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Insurance and Benefits

    Results: 11

  • Benefits Assistance (1)
    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 to which they are entitled by law. 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 (1)
    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 (2)
    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.
  • Medicaid Applications (8)
    NL-5000.5000-520

    Medicaid Applications

    NL-5000.5000-520

    County or state offices that accept applications and determine eligibility for the Medicaid program; and reinstate individuals who have lost their Medicaid benefits due to incarceration, institutionalization, noncompliance or other reasons. Also included are other programs that help people prepare and file Medicaid applications and/or are authorized to do eligibility determinations for the program.
  • Medicaid Fraud Reporting (1)
    FN-1700.9500-500

    Medicaid Fraud Reporting

    FN-1700.9500-500

    Programs that provide a hotline or other mechanisms that Medicaid recipients and the public at large can use to report recipients or health care providers that make false statements or representations which result in an unauthorized payment by the Medicaid program to themselves or another. Examples of fraud include incorrect reporting of diagnoses or procedures to maximize payments; billing for services, medical supplies or equipment not furnished; misrepresentation of the dates and descriptions of services furnished, the identity of the recipient or the individual furnishing services; and billing for noncovered or nonchargeable services as covered items.
  • 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 the eligibility requirements for Medicare; selection and enrollment in a Medicare prescription drug plan; benefits covered (and not covered) by the program; the payment process; the rights of beneficiaries; the process for determinations, coverage denials and appeals; consumer safeguards; and options for filling the gap in Medicare coverage. These programs also provide counseling and assistance about the subsidies that are available to low income beneficiaries enrolled in the Part D Prescription Drug Benefit; and 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, fiscal intermediaries and carriers), and assistance in completing Medicare insurance forms.
  • Medicare Savings Programs (1)
    NL-5000.5000-700

    Medicare Savings Programs

    NL-5000.5000-700

    Programs that pay all or a portion of Medicare costs for low income Medicare beneficiaries with limited resources/assets. The programs 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 available on a first come, first served basis. Asset/resource limits are uniform for the QMB, SLMB and QI programs and are $7,160 for single individuals and $10,750 for married couples. Resource limits for the QDWI are $4000 in countable assets/resources for individuals and $6000 for married couples.
  • Prescription Drug Discount Cards (1)
    LH-6700.6250

    Prescription Drug Discount Cards

    LH-6700.6250

    Private organizations that issue cards that offer discounts on prescriptions at participating network pharmacies including chain and independent retail outlets, generally for an annual enrollment fee. Also included are programs that maintain lists of these types of programs for referral purposes.
  • Prescription Drug Patient Assistance Programs (2)
    LH-6700.6300

    Prescription Drug Patient Assistance Programs

    LH-6700.6300

    Pharmaceutical companies or pharmacies that make brand name or generic prescription drugs available to patients who are uninsured or underinsured or, for other reasons, cannot afford to pay the market price. Also included are organizations that help qualifying patients complete and file paperwork for submission to drug manufacturers to request such medication or which maintain lists of these types of programs for referral purposes.
  • Veteran Benefits Assistance (12)
    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 rights organizations that offer a range of advocacy services as well as legal aid programs that offer more formalized legal assistance.
 
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