A 'critical service': Senior centers help local residents navigate complexities of Medicare coverage

Marion Aspinall has counseled people about health insurance for 30 years.

Now, she volunteers as a Medicare navigator at Attleboro's Larson Senior Center. Like many other communities, Attleboro offers help to seniors navigating Medicare and supplemental health insurance options.

How many people come to Aspinall feeling overwhelmed by their choices?

"Ninety-nine percent," she said. "Most people say they have no idea what's going on."

Pat Maguire also volunteers with Attleboro's Medicare Navigator program, which replaced the SHINE program used in most Massachusetts communities. SHINE stands for Serving the Health Insurance Needs of Everyone. Attleboro's program has five volunteers.

"They get a little overwhelmed," Maguire said of the seniors she counsels. "They'll talk to a neighbor who will tell them one thing, but what works for your neighbor might not work for you."

Advertising can add to the confusion.

"They receive all these ads in the mail saying that this company can provide you with complete coverage and save you money, but that's not necessarily the case," Aspinall said.

Time for an insurance checkup

Checkups are important for your health. If you have Medicare, they are important for your health insurance, too.

Medicare's annual open enrollment period began Oct. 15 and ends Dec. 7. Changes made during that period take effect Jan. 1, 2027.

Options for changing coverage after Dec. 7 are more limited, although some beneficiaries qualify for special enrollment periods. People enrolled in Medicare Advantage also have an opportunity to change coverage from Jan. 1 through March 31.

Aspinall and Maguire said changes to Medicare's website, including a requirement for a verification code when signing in, have created another hurdle for some seniors.

They said users often need help obtaining the code and sometimes encounter website outages.

"We find it's better early in the morning when the West Coast people aren't on it yet," Aspinall said.

Changes to prescription drug and Medicare Advantage plans could also complicate coverage decisions for 2027. Some insurers are discontinuing plans, while others are sharply increasing premiums, the Attleboro counselors said.

About 20,000 Massachusetts seniors will need to find new coverage after Blue Cross Blue Shield of Massachusetts decided to discontinue several Medicare Advantage plans for 2027, The Boston Globe reported.

The state's largest health insurer is also limiting enrollment in its remaining Medicare Advantage plans.

Private insurers offer Medicare Advantage as an alternative to original Medicare. The plans provide Medicare Part A and Part B benefits and usually include prescription drug coverage. Medicare serves primarily people 65 and older, but some younger people also qualify.

Blue Cross said it lost $275 million on its Medicare Advantage plans in 2024 and 2025, according to the Globe.

"It makes it more difficult choosing what's best for each person," Aspinall said.

"The stakes this year may be higher for people who don't compare plans during the open enrollment period," Juliette Cubanski, vice president and director of the program on Medicare policy at KFF, a nonprofit health policy research organization, told The New York Times. "You could definitely be leaving more money on the table."

People with original Medicare — Parts A and B — do not need to renew that coverage during annual open enrollment. But they should review any separate prescription drug coverage and supplemental insurance.

Start by reviewing notices about changes to current coverage. Medicare Advantage and Part D prescription drug plans must provide an annual notice of change by Sept. 30.

The notice explains changes to premiums, deductibles and other costs for the coming year. Beneficiaries should also check whether their plans will continue to cover their medications and whether their doctors and other providers will remain in their networks.

Medicare Advantage is not supplemental insurance. Medigap policies supplement original Medicare by helping pay certain out-of-pocket costs.

Attleboro's counselors said some seniors mistake notices about upcoming changes for notices that their current coverage has ended.

The counselors help them understand when changes take effect and what options they have during open enrollment.

Higher premiums?

The prescription drug insurance market, known as Part D, is changing following provisions in the Inflation Reduction Act of 2022 that capped annual out-of-pocket spending on covered drugs, The New York Times reported.

The cap has provided substantial relief to beneficiaries who take expensive medications for conditions such as cancer and multiple sclerosis. It also helps them plan for health care expenses.

In 2027, the annual out-of-pocket cap for covered Part D drugs will be $2,400, and the maximum deductible will rise to $700 from $615 in 2026. Premiums do not count toward the cap.

The Biden administration introduced a temporary subsidy program to limit premium increases as insurers adjusted to the changes. The Trump administration ended those subsidies for 2027, the Times reported, prompting concerns about higher costs.

Many beneficiaries will see premiums fall or increase only modestly if they keep their current plans, according to a KFF analysis. Others will face substantially higher premiums.

Some of the largest increases involve UnitedHealthcare's AARP-branded plans, which cover more than 2 million people, the Times reported.

Monthly premiums for AARP Medicare Rx Preferred will rise by at least $50 in all 50 states and the District of Columbia. Increases will exceed $75 in 37 states, though not in Massachusetts. AARP Medicare Rx Saver will raise monthly premiums by at least $50 in 33 states.

Coverage of GLP-1 drugs will also require careful review.

Medicare Part D can cover drugs such as Wegovy for certain approved medical uses, including reducing cardiovascular risk in eligible patients. Beneficiaries should check their plans' coverage rules and any prior authorization requirements.

Separately, the Medicare GLP-1 Bridge program provides eligible beneficiaries access to certain drugs for weight management. The program began July 1, 2026, and continues through Dec. 31, 2027, according to the Centers for Medicare & Medicaid Services.

The program operates outside Part D coverage. Eligible patients pay $50 a month for covered drugs, but those payments do not count toward their Part D deductible or annual out-of-pocket cap.

Help with the choices

Although Attleboro replaced SHINE with its Medicare Navigator program, its volunteers receive the same training as SHINE counselors. The city's counselors helped about 500 seniors last year.

Other area councils on aging offer SHINE counseling at their senior centers.

During open enrollment, counselors "are extremely busy," said Kelly Lee, Attleboro Council on Aging director. She urged seniors to schedule appointments soon.

Caregivers helping someone with Medicare may also benefit from an appointment.

Health care needs and personal circumstances change. Reviewing coverage each year can help beneficiaries find plans that better fit their medical needs and budgets.

SHINE counseling is free, and comparing plans can produce significant savings. Seniors should bring:

Their Medicare card.Their Medigap or Medicare Advantage insurance card, if applicable.Their Part D prescription drug plan card, if applicable.A current list of medications and dosages.

Those with a Medicare.gov account should also be prepared to sign in if needed.

Lee said the growing complexity of Medicare and the potential costs for people with limited incomes make the counselors' work a "critical service."

"The SHINE counselors are angels from above and are a key component of the senior center," said Karen Testa, director of the North Attleboro Senior Center.

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