medicare Advantage Plan (Part C) that combines A, B and D and offers some vision, hearing and dental coverage. Unless you are covered by an employer group plan past age 65, signing up for Parts A and B must be done at age 65 to avoid a penalty.
Are you still with us? Great! For those on original Medicare, choosing a supplemental plan involves a whole other round of choices. It’s a big decision and not all plans may be available in Barnstable County; SHINE can help you navigate that choice as well.
Medicare Advantage offers things that traditional Medicare can’t, like possibly vision and dental insurance or gym membership. The Advantage programs generally include a network of providers, which may be a narrower group than accepted by traditional Medicare. Co-payments may also differ in Medicare Advantage.
Deciding which option is best depends on a lot of things, Whiton-O’Brien stressed. “It’s a very personal decision and unique to everyone based on the person’s own medical needs and budgets,” she wrote. “In fact, some couples could even have different Medicare plans.”
Oct. 15 to Dec. 7 is the biggest rush for Medicare decisions. That’s open enrollment for recipients to make any changes they might want and when new pricing may be announced. Meeting with a SHINE counselor can help answer any questions and help the individual find the most cost effective plan for the next year.
The Medicare website and its plan finder are very good tools, she said. A counselor can either create a Medicare.gov account for the older adult or enter their prescription and pharmacy information. The plan finder will then generate a list of Part D drug plans and a list of Medicare Advantage plans that will be the most cost effective for the individual. Medicare.gov is an intuitive and user-friendly tool anyone can use at home with a computer.
That doesn’t mean you are necessarily stuck with your decision all year if something changes in your life. Perhaps you lost a job or you have moved. There are special enrollment opportunities during the year and SHINE is available to help navigate that process, too.
Although their services are limited to Medicare, SHINE also screens for Medicaid and the state’s version of Medicaid, MassHealth. In addition, referrals to other senior services, like fuel assistance or food stamps, can be made when necessary.
SHINE is an unbiased service working to help Medicare-eligible residents navigate the system, Whiton-O’Brien added. For more information about SHINE and Medicare, visit www.capecod.gov/departments/humanservices/ initiatives/shine or inquire at your senior center.
For more information about SHINE and Medicare, visit www.capecod.gov/departments/human-services/initiatives/shine or inquire at your senior center.
