Florida Health Insurance for Seniors

Every state in the U.S. has its own insurance program designed to provide state residents with information, advocacy, and in some cases, with insurance coverage. Within the State of Florida, the organization that provides elderly state residents with these services is SHINE. SHINE stands for Serving Health Insurance Needs for Elders.

What is SHINE?

SHINE is the Florida State Health Insurance Program, and is an organization powered by primarily volunteer efforts. It is administered through the Florida Department of Elder Affairs and provides older residents of the state, and their caregivers and family members, with information and assistance in a range of healthcare and insurance-related matters.

What does SHINE do?

SHINE’s main purpose is to help seniors understand insurance options and get the coverage they need. SHINE representatives can help you learn about the different insurance programs available. They can also help you determine which programs will make it possible for you to get the medical care you need, including everything from routine doctor visits and prescription medications to long-term, in-home or residential care in a nursing facility.

In addition to helping elders learn about and choose insurance coverage, SHINE representatives can help you fill people fill out applications and other forms for the different programs available. Some of the services SHINE provides include counseling and assistance with Medicaid, Medicare, Medicare supplemental insurances (like Part D, etc), prescription assistance programs, and long-term care insurance.

How to Get Help from SHINE

SHINE staff members provide help to seniors and their advocates in a number of ways. Individuals who need help can visit counseling sites. Each county has a dedicated number of locations at which SHINE staff regularly conducts onsite counseling for people in need of assistance. These sites can include community centers, senior centers, hospitals, and Social Security offices, to name just a few.

To find the closest site at which SHINE counselors are available, you can visit the SHINE website here.  Once on the site, you simply click on your county of residence to bring up a list of nearby counseling centers, including addresses and contact information. Or, you can call the main telephone line for SHINE, at 1-800-963-5337, for further assistance.

Counseling services are also offered by phone, and home visits can be arranged for seniors who are unable to get around easily. To get assistance by phone, you can call the main phone number for SHINE, listed above, or you can contact one of the county-based counseling centers listed on the SHINE website. You may also schedule a home visit by calling SHINE or contacting your local SHINE counseling center.

What are the Insurance Options Available?

Elder residents of the State of Florida have several insurance coverage options for which they may be qualified. These include Medicaid, Medicare, Medicare Supplemental Coverage, Long-Term Care Insurance and several
Prescription Assistance Plans.

SHINE is able to assist seniors in getting the coverage they need and can help elders complete all of the necessary applications and other paperwork for getting every form of insurance for which they are qualified. SHINE counselors can also help seniors understand the options that are available, including what’s covered, how each program works, and any costs that are associated with the different insurances. SHINE is committed to helping seniors make well-informed healthcare coverage choices and to helping seniors choose the best options to meet their specific needs.

More about Medicare

Medicare is federally funded health insurance for people age 65 and older, and for certain disabled individuals under age of 65. Medicare Part B is the most common form held by elders and provides medical coverage for doctor visits, diagnostic tests and other more routine services. Medicare also offers other types of coverage, like Part A, which covers hospitalization, Part C for managed care, and Part D, which is prescription drug coverage.

Understanding the different Medicare options available can be challenging for many older Floridians, but SHINE staff is available to help. They can assist you with learning about your coverage choices and help you determine which are best for you given your specific health care needs. SHINE representatives can also help you fill out your initial application for benefits. They can additional help you complete enrollment changes and plan adjustment paperwork during Medicare open enrollment periods.

More about Medicaid

Medicaid is a program which provides a range of resources, including medical coverage and other forms of assistance, to low income individuals of all ages. It’s administered by the Department of Children and Family, and offers several programs for seniors who are also receiving Medicare benefits.

To be eligible for Medicaid, you must also meet income requirements. Many elderly individuals have limited income and often have few other financial resources, like savings or other assets. SHINE staff can help you understand the eligibility requirements for Medicaid. They can also help you complete the application for Medicaid coverage. To learn more, you can contact SHINE’s Elder Helpline at 1-800-963-5337, or visit the Medicaid section of the SHINE website at http://www.floridashine.org/medicaid.html.

Medicare Supplemental Coverage

Medicare Supplemental insurance, which is also commonly called Medigap, is insurance offered by private companies, but which is still regulated by federal laws. Medigap plans are designed to work in conjunction with Medicare Part B and to fill in the “gaps” in that plan.

In other words, Medigap plans can pay the co-pay, deductible and other medical expenses that Medicare B does not pay. Some Medigap plans also pay for certain kinds of medical procedures and treatments that Medicare B does not cover at all. To learn more about Medigap, you can contact SHINE, or view the additional resources on the topic on SHINE’s website at http://www.medicare.gov/publications/pubs/pdf/02110.pdf.

Prescription Assistance Options

SHINE has a number of resources available for elders who need help paying for their prescription medications. These include state and federal resources as well as military and private prescription assistance programs.
Florida has a state sponsored Prescription Drug Discount Card. Medicare Part D is also an option for those elder Floridians who need prescription insurance coverage. More information on these and other prescription assistant and prescription insurance options can be found in the “Additional Resources” section at the end of this document.

Long-Term Care Insurance Programs

Long-Term Care Insurance provides seniors with assistance in everyday activities, including personal care needs, like dressing, bathing and other daily efforts which can become overwhelming or too difficult with time. Medicare, Medicaid and private insurances don’t typically pay for long-term care needs, which is the reason many individuals decide to purchase a separate insurance policy specifically to cover these potential issues.

Along with all the other insurance education and advocacy services that SHINE offers, the organization can also help elder Floridians better understand long-term care insurance options. SHINE can also assist seniors in choosing a plan which will provide the services they may one day require.

Additional Resources

  • Florida Discount Drug Card – designed to assist all Florida residents in getting discount prescription medications, the Florida Discount Drug Card is provided through a partnership between Envision Pharmaceutical Services and the State of Florida. For more information, call 1-866-341-8894 or visit http://www.floridashine.org/docs/FlaDiscountDrugCard.pdf.
  • VA Prescription Drug Benefits – Anyone who has served in the U.S. military and received an honorable discharge from service has access to discounted prescription medications through the VA Health Services programs. For more information, call 1-877-222-8387 or see the VA’s website at http://www.va.gov/healtheligibility/.
  • TRICARE – Another resource for discount prescription medications for former military personnel is TRICARE. To learn more about TRICARE and the TRICARE-for-Life (TFL) programs, visit http://www.tricare.mil or call 1-866-773-0405.
  • Community Health Centers – Discounted medical services are available for Medicare recipients at Community Health Centers located throughout the State of Florida. To find locations near your or to learn more about the services available, contact SHINE or see the resources listed with the Florida Association of Community Health Centers at http://echealthinsurance.com/florida-association-health-centers.pdf.
  • Rural Health Clinics – Elder Floridians who live in more isolated or rural areas can also find discounted medical services available at Rural Health Clinics located throughout the state. To learn more, contact SHINE or see the directory listing for Rural Health Associations in the State of Florida at http://www.doh.state.fl.us/workforce/ruralhealth/PDFs/RH_Networks_Directory_Feb2011.pdf.
  • Aging Resource Centers – Florida’s Aging Resource Centers help individuals age 60 and above understand the resources available to them and discover ways they can get the help they need with medical care, insurance, social services and other programs. To learn more, or to find a resource center near you, visit http://www.agingresourcecentersofflorida.org/ or see the listings at http://elderaffairs.state.fl.us/doea/arc.php#arclist.
  • Florida Department of Elder Affairs – The state agency responsible for monitoring and developing programs for Florida’s elderly population is the Department of Elder Affairs. There are many resources available on the Department’s website at http://elderaffairs.state.fl.us/.
  • ACHA Nursing Home Guide – The Florida Agency for Health Care Administration (ACHA) offers extensive resources for elder Floridians who are considering nursing homes. Find additional information at http://apps.ahca.myflorida.com/NHCGUIDE/.
  • Long-Term Care Provider Resources – While residential nursing care facilities are certainly among the list of long-term care options available, long-term care provides include more than just nursing homes. For more information on the different care providers available, check out the Florida Agency on Health Care Administration’s Long-Term Care Provider Resources page at http://www.floridahealthfinder.gov/seniors/long-term-care.aspx.
  • Long-Term Care Ombudsman Program – The Long-Term Care Ombudsman Program is an advocacy group that works to protect the rights of Floridians living in long-term care facilities like nursing homes and other residential care facilities. To learn more, call 1-888-831-0404 or visit http://ombudsman.myflorida.com.
  • Meals on Wheels – A national organization providing nutritional assistance and ready-made meals to seniors throughout the country, Meals on Wheels offers programs at local senior centers and other organizations and also delivers meals to private homes for those in need. To find the local Meals on Wheels programs in your area, visit http://www.mowaa.org/page.aspx?pid=253.
  • National Council on Aging – The National Council on Aging provides comprehensive resources for finding local help with medical issues, food assistance and other resources. Visit the “Benefits Check Up” website of the National Council on Aging at http://www.benefitscheckup.org/ to learn more.
  • National Institute of Health – Various information and educational resources for seniors can be found on the National Institute of Health’s website at http://nihseniorhealth.gov/.
  • Disaster Preparedness for Medicare Recipients – Medicare recipients have additional resources available to them in times of severe weather and other disaster-related emergencies. These include resources for getting prescription medications and other medical services during emergencies. To learn more, visit http://www.medicare.gov/Publications/Pubs/pdf/11377.pdf, or contact SHINE’s Elder Helpline at 1-800-963-5337.