Managing Caregiving Details: The Basics
By: Source: AARP.org Date Posted: 2003-06-19 12:38:00-04:00
Session 3: Public Programs to Investigate
Often, older adults need help in paying for health care, food and other services and are unaware that there are programs available to them. The United States provides a variety of public programs, run by both the federal and state governments, that address the needs of older adults. This session introduces some of these programs and indicates how to get more specific information.
What’s available
Social Security
This is a national program that provides a monthly income to eligible people who are at least 62 and have worked long enough, and to some people who are disabled. The program also provides benefits for family members. The amount of your Social Security benefit is based on how long you worked, how much money you made, and how old you are when you start receiving benefits.
Medicare
This national program provides medical coverage for most people over the age of 65 and some younger people with disabilities. Medicare coverage of skilled nursing home care and home care services is very limited. Medicare has four parts:
- Medicare Part A is hospital insurance that helps pay for care in a hospital or nursing home, limited home health services, and hospice care. There are usually no premiums for Part A, but there is an annual deductible and a coinsurance payment.
- Medicare Part B helps pay for doctors’ services, outpatient hospital care, and other medical services that Part A doesn't cover. Participants must pay a monthly premium, usually deducted from one’s Social Security check, plus an annual deductible and a co-insurance payment of 20 percent of approved charges.
- Medicare Part C (sometimes called Medicare Advantage) plans that provide both medical and hospital services, and in some cases, prescription drugs. Participants are restricted in their choice of health care providers, but they may get more benefits than the traditional Medicare fee-for-service programs available through Part A and Part B.
- Medicare Part D is insurance that helps pay for prescription drugs. Participants can obtain coverage through a private “stand-alone” prescription drug plan that works with the more traditional fee-for-service Medicare program or through a Medicare Advantage plan that covers both medical services and prescription drugs. Participants may pay a monthly premium, annual deductible, and co-pays or coinsurance, depending upon the particular plan. Premiums can be deducted from one’s Social Security check, as in Part B, or be directly billed.
Public Benefits Programs
Medicaid. This is a federal and state health insurance program for people with low incomes. Some people with higher incomes and high medical bills also may be eligible. States run the program, so eligibility and coverage are different from state to state and the name may also be different. Low income older people who receive Medicare may also be eligible for Medicaid. Medicare often covers some services that Medicare does not, such as deductibles, long-term nursing home care, eye exams, and eyeglasses, and transportation to medical services.
Food Stamps. Food stamps help people who low incomes buy food. The amount received each month depends on income, assets, expenses, and how many people live in the household. Financial eligibility and limits change from year to year. Food stamps are free and come in the form of coupons or an electronic benefit card that looks like a credit card.
Medicare Savings Programs (QMB/SLMB or QI-1). People with limited incomes and few resources who receive Medicare might qualify for state assistance in paying for their share of Medicare costs. The programs offering this help are the Qualified Medicare Beneficiary (QMB) Program, Specified Low-income Medicare Beneficiary (SLMB) Program, and Qualifying Individuals-1 (QI-1) programs. The QMB programs pays for Medicare Part A deductibles and coinsurance. It also pays for the annual Part B deductible and coinsurance costs. If your income is too high to qualify for QMB, you might be eligible for SLMB and QI-a, which pay for the Part B premium only.
Supplemental Security Income (SSI). This program pays monthly benefits to people age 65 and older and to people who are blind or have disabilities, if they have limited monthly incomes and resources. There is a federal limit, but some state add a supplement to SSI. Income includes job pay, Social Security benefits, and pensions, the value of some non-cash items like food and housing also are counted. People may receive both Social Security and SSI payments if income requirements are met.
Additional Benefits
State and local government agencies as well as nonprofit organizations often offer a variety of additional programs that can help financially strapped older people. These can range from free or reduced cost home repairs to food pantries that distribute groceries to help paying for heating oil in the winter. You will have to do some research to find out what's available in your parent's area.
A good place to start is your local Area Agency on Aging (AAA), which should be able to refer you to programs nearby. You can find your local AAA by contacting the Eldercare Locator (800-677-1116), Monday-Friday 9 a.m.-8 p.m. (EST). You may also want to contact your local social services agency, which should be listed in the government pages of the phone book.
A free online service, BenefitsCheckUp, can help identify federal and state assistance programs your parents might be eligible for.
How to help
Talk to your parents about the benefits they are already receiving and what else they may qualify for. If it appears that they may qualify for a program, find out if they would like to apply and if they need your help in doing so.
Help your parent apply for appropriate programs. The first step is to gather proof of your parent’s monthly income and resources. The next steps vary, depending on which of the following programs you apply for:
- Food Stamps. Call your parent’s local Department of Social or Human Services to find out where to apply. The phone number is in the special government section (usually blue) of the telephone directory.
- Medicaid. Call your parent’s local Department of Social Services or the Centers for Medicare and Medicaid Services toll free at 800-633-4227 to find out where to apply.
- Medicare Savings Programs (QMB, SLMB or QI-1). Call your parent’s local Department of Social or Human Services and tell them you want to apply for the QMB program. The phone number is in the government section of the telephone directory. You can also call the Centers for Medicare and Medicaid Services toll-free at 800-633-4227, and they will give you a local number to call.
- SSI or Social Security. Visit your parent’s local Social Security office or call 800-772-1213.
Take care of the details. Help fill out required paperwork, deal with hospital accounting departments or insurance personnel or handle disputes.
Inside This Lesson
Communicating with Health Professionals
Public Programs to Investigate
Knowledge Test
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