SHINE: August 2024

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SHINE (Serving the Health Insurance Needs of Everyone)
Barnstable County Regional SHINE office
shine@capecod.gov
508-375-6762

Congratulations to three volunteers who have graduated from SHINE Volunteer Training! Doreen Anderson, Rachel Perry, and Ann Raymond, thank you!

MassHealth Members – Co-payment Rules Effective April 1, 2024

MassHealth members do not have to pay co-payments for prescription drugs. This policy includes members in the following:

  • MassHealth Fee-for-Service (FFS) plans
  • Primary Care Accountable Care Organizations
  • Accountable Care Partnership Plans (ACPPs)
  • Managed Care Organizations (MCOs)
  • One Care Plans
  • Senior Care Options (SCO) Plans
  • Program of All-Inclusive Care for the Elderly (PACE) Organizations
  • Health Safety Net (HSN) patients

The policy does not apply to Children’s Medical Security Plan (CMSP) members. These members must still pay co-payments. 

If your pharmacist charges you a co-payment, and you think they should not have, be sure to tell your pharmacist. If you have questions about the co-payment policy or need to report changes, like a change in your contact information, call the MassHealth Customer Service Center (CSC) at 800-841-2900, TDD/TTY: 711.

Getting Care in a Disaster or Emergency

As hurricane season approaches, please review emergency protocol. The rules for getting care may change for a short time in areas where one of these has happened:

  • The president has declared it an emergency or disaster. Visit the Federal Emergency Management Agency (FEMA), or call 1-800-621-FEMA (1-800-621-3362) to see if your area is affected (TTY: 1-800-462-7585).
  • A governor has declared it an emergency or disaster. Visit your state government’s website to find out if your area is affected.
  • The Secretary of the Department of Health and Human Service (HHS) has declared a public health emergency. Visit the HHS Public Health Emergency website. Or call us at 1-800-MEDICARE (1-800-633-4227), to find out if your area is affected.

Getting Drugs in a Disaster or Emergency

If you have Medicare drug coverage, and are in an area that’s been declared an emergency or disaster, contact your plan for help on:

  • Finding another in-network pharmacy nearby. An in-network pharmacy is a pharmacy that agrees to provide members of certain Medicare plans with services and supplies at a discounted price. In some Medicare plans, your prescriptions are only covered if you get them filled at in-network pharmacies.
  • Replacing lost or damaged drugs, or replacing a drug you couldn’t take with you when you evacuated.
  • Getting drugs at an out-of-network pharmacy when you can’t reasonably get to an in-network pharmacy.

Using in-network pharmacies:

  • You’ll be able to move most prescriptions from one in-network pharmacy to another, and back to your regular pharmacy when the emergency or disaster ends. If you need help finding the closest in-network pharmacy, contact your Medicare plan.
  • You’ll need to tell the new pharmacy the name of your regular pharmacy and the drugs you need refilled.
  • If you lost your plan membership card and don’t know your plan’s phone number, call 1-800-MEDICARE (1-800-633-4227) to get your plan’s contact information. TTY users can call 1-877-486-2048.

Using out-of-network pharmacies:

  • Contact your plan for information about their out-of-network rules.
  • When you buy your drugs at an out-of-network pharmacy, you’ll probably have to pay full cost for the drugs at the time you fill your prescriptions.
  • If you paid full cost for the drugs, save your receipts so you can ask your plan if it’ll refund you for your costs. (Note: You won’t get a refund for the out-of-network cost-sharing amount.) Ask your plan how to submit your claim.

Paying premiums in a disaster or emergency:

  • If you’re in a Medicare Advantage Plan (Part C), other Medicare health plan, or Medicare drug plan (Part D), you’re still responsible for paying your premium on time, even in an emergency or disaster. If you don’t pay your premium on time, your plan may disenroll you. 
  • You can make sure your premiums are paid on time by asking your plan to withhold your premium from your Social Security check, or by paying with electronic funds transfer through your bank.