 I'm James Milan. Welcome to this episode of Talk of the Town. I am joined today by Mark Heumann, and Mark is a shine-lehi liaison. Now, you may wonder, what is that? We're going to get into that, don't you worry. More importantly, Mark is here to share with us changes to Medicare that are going to be taking effect this year, and that are likely to be real good news for folks who qualify here in Arlington and well beyond, obviously. So, we'll look to kind of dig into some of those changes, and we'll do that a little bit later in the conversation. But first, let me welcome you. Hello, Mark. Thank you, James. Thanks so much for being here. Yeah, no, we really do appreciate it. Great. And I wanted to ask you, we will get to discussing those changes, as I mentioned, but let's start just by finding out a little bit more about you and what brought you to this work, and what it is that you are impassioned about it. I used to work as a project manager for big computer projects. That was my career, and I retired about 10 years ago and thought, I want to do something that helps people, and I heard about the SHINE program. The SHINE program was to help people understand Medicare, to solve problems with Medicare, and so I said, oh, I'd like to volunteer for that, and they said, well, you can volunteer, but there's a 10-week training course, and I thought, do they think I'm stupid that I need 10 weeks to learn this? At the end of the 10 weeks, I said, can we have 10 more weeks? Interesting, right? I mean, that was one of the first peeling away of the onion layers there, right? And that's really, I guess, a reflection in a sense of just how complicated this work and explaining, this being able to explain and apply your knowledge. It's very complicated, and it doesn't necessarily make any sense, which makes it more complicated. And might not have even made sense if you had another 10 weeks as it turned out, although I assume you were not afforded that luxury. Right. So you got right to the work. I think that, to me, that's really interesting in and of itself, the fact that you had this whole long working career, which followed a similar trajectory to many of what many of us understand about our often white-collar jobs that are benefiting our employers, undoubtedly, and perhaps other sectors of the world. But the idea that you would retire at an age where you still had energy, still had that just the opportunity to really make a contribution to helping others. That was really my goal, and I think I've done it. That's wonderful, and that is really great to hear. So I mentioned at the outset and describing your job title, that you are a Shine Lehi liaison. You mentioned the program, Shine. We should talk about it a little bit so that we should make sure that people understand it. So I know that Shine stands for serving health insurance for every, or sorry, needs, serving health insurance needs for everyone. Correct. Love that. Love that for everyone, peace especially. Yes. So tell us a little bit about what the program, the organization actually is and does here in Massachusetts and beyond. Okay. Shine is actually nationwide, or the idea of helping people with Medicare and Medicaid is nationwide. Massachusetts piloted the program, not sure when, but in Massachusetts here we have probably over 600 volunteers working on Shine. Three of them are in Arlington, and Arlington is one of our bigger communities, and we have three excellent Shine workers here in Arlington, and we'll talk about them later. It's not totally easy to become a Shine volunteer. You have to take an exam every year to make sure that you're up to par on everything that's happening. You have to go to a meeting once a month where you'll learn whatever has changed that month, and we have a great group of volunteers in the Minuteman area, and I work in the Minuteman area for through Minuteman Senior Services, and they are a non-profit multi-service agency that helps elderly and disabled people. In a lot of different ways, I think, right, with information, with sometimes with food, you know, meals, meal deliveries, all kinds of things. All of that case management, and Shine is just one of their services that conduct through them. That makes sense, and I know from talking to you before we went on camera that, as you said as well, you know, as part of the interview, you've stated that Shine is a program that is available across the country, but that Massachusetts piloted it, and I noted in terms of the acronym how much I like that needs, you know, health needs for everyone. I understand, and I'm not going to ask you to tell me what the acronym stands for in other parts, but in the rest of the country, it doesn't even go by Shine. Right, it goes by SHIP. SHIP. Okay, so we'll just, we'll let you guys decide out there in the audience what that P stands for. Serving health insurance? Something. Right, program. Anyway, there you go. But I do think that I really do love that, the Shine acronym and what kind of, what lies beneath, what it means to say that you are, you know, truly serving the needs of everyone. And again, Medicare, Medicaid, these are programs that Americans of all ages know are absolutely sacrosanct to the way that we live and age in this country. And, you know, every time, just most recently out of Washington, every time one of these kinds of programs is threatened or people make noise about doing something that could affect those programs, the chorus is loud and clear. Absolutely. Right, that these things need to be protected. So I think everybody has that awareness of Medicare and Medicaid, but only when you get to my age, I'm afraid, or you might have aging parents that you're thinking about or something like that, only then do you realize both what a tremendous benefit Medicare and Medicaid are, but also how incredibly complicated and difficult to understand a lot of the requirements. And as you said, for Shine volunteers to have to actually attend a training each month, you said, just to figure out or just to find out, I guess, what changes might have transpired since the previous month. Correct. That sounds like Medicare. And I've been at Shine Counselor for 10 years. I've had people come to me and say, I have three PhDs and I don't understand any of this. Yeah. I've had lawyers come and say, how do I do this? Right. I mean, I think that as you said before about that 10 weeks of training and you thought, come on, I can learn anything. I can be trained, thoroughly trained in anything in 10 weeks. And then by the time you got to the end of it, you knew enough to know what you didn't know. And it does feel that way to a lot of us who, for me, for instance, I'm looking at the onset of Medicare coming soon. And I'm quite intimidated by it, just by the demands of trying to figure out which options to choose and then knowing what the implications of all that is for my actual healthcare, et cetera. So all of that is to say, I hope in the future we can have you back to explain Medicare itself more thoroughly. I'd be glad to do that. And also, I usually start out my conversations with people that I'm here to unconfuse you. Mm-hmm. Well, let's just start from that premise. Yeah, that is great. So, yeah, so why don't you, unless, well, we can talk a little bit more about SHINE as a program if you'd like, or we can get right into the changes that are transpiring this year that people should know about. What do you think? No, let's talk about SHINE a little bit. Great. As I said, there's probably 600 volunteers, three of them in Arlington, and sometimes if we need more, I'm pulled in. Mm-hmm. So I have done some work in Arlington. Where are you based out of? I'm based out of L.A. Hossville and Winchester Hossville. Okay. So we're Winchester, huh? Yeah. And the appointments, people can come and see a SHINE counselor at the Arlington Council on Aging. They need to call the Arlington Council on Aging and say, I want an appointment with a SHINE counselor. And let me tell you about some of the things that they can do. Mm-hmm. They want to, first of all, understand and explain insurance to you. It's complex, and it needs some gentle explanation. And patient, yes. And patience, because there's these different parts. There's part A, part B, part C, part D. And of course, they roll off the top of my head, but it won't mean anything to you until you know what they are. Yeah. So one of the things a SHINE counselor can do is find the right coverage for you, help you understand what it is that you need. And we spend a lot of time talking to people. Most people come in and say, my spouse is doing this, so I know what I want. Or my neighbor is doing this. And right away, we have to say, your health is different than your spouse's or your neighbor's. Your health is your own, and not everything fits into one category. So that's important for people to know. Yeah, because you've mentioned that, I'll just say that my sister and I have, in these last few years, because of caring for our mother, we have encountered a lot of what you're talking about. And I sure wish I had talked to a SHINE counselor at that time, seriously, because just like the PhDs and other folks that you were alluding to before, I'm a perfectly smart guy who spent his life with text. And it was very difficult to understand. And really sitting down with a person who could, like you say, gently and patiently listen to where I'm at, to what makes me a particular profile in terms of my health, and then be able to just say, no, here's what you, and eliminate all the rest of the stuff. What an invaluable service. And even many people read before seeing a SHINE counselor, Massachusetts is very unique. Massachusetts has rules that no other state has, and I consider them all better. That's great, but they are different. They are different. For example, most states have 10 ways to do what they call Medigap or to supplement Medigap. Massachusetts has two, and you only need two. And that's great. Yeah, these, again, we'll table this to some degree for that future conversation that really focuses on Medicare but I will say that that was the single largest decision that we had to make and also confusing peace was how to supplement. Because for most of us, we'll need to supplement what Medicare offers in some way and which of those to choose. Again, in Massachusetts, the fact that at least they brought it down to a choice of two is very helpful. So the other big thing that we do is prescription drugs that is a very complicated part of Medicare. We can help people figure out which is the best prescription health insurance to get because that's a separate Medicare insurance. And that can be very confusing. In, for example, Massachusetts has 26 different insurance companies that cover prescriptions. They all have their own formularies. They all have a different price. They all cover different drugs and have different costs, different amount for the same medication. So we can help with that. That's wonderful. You know, I'll just another aside mark, excuse me, but I sat at this very table not too long ago with Cindy Friedman, who is our state senator for this area, as she explained to me changes in prescription drug policy at the state level as part of a package that she was sponsoring as a legislator. And the end result of that conversation was me saying, are you serious that there is that much variability? And her identifying that as really one of the big challenges going forward for legislators is to uniformize this process and the prices, et cetera, to a much greater degree, which might put some shine volunteers, might make some of those meetings a little shorter. But undoubtedly, there will always be a need for shine. Right. And I'll talk about some of the changes in prescription insurance that's coming this year, coming this year and coming in the future years. Okay, great. But we can also help people lower their cost. We know almost everything about how to lower costs and that's very important to people. And we can help with billing questions. Sometimes there are need to appeal. We can help with that. So a shine counselor can do a lot of information. I know the Arnold Nixon shine counselors work hard with the community and they can help. And the best thing to do is call the council on aging, get an appointment, and they will speak to you and go from there. That's great. Excellent, excellent information for our population. All right, shine itself is clearly a program we can all benefit from. And again, it goes back to your original point in our conversation that you really wanted to spend these last number of years just directly being of service to others. And clearly I can see how that is the case for the work that you're doing. So let's talk, we've got about 10 minutes left or so. Let's talk about the changes that are forthcoming. Sure. Most of the changes are going to be about prescription drugs. There, the prescription part of Medicare wasn't passed till 2006. Before that, it wasn't part of Medicare. Wow. And it was passed with the idea that Medicare cannot negotiate the prices, which has of course led to this mirrored of what you were describing. Right. The 26 companies here in Massachusetts. Right. In this past fall, the president signed the Inflation Reduction Act, and in that act, there were several things that would change about prescription drugs. And they are phased in over a number of years. So this year, 2023, for the first time, people that need insulin will be charged no more than $35 per month for insulin, which is an enormous saving. Enormous. Yes. In addition to that, this year, all vaccinations are free. They're paid for by Medicare now. So, for example, the shingles vaccine, which had been costing people at least $100 or $200, will be free. Wow. Okay. So those changed one. Coming down the pike, though, next year, 2024, there will be some increases in what they call the extra help or low-income subsidy. More people will be eligible for that because they're raising the income level. So that won't happen until 2024. In addition to that, this gets complicated. Yeah, it's okay. At some point, you're paying for a prescription drug. It's usually maybe 25% of the cost of the drug. Then there's something called the donut hole, which actually was supposed to be gotten rid of, but it's still there. And after you pass through the donut hole, and these are all by how much you spend on medications, you are into what they call catastrophic coverage. And that cost 5% of the cost of the drug. Now, we have medications that are $20,000 a month. So 5% is still a lot of money. Significant hit, yeah. In 2024, we're getting rid of that. Once you hit that catastrophic coverage, it will be free. So each of the things that you've just mentioned pertaining to prescription drugs, at very least, will lower costs for people and or increase the number of people who are eligible for help of some sort with paying for this stuff. And in 2025, you will pay out of pocket no more than $2,000 a year for your prescriptions. And after that, it'll be free. No matter what. No matter what. So that's been enormous. And the year after that is when the government can start negotiating prices. And they have to start with 10 prescriptions, and they will start with the most expensive. And that gets added to every year so that we're finally in a place where the government can negotiate the price. And there's a lot of power on that because if you add up all the people that are taking a certain medication, we can absolutely lower the price. So that's very exciting. And that's all part of what the president signed this fall. Great. So costs will become for those who are eligible for or who need a prescription drugs for as seniors, they can expect that their prices that they'll be paying will be coming down each year until we get to a point you said about four or five years hence where 2,000 will be the limit and that will be that. And given, as you said, that there are a bunch of drugs out there on the market that can be $20,000 per month. All the ones that you see advertised on TV. There you go. What a thing to anticipate. Wow. Great. Is that the sum total of the changes? Those are the changes that were in the Inflation Reduction Act. Okay. Great. And while I have you, because I have another five minutes, I'm wondering the 10 years of work that you've done in this area, if you had yourself a little magic wand with the ability to kind of bewitch the legislative chambers down in Washington and get them to come up with some more changes to Medicare, what would be your choices? Well, Medicare has some things it does not cover. It doesn't cover dental, it doesn't cover hearing, it doesn't cover vision. Those seem to be important things. More and more people need hearing aids. More and more people have vision problems. It's a great point because hearing aids in particular are super expensive. They are super expensive. Again, referencing my own mother, her hearing aids which are in ear, they're kind of implants, but they're $5,000 a year. And so, yes, clearly. So part of what you would recommend or suggest or hope for would be that more things that are essential for folks would be covered. Dental is a lot of diseases that are caused by people not caring for their teeth. And so it should be, dentals should be covered. Yeah, I mean, you know, visual services, hearing services, dental services, clearly you never stop needing those, right? And in a lot of ways you need them even more because of the health implications that you were mentioning as you age. So definitely areas still to be worked on there. Anything else that would fit into your wish list for you? This isn't as much a wish list as what we have available in Massachusetts, which we call prescription advantage. Again, I'm talking about medications. And prescription advantage is unique to Massachusetts. It's run by the state of Massachusetts. It's income based, but it's a pretty high income. It doesn't look at assets, so it only looks at income. And it will help pay for your drugs if they get very expensive. But really what is unique about it is if you're a member of this and many people have the membership for free, the majority have it for free, we can change your prescription plan in the middle of the year. So no one else can do that, usually. And you might go along and say, well, I'm taking two or three medications. It's not costing me much. I'm not paying much. And all of a sudden you get sick in the middle of the year and you're stuck not being able to change your insurance. This allows you to change your insurance. So that's a fantastic Massachusetts program. And I assume then that you would love to see that extended to other areas. Yes. I mean other parts of the country. Yeah. Some other parts have something similar. But again, Massachusetts is the lead on a lot of us. All right. Well, this has been extremely helpful. And really, the fact that you have described both what Shine does and how accessible Shine counselors are, again, through the Council on Aging here in Arlington, and the reasons to speak to Shine counselors and how much they can help you through this kind of internecine labyrinth that is Medicare, that's wonderful in and of itself. But then also the fact that we can anticipate that prices are going to be coming down around really the most important piece in a lot of ways from our approach to things, the most important piece of elder care in a lot of ways, which is prescription drugs. You know, this is all quite good news. We really appreciate you coming here and sharing this with us. I had fun and enjoyed it. Good. I'm glad. And really, we just expect that the next time we talk to you, you'll have more good news for us, okay? Absolutely. No pressure. I have been speaking with Mark Heumann and he is the Shine, now you know what that is, Leahy Liaison. And he has joined us and we appreciate it very much. Thanks so much for your time. Thank you. Thank you for doing this work. Really appreciate it. So with our thanks to Mark and our thanks to you for joining us, I am James Malan. This is Talk of the Town. We'll see you next time.