SHINE Counselor

S.H.I.N.E.

 

The SHINE (Serving the Health Insurance Needs of Everyone) Program 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 for Medicare, can meet with a counselor to learn about benefits and options available. A counselor will review programs that help people with limited income to pay health care costs.

 

Mattapoisett SHINE Counselor is available by calling 508-758-4110 and requesting the SHINE Counselor contact you.

 

How can a SHINE counselor help me?

SHINE counselors can answer your questions about Medicare and also help you make decisions about your benefits.

 

A SHINE counselor will help you:

Understand your insurance coverage

Find the right coverage for you

Find ways you can save money on your prescription drugs and health insurance

Help you apply for programs that will lower your costs

Select the Medicare prescription drug plan that covers your medications

Typical Questions for SHINE Counselors.

What does Medicare Pay for?

What is "Medigap" insurance?

Which Medigap policy is best for me? When can I buy a Medigap policy?

Where can I get help paying for my prescription drugs?

What is "Medicare + Choice" or a "Medicare Health Plan"?

How do I appeal a denial of service under Medicare or a Medicare HMO?

What do "balance billing" and "accepting assignment" mean?

Is an HMO better for me?

If I join a Medicare HMO, will I have to change physicians?

Does Medicare or Medigap insurance pay for nursing home or home health care?

Where do I go to apply for Medicaid?

Do I qualify for Supplemental Security Income ( SSI)

When can I sign up for Medicare Part B? Can I get help paying for the monthly premium? 

 

 

MassHealth coverage types for seniors and people who need long-term-care services

 

Learn about MassHealth coverage types for individuals age 65 years or older or people who needs long-term care.

Described below are the five MassHealth coverage types offered to eligible seniors and people of any age who need long-term-care services:  Standard, Family Assistance, Limited, Senior Buy-In, and Buy-In. When you complete a Massachusetts Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (SACA-2), MassHealth will determine which program or MassHealth coverage type you can get. MassHealth will give you the most complete coverage that you can get. Your eligibility depends on things like income, citizenship or immigration status, age, and special circumstances. You must be a Massachusetts resident to get any of these services. See the links on the right side of this page to learn more about eligibility rules and coverage limits and to apply for MassHealth.

 

MassHealth Standard

MassHealth Standard is the most complete coverage offered by MassHealth. It pays for a wide range of health care benefits, including long-term-care services.

Covered services

For MassHealth Standard, covered services include the ones listed below. There may be some limits. 

Inpatient hospital services

Outpatient services: hospitals, clinics, doctors, dentists, home health care

Medical services: lab tests, X-rays, therapy, prescription drugs*, dentures, eyeglasses, hearing aids, medical equipment and supplies 

Mental health and addiction services: inpatient and outpatient

Hospice services

Pharmacy services*

Transportation

Personal care attendant services

Long-term-care services 

Chronic disease and rehabilitation inpatient hospital services 

Adult day health and adult foster care

Care and services related to an organ transplant procedure (if approved)

Payment of Medicare cost sharing: Medicare Part A and B premiums and nonpharmacy Medicare copayments and deductibles

* If you're eligible for both Medicare and MassHealth, Medicare provides most of your prescription drug coverage through a Medicare prescription drug plan. This means you must choose and enroll in a Medicare prescription drug plan. If you don't choose a drug plan, Medicare will choose one for you. You may change plans at any time.

 

MassHealth Family Assistance

MassHealth Family Assistance is available to seniors who meet the income and asset rules for MassHealth Standard, but have an immigration status that keeps them from getting MassHealth Standard. Family Assistance pays for a wide range of health care benefits. Family Assistance doesn't pay for long-term care.

Covered services

For MassHealth Family Assistance, covered services include the ones listed below. There may be some limits. 

Inpatient hospital services 

Outpatient services: hospitals, clinics, doctors, dentists

Medical services: lab tests, X-rays, therapy, prescription drugs, dentures, medical equipment and supplies

Mental health and addiction services: inpatient and outpatient

Pharmacy services

Ambulance transportation for an emergency medical condition only

 

MassHealth Limited

MassHealth Limited coverage is available to people 65 and older who meet the income and asset rules for MassHealth Standard or MassHealth Family Assistance, but have an immigration status that keeps them from getting MassHealth Standard or Family Assistance. MassHealth Limited doesn't pay for long-term-care services. MassHealth Limited coverage is for emergency medical services only.

Covered services

MassHealth Limited covers only care for medical emergencies (conditions that could cause serious harm if not treated). Examples of covered services are listed below.There may be some limits. 

Inpatient hospital services: emergency services only

Outpatient hospital services: emergency services and emergency visits to emergency departments

Certain medical services provided by doctors and clinics outside of a hospital

Pharmacy services for treating an emergency medical condition

Ambulance transportation for an emergency medical condition only

 

MassHealth Senior Buy-In

If you have Medicare, you may qualify for help paying for your Medicare Part A and B premiums and nonpharmacy Medicare copayments and deductibles. Certain MassHealth Standard members may also get this benefit.

Covered services

Payment for Medicare Part A and B premiums and nonpharmacy Medicare copayments and deductibles.

 

MassHealth Buy-In

If you have Medicare and qualify for MassHealth Buy-In, MassHealth will pay for your Medicare Part B premium.

Covered services

Medicare Part B premium payment

To make an appointment to see Mattapoisett's Certified S.H.I.N.E. Counselor, call the Mattapoisett Council on Aging at 508.758.4110.