By Debbie Gardner
dgardner@thereminder.com
Karen Fisk has been working as a volunteer SHINE (Serving Health Insurance Needs of the Elderly) counselor at the East Longmeadow Senior Center for over four years. Director of the HR department for Western Mass Elder Care before retirement, Fisk had a background in working with insurance plans, and said she “wanted to continue to do something that made a difference” when she stopped working full time. “Having worked in a home care setting and hearing the stories of elders dealing with health care Issues, when the opportunity to be trained as a SHINE counselor came up, I took the opportunity,” Fisk said.
With the Medicare Open Enrollment period in full swing in November, Prime reached out to Fisk for advice on how to evaluate current Medicare health insurance plans and what to consider when making any changes.
Here’s what she shared:
Q: We are in the 2024 Medicare Open Enrollment Period. What should everyone who has a Medicare plan - either Original Medicare with a supplement or an Advantage plan - be sure to do before the Dec. 7 deadline?
“It’s very important that you pay attention to the mailings from your current company, that is your Prescription Plan or Medicare Advantage plan. You should have received information regarding change in premium, change in benefits and/or change in drug formularies for 2025. There can be drastic changes in premium costs and drug formularies that can make a big, big difference, so be aware..
“After you’ve looked over the mailings, review your current situation and your current plan to see if it is still the best option. Even if you like your plan and do not like change…sometimes there are changes you are not aware of. You can do this review by using the Medicare.gov plan finder. This requires you to establish a Medicare.gov account. Using the plan finder gives you the opportunity to compare your current plan with other Medicare plan options. There are PPOs and HMOs in the Medicare Advantage plans, and original Medicare with Medigap – or supplemental insurance– plans available.
“Though many people are used to computers and can do this on their own, there are still people for whom the computer is not their friend. If someone wants assistance looking over their plan, they can get this by meeting with a SHINE councilor. Most senior centers have SHINE volunteers. These appointments, however, do fill quickly. Note: You must have Medicare Part A and Part B to be enrolled in any plan.
“If you decide to make an appointment to meet with a SHINE councilor be sure to:
“During appointments, SHINE councilors also screen your eligibility for other resources that may be able to assist with medical and prescription costs, so it is helpful if you know your current monthly income at the time of your visit.”
Q: If you decide to shop for new coverage, what are the key points to consider when comparing different plans? How can changes to your lifestyle, health or finances affect these decisions?
“If you decide to shop for new coverage, these are key points to consider:
Some plans may offer extra benefits.
“Many insurance plans offer flex cards or benefit cards – but it is more important to make sure your medical needs are met. Do you need to see providers and/or specialists more frequently? Are the providers, including hospitals, in your current plan? Do you need MRIs, CT scans, etc.? Does hospitalization seem likely? Look at coverage for those items
“Changes in lifestyle, health, or finances can also affect your choice of coverage. Married individuals do not need to have the same plan as their spouse because their needs may be very different. The beauty of open enrollment is that what you have now does not have to be forever…every year you can make changes that meet your current situation.
“Here’s a basic comparison between Medicare Advantage plans and Original Medicare:
Medicare Advantage plans have premiums from $0 to $245
Medigap or Medicare supplement plans
Q: If you feel you need help deciphering plan offerings, where can you turn for help before you make your decisions?
“Try and get an appointment with a Shine volunteer. Most senior centers have a SHINE councilor. If you are advised that there are no appointments available, ask to have your name put on a waiting list. You can also call the SHINE Regional Office to find out if they know of any senior centers with appointments. The SHINE Regional Office number is 413-750-2893.
“Also please, if you have an appointment with a SHINE counselor and cannot keep it, call the Senior Center and cancel it so that someone on the waiting list can be given the appointment.
