Frequently Asked Questions

How does Medicaid work with Medicare?

When someone has Medicare there is the possibility that they may also be eligible for a form of Medicaid often referred to as QMB.

Do you qualify for Medicaid and Medicare? If so, you can benefit from both.

What is the Medically Needy program?

The “medically needy program” is a Medicaid program for people who have too much income or assets are over the limits for Medicaid, Some people call it the “share of cost” program. The Department of Children & Families (DCF) determines eligibility for the Medically Needy Program.

Under Medically needy or “Share of Cost” Each month certain medical expenses you owe or have paid are counted toward your share of cost. When your allowable medical expenses are equal to your share of cost, you are eligible for Medicaid for the rest of that month.

What is the best Advantage plan?

This, or some variation, is often the first question out of someone’s mouth when then come to our desk.

“Just tell me the BEST plan,” Or “What is the BEST plan?”

Our response is usually the same: there is not really a best plan. Some companies’ service offerings are better than others but there can’t really be a best plan that would fit everyone. There are a number of things to consider when selecting the plan that best fits your income and lifestyle.

What supplement should I get?

This is a common question we get asked almost every day. As if there is one supplement that is perfect for everyone. If you’ve spoken to a Shine volunteer you probably got the standard answer.

“Get an F supplement.”

That about the only answer I’ve ever heard anyone ever receive if they went to Shine for advice. So, is the F plan the right Plan for everyone?

Why was my claim denied?

People often are quick to blame an insurance company for any problem or claim denial.

Is it really the insurance company? Sometimes, but much more often is either the beneficiary submitting something incorrectly or the doctors office staff doing something incorrectly.

What do we mean? Here are some common pitfalls when submitting your claims and dealing with doctors.