Social Services

Senior Monongalians is fortunate to have two wonderful Social Services workers, Sue and Melissa,  assisting seniors and their families. Melissa and Sue work with clients to understand & enroll for Medicare Part D, finding answers to Social Security questions, directing clients to utility assistance programs, senior housing options, and much more.

Article posted August 20, 2010

Xc  What Questions Should I Ask

Before Joining A Medicare Private Health Plan?

A.  Doctors, Hospitals and Other Health Care Providers

• Will I be able to use my doctors? Are they in the plan's network and are they taking new patients who have this plan?
• Do my doctors recommend joining this plan?
• Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan's network?

B.  Access to Health Care

• Who can I choose as my Primary Care Physician (PCP)?
• Does my doctor need to get approval from the plan to admit me to a hospital?
• DoI need a referral from my PCP to see a specialist?

C.  Benefits

• What extra benefits does the plan offer? What rules do I have to follow to get them?
• Physical exams
• Dental services
• Vision care
• Hearing aids
• Are my prescription drugs on the plan's formulary (list of covered drugs)?
• Does the plan require that I get “prior authorization” before my prescription will be covered, or impose other restrictions (like limiting the quantity or requiring that I try a cheaper medication before it will cover a more expensive one)?

D.     Cost

·         How much is my monthly premium?

·         How much will I have to pay out of pocket before coverage starts (what is the deductible)?

·         How much is my copayment for a visit with my PCP or a visit with a specialist?

·         How much will I pay for brand-name drugs? How much for generic drugs?

·         How much will I pay if I use a non-network doctor or hospital?

·         Are there higher copays for certain types of care, such as hospital stays or cancer treatment?

·         Is there an annual out-of-pocket maximum? (After you spend a certain amount will your care be free or very low-cost?) Are all services included in the out-of-pocket maximum?

E.  Service Area

• What service area does the plan cover?
• What kind of coverage do I have if I travel outside of the service area?

Taken from: www.medicareinteractive.org

Posted June, 2010

Closing the Prescription Drug Coverage Gap

You Could Be Eligible For

A $250 Rebate This Year

 to Help with your Medicare Drug Costs

The Affordable Care Act passed by Congress and signed by President Obama this year contains some important benefits for Medicare recipients.

If you have Medicare prescription drug coverage, and aren’t already getting Medicare Extra Help, Medicare will automatically send you a one-time $250 rebate check after you reach the coverage gap (also called the “donut hole”) in 2010. This rebate is the first step toward closing the Medicare prescription drug coverage gap.

What is the coverage gap and how will I know if I’ve reached it?

Most Medicare drug plans have a coverage gap. This means that after you and your plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your drugs (up to a limit).

The Explanation of Benefits notice, which your drug plan mails to you each month when you fill a prescription, will tell you how much you’ve spent on covered drugs and whether you’ve entered the coverage gap.

Will I need to do anything to get this rebate check?

No. There are no forms to fill out. Medicare will automatically send a check that’s made out to you. You don’t need to provide any personal information like your Medicare, Social Security, or bank account numbers to get the rebate check. Don’t give your personal information to anyone who calls you about the $250 rebate check. Call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

When will I get the rebate check?

If you reach the coverage gap this year and enter the Part D “donut hole”, you will receive a one-time $250 rebate check if you are not already receiving Medicare Extra Help.  These checks will begin to get mailed to beneficiaries starting in mid-June.

Checks will be mailed monthly throughout the year as beneficiaries enter the coverage gap. However, this is a one-time benefit and beneficiaries who qualify will only receive one check after they reach the coverage gap.

What if I don’t get the rebate check when I should?

Beneficiaries who hit the donut hole after the program has begun should expect to receive their check within 45 days. Your rebate may be delayed if Medicare doesn’t have information from your Medicare drug plan showing that you reached the coverage gap in time to include you in the next mailing. You should call your Medicare drug plan to make sure all of your information has been sent to Medicare.

If you don’t get your rebate check, contact Medicare. Individuals receiving Medicare Extra Help will not receive a rebate check.

You can also check to make sure Social Security has your correct home address. Call 1-800-772-1213 or your local Social Security office. TTY users should call 1-800-325-0778.

What’s Next ….Coming in 2011

If you reach the coverage gap in 2011, you may get a 50% discount on your brand name prescription drugs at the time you buy them. Stay tuned for more information from Medicare.

Closing the Prescription Drug Coverage Gap

Presented by: The Centers for Medicare and Medicaid Services

Posted May, 2010

SERVICES NOT COVERED BY MEDICARE

Original Medicare does not cover all health care services.  Some of the services that are not covered by Original Medicare include:

• Alternative medicine, experimental procedures and acupuncture
• Most care received outside of the United States
• Most dental care
• Hearing aids or the examinations for prescribing or fitting hearing aids (except for implants to treat severe hearing loss in some cases)
• Cosmetic surgery (unless it is needed to improve the function of a malformed part of the body)
• Personal care or custodial care, such as help with bathing, toileting and dressing (unless homebound and receiving skilled care), and nursing home care (except in a skilled nursing facility if eligible)
• Housekeeping services to help you stay in your home, such as shopping, meal preparation and cleaning (unless you are receiving hospice care)
• Non-medical services, including hospital television and telephone, a private hospital room, canceled or missed appointments, and copies of X-rays
• Most non-emergency transportation, including ambulette services
• Some preventive care, including most routine physical examinations and tests, immunizations, and routine foot care and eye care
• Transportation, except for medically necessary ambulance services
• Most vision (eye) care, including eyeglasses (except when following cataract surgery) and examinations for prescribing or fitting eyeglasses

Although Original Medicare does not cover these services, a Medicare private health plan may cover some of them. Check with your plan to see which, if any, they cover. Remember, too, that even if services are covered, Medicare typically does not pay100 percent.  Unless you have supplemental insurance, you will have to pay premiums, deductibles and coinsurances.

Taken from www.medicareinteractive.org

EXTRA HELP WITH THE MEDICARE PRESCRIPTION DRUG PROGRAM

Under a new law, more Medicare beneficiaries could qualify for Extra Help with their Medicare prescription drug plan costs because some things no longer count as income and resources.

Who Can Get Extra Help?

Anyone who has Medicare can get Medicare Part D prescription drug coverage. Some people with limited income and resources are eligible for Extra Help to pay for the costs (monthly premiums, annual deductibles, and prescription co-payments) related to a Medicare prescription drug plan. To qualify for Extra Help:

• You must reside in one of the 50 states or the District of Columbia.
• Your resources must be limited to $12,510 for an individual or $25,010 for a married couple living together. Resources include such things as bank accounts, stocks, and bonds. The Social Security Administration (SSA) does not count your house and car as resources; and
• Your annual income must be limited to $16,245 for an individual or $21,855 for a married couple living together. Even if your annual income is higher, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse:
• Support other family members who live with you;
• Have earnings from work; or
• Live in Alaska or Hawaii.

Why Will It Be Easier To Qualify For Extra Help?

Under a new law, more Medicare beneficiaries could qualify for Extra Help with their Medicare prescription drug plan costs because some things no longer count as income and resources.  Beginning January 1, 2010, when determining your eligibility for Extra Help, Social Security will no longer count as a resource any life insurance policy; and it will no longer count as income the help you receive regularly from someone else to pay your household expenses—food, mortgage, rent, heating fuel or gas, electricity, water, and property taxes.  If you already receive Extra Help, you will not need to reapply in 2010.  However, if you applied for Extra Help in the past and were denied help because you had a life insurance policy or because someone helped you pay for household expenses, you should apply again.  To apply, visit your local Social Security office or call Social Security at either 304-291-4784 or 1-800-772-1213.  You may also apply on-line at www.socialsecurity.gov.

Information taken from www.socialsecurity.gov