Insurance and Benefits

Results: 9

• Benefits Assistance (3)
  FT-1000

  Benefits Assistance

  FT-1000
  
  Programs that provide assistance for people who are having difficulty understanding and/or obtaining grants, payments, services or other benefits for which they are eligible. The programs may help people understand the eligibility criteria for benefits, the benefits provided by the program, the payment process and the rights of beneficiaries; provide consultation and advice; help them complete benefits application forms; negotiate on their behalf with benefits administration staff; and/or represent them in administrative processes or judicial litigation. Included are benefits counseling organizations that offer a range of advocacy services and legal aid programs that offer more formalized legal assistance.
• Dental Care Expense Assistance (1)
  LH-5100.1700

  Dental Care Expense Assistance

  LH-5100.1700
  
  Programs that pay the dental bills of people who are unable to obtain necessary dental care without assistance. Also included are programs that provide vouchers which enable eligible individuals to obtain dental care. Dental bill payment assistance programs may have age, income, disability, need or other eligibility requirements.
• Health Insurance Premium Assistance (2)
  LH-5100.3000

  Health Insurance Premium Assistance

  LH-5100.3000
  
  Programs that make health insurance payments for individuals who are at risk for losing their health, dental and/or vision care coverage and who meet age, income, disability, need or other requirements. Some programs may also provide assistance with deductibles and co-pays.
• Long Term Care Ombudsman Programs (1)
  FT-4950

  Long Term Care Ombudsman Programs

  FT-4950
  
  Programs that investigate and attempt to resolve complaints made by or on behalf of residents of nursing facilities, residential care homes, assisted living facilities and other supervised living facilities for older adults. The program also promotes policies and practices that improve the quality of life, health, safety, welfare and rights of residents; monitors laws, regulations and policies that affect those who live in long-term care facilities; provides the public with information about long-term care options; and promotes the development of consumer organizations concerned about long-term care. Under the federal Older Americans Act, every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long term care system.
• Medicare (1)
  NS-8000.5000

  Medicare

  NS-8000.5000
  
  A federally funded health insurance program administered by the Centers for Medicare & Medicaid Services (CMS) under the U.S. Department of Health and Human Services for people age 65 and older; for individuals with disabilities younger than age 65 who have received or been determined eligible for Social Security Disability benefits for at least 24 consecutive months; and for insured workers and their dependents who have end stage renal disease and need dialysis or a kidney transplant. As with ESRD, the 24-month waiting period is waived for disability beneficiaries diagnosed with Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig's disease). Premiums, deductibles and co-payments or out-of-pocket costs apply to Medicare coverage for most people. Special programs that assist with paying some or all of these costs are available for low income individuals who qualify. Medicare has four parts, but not every Medicare beneficiary has every part. Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care and home health care that meets the program eligibility criteria. Medicare Part B (Medical Insurance) covers services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, preventive services and more. Together, Medicare Part A and Part B are called Original Medicare. Medicare Part C enables private insurance companies to offer Medicare Advantage (MA) Plans under contract with CMS that provide all Part A and Part B benefits to plan enrollees. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans and Medicare Medical Savings Account Plans. Some plans offer extra benefits and services that aren't covered by Original Medicare, sometimes for an extra cost; and most (but not all) include Medicare prescription drug coverage. Medicare Part D (Medicare prescription drug coverage) is an optional benefit that helps beneficiaries cover the cost of prescription drugs. The plans are offered by insurance companies and other private companies approved by Medicare and add prescription drug coverage to Original Medicare, some Medicare Private-Fee-for-Service Plans and Medicare Medical Savings Account Plans.
• Medicare Information/Counseling (1)
  LH-3500.5000

  Medicare Information/Counseling

  LH-3500.5000
  
  Programs that offer information and guidance for older adults and people with disabilities regarding their health insurance options with the objective of empowering them to make informed choices. Included is information about benefits covered (and not covered); the payment process; the rights of beneficiaries; the process for eligibility determinations, coverage denials and appeals; consumer safeguards; and options for filling the gap in Medicare coverage (Medigap supplement insurance). Also available is information relating to an individual's eligibility for benefits and assistance with evaluating their options and enrolling in a Medicare plan (A, B, C, and/or D) that will best meet their needs. These programs also address coordination of benefits when beneficiaries have other types of health insurance in addition to Medicare (e.g. Medicaid, employer coverage or retiree insurance) and provide counseling and assistance regarding the subsidies that are available to low income beneficiaries enrolled in the Part D Prescription Drug Benefit (which help pay for Part D premiums and reduce the cost of prescriptions at the pharmacy) and the Medicare Savings Programs which help pay for Medicare out-of-pocket costs. They may also provide information about Medicaid and the linkages between the two programs, referrals to appropriate state and local agencies involved in the Medicaid program, information about other Medicare-related entities (such as peer review organizations, Medicare-approved prescription drug plans, Medicare administrative contractors), and assistance in completing related Medicare insurance forms.
• Medicare Savings Programs (1)
  NL-5000.5000-700

  Medicare Savings Programs

  NL-5000.5000-700
  
  Programs that cover all or a portion of Medicare costs for low income Medicare beneficiaries with limited resources/assets. Medicare Savings Programs (MSPs) are administered by Medicaid medical assistance offices, pay all or a portion of Medicare premiums and may pay Medicare deductibles and co-insurance. Included are the Qualified Medicare Beneficiary (QMB) program that pays Medicare premiums, deductibles and co-payments for people with combined incomes that do not exceed 100 percent of the federal poverty level; the Specified Low-Income Beneficiary (SLMB) program that pays Medicare Part B premiums for people with combined incomes between 100 and 120 percent of the federal poverty level; the Qualifying Individuals (QI) program that pays Medicare Part B premiums for people with combined incomes 120 and 135 percent of the federal poverty level; and the Qualified Disabled and Working Individuals (QDWI) program that helps pay the Part A premium for individuals under age 65 who have a disability and are working, have lost their premium-free Part A when they returned to work, are not receiving medical assistance from their state and meet income and resource limits required by their state. The QI program is a limited program (block grant to states), and is available on a first come, first serve basis. Asset/resource limits for these programs are adjusted each year and may vary by state.
• State/Local Health Insurance Programs (1)
  NL-5000.8000

  State/Local Health Insurance Programs

  NL-5000.8000
  
  Programs that provide health insurance for people who do not qualify for Medicaid, do not have access to insurance provided by an employer or cannot afford privately purchased health insurance. Services covered by these programs vary by state but generally include hospitalization, physician services, emergency room visits, family planning, immunizations, laboratory and x-ray services, outpatient surgery, chiropractic care, prescriptions, eye exams, eye glasses and dental care. Other services may include alcohol and drug treatment, mental health services, medical and equipment and supplies and rehabilitative therapy. Eligibility requirements also vary. Included are state and/or local government health insurance programs which may be administered by the state or at the local level, and public/private partnerships between state and/or local government entities and health insurance companies or other private organizations. Health care is generally provided through participating managed care plans in the area.
• Veteran Benefits Assistance (15)
  FT-1000.9000

  Veteran Benefits Assistance

  FT-1000.9000
  
  Programs that provide assistance for veterans who are having difficulty understanding and/or obtaining the full benefits and services to which they are entitled by law based on service to their country. The programs may help veterans understand the eligibility criteria for benefits, the benefits provided by the program, the payment process and the rights of beneficiaries; provide consultation and advice; help them complete benefits application forms; negotiate on their behalf with U.S. Department of Veterans Affairs staff; and/or represent them in administrative processes or judicial litigation. Included are Veteran Services Officers (VSOs) who are trained and accredited by the Veteran's Administration (VA) and can be found in offices specific to each state, the county courthouse, the local VA office and local veteran's rights organizations; as well as legal aid programs that offer more formalized legal assistance.