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Information & Education
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Public Benefits
Use this part of our web site to learn more about benefits that are available to older adults. This site is not intended to be comprehensive on any subject; additional phone numbers, web sites and resources are included for further information and study on any topic.
Topics included in this section are:
MEDICARE
Medicare is the country=s health insurance program for people ages 65 and over. Medicare also covers some disabled persons under age 65 and persons with end stage kidney disease (renal failure). You can apply for Medicare up to three months before your 65th birthday at your local Social Security office, or after you have received Social Security disability benefits for 24 months. Responsibility for the Medicare (and Medicaid) programs falls to the Centers for Medicare and Medicaid Services (CMS).
Traditional Medicare
Traditional Medicare is the pay-per-visit arrangement most people are familiar with. Under this plan, a beneficiary can go to any doctor, hospital or other health care provider that accepts Medicare. The beneficiary must pay a deductible each benefit period before services are covered. After the deductible is met, Medicare pays its share of the medical bill, and the beneficiary pays their share; this is called coinsurance.
Medicare services are covered under Part A or Part B. For most individuals, Part A is free. Part A beneficiaries may have to pay yearly deductibles and co-insurance for services received, but will not pay a monthly premium for this part of the program. Part A of Medicare covers hospitalization, hospice care, some skilled nursing care and some home health care. The benefit period for Part A covered services varies depending on the service provided, so the deductible an individual pays each year may vary as well.
Part B is optional coverage, provided for those who pay the monthly premium, which is automatically deducted from the recipient=s Social Security check each month. You may elect to not enroll in Part B, but the two parts work together to provide more complete care. If you do not elect to enroll in Part B when you are first eligible, your premium will be higher when you do decide to enroll. Part B of Medicare covers all but 20% of necessary medical services and equipment, such as: doctor=s fees, physical, occupational and speech therapies, durable medical equipment (hospital beds and wheelchairs for example), X-rays and lab tests. Individuals enrolled in Part B must pay a yearly deductible before coverage begins.
Medicare Supplement Insurance
Medicare does NOT cover all the costs of medical care for beneficiaries, nor does Medicare cover the costs of long term care (extended nursing facility or home based care). Persons seeking to round out their medical care may want to consider a Medicare Supplement Insurance or Medigap policy. These are private insurance policies, paid for out of your own pocket, that provide medical coverage in addition to benefits provided by Medicare. Insurance companies offering Medicare Supplement Policies in Ohio offer ten standardized policies, A-J. The plans can carry costly monthly premiums, so it is important to understand what additional benefits may be provided for the cost. The higher the letter of the alphabet, the more the policy offers, and no doubt, the higher the cost. Individuals considering Medicare Supplement Policies should contact the Ohio Department of Insurance at 1-800-686-1578 for a copy of their free publication, Ohio Shopper=s Guide to HMOs and Medicare Supplement Insurance.
Medicare Managed Care Plans- Medicare + Choice
Medicare also provides services under Managed Care plans. The Balanced Budget Act of 1997 put into law a range of new options giving beneficiaries choice in how they receive their Medicare benefits. Those options include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs).
Under an HMO or PPO, the recipient receives all of the same services covered under traditional fee-for-service Medicare, but may also be eligible for additional services not covered by traditional Medicare, such as eye and dental exams. Ideally, Medicare HMOs and PPOs take the place of traditional Medicare and the Medicare Supplement Policy, while providing the beneficiary with out-of-pocket cost savings. Medicare HMOs and PPOs vary from each other in what benefits they offer, and the amount and rules attached to those benefits. Additional benefits provided under an HMO or PPO vary depending on the plan in which the recipient enrolls. It is essential to understand the benefits that will be provided, and the limits and rules on those benefits before enrolling in any managed care plan. A current list of Medicare Managed Care plans available in your area is available from the Ohio Department of Insurance's Ohio Senior Health Insurance Information Program (OSHIIP) at 1-800-686-1578. Information about the plans available in your area can also be found on the Medicare web site at www.medicare.gov or from 1-800-MEDICARE (633-4227).
You can join a Medicare managed care plan as long as you carry Part A and B of Medicare, don't have end stage renal disease, fill out and sign the plan=s forms, agree to follow the plan's rules, and don=t belong to more than one plan at a time. You CANNOT be turned down based on your age, health and the amount or cost of services you need. Managed care plans are on one year contracts with the Centers for Medicare and Medicaid Services, so each year they make decisions about whether they will continue providing service in a geographic service area.
The Ohio Department of Insurance publishes an excellent Ohio Shopper's Guide to Medicare Managed Care Plans and Medicare Supplement Insurance. It is available free of charge by calling 1-800-686-1578.
Medicare Prescription Drug Plans
Beginning in 2006, Medicare now offers prescription drug coverage to all Medicare beneficiaries. The prescription drug benefit, known as Part D, is a voluntary benefit which provides drug coverage for a monthly premium. Medicare's prescription drug plans are offered by private insurance companies and can vary tremendously in what drugs they offer, yearly deductibles and the monthly premium charged. The prescription drug coverage offered under Medicare has limitations as to how much drug coverage will be provided before a beneficiary reaches the coverage gap. In order to make the best choice of a plan, an individual should use the prescription drug plan finder on the Medicare web site or contact the Ohio Department of Insurance's Senior Health Insurance Program (OSHIIP) at 1-800-686-1578.
Learn more about Medicare and all of the options available at the government's Medicare web site at www.medicare.gov.
Other Medicare resources:
www.cms.hhs.gov (information about Medicare and Medicaid)
www.medicarerights.org (The Medicare Rights Center- an information and advocacy service for Medicare beneficiaries.
MEDICAID
Medicaid is a health care program for low income individuals of all ages. It is paid for jointly by the state and federal governments, and administered by the state department of human services. Services provided under Medicaid are free to those enrolled, but the financial eligibility guidelines are strict.
To be eligible for Medicaid as an older adult you must:
- Be a member of an eligible group (age 65 and over, disabled or blind);
- Have income below the Medicaid limits; and,
- Have resources (savings, property, investments, etc.) below the Medicaid limits.
Financial eligibility guidelines vary somewhat depending on the Medicaid program under which an individual is covered. Medicaid can pay for services like doctor visits and lab tests, home health care, medical equipment and transportation. Services must be medically necessary before Medicaid will pay for them, and services must be provided by Medicaid providers or vendors.
Ohio's Medicaid program also offers services through waiver programs. Waiver programs are designed to pay for services to keep individuals in their own home, rather than in a institutional setting. Each of the four waiver services is for a specific group of people, and each may pay for a different set of services. Waivers can only serve a limited number of people, so the openings in these programs fill quickly.
There are four Medicaid waiver programs in Ohio:
- Home Care Waiver: For a person under age 60 who otherwise would require the services provided in a nursing facility for either a skilled or intermediate level of care. Or for a person over age 60 who would otherwise require the services of a skilled care nursing facility. Apply at your county department of human services.
- Individual options waiver: For any person injured before age 22 who would otherwise require the services of an intermediate care facility for people with mental retardation. Apply at your County Department of Mental Retardation and Developmental Disabilities.
- Residential Facilities Waiver: For any person injured before turning age 22 who would otherwise require the services of an intermediate level of care facility for people with mental retardation. Individuals served by this waiver must reside in a facility licensed by the Ohio Department of Mental Retardation and Developmental Disabilities (i.e. a group home). Apply at your County Department of Mental Retardation and Developmental Disabilities.
- PASSPORT waiver: For persons ages 60 and over who would otherwise require an intermediate level of care in a nursing facility. To read more about the PASSPORT program, click here.
For more information about Ohio's Medicaid program, visit the Medicaid web site at:
www.ohio.gov/odjfs/ohp or call the Medicaid consumer hotline at 1-800-324-8680.
Applications for Medicaid can be made at your County Department of Human Services:
- Ashtabula: 440-998-1110
- Columbiana: 330-424-1471
- Mahoning: 330-740-2305
- Trumbull: 330-675-2000
QMB, SLMB, QI-1 and QI-2
Programs that provide savings for low income Medicare Beneficiaries
Medicare ABuy-In@ benefits help low-income Medicare beneficiaries pay their share of Medicare premiums, and in some instances, deductibles and co-payments. Eligibility for these buy-in programs vary depending on income level. There are several programs designed to help Medicare beneficiaries pay Medicare premiums and some out-of-pocket expenses. To qualify for assistance under these programs, an individual must:
- Have Part A of Medicare (hospital insurance);
- Have income below certain limits (see below); and,
- Have other financial resources (bank accounts, stocks and bonds) below $4,000 for an individual or $6,000 for a couple. Your house, one car, furniture and some other items are not counted in that total.
Unlike with other parts of Medicaid, there is no spend-down provision with these programs- either your income and assets qualify you for the programs, or they don't.
Programs that help pay Medicare=s costs:
Program Name |
Monthly Income Limits |
What Program Pays |
Qualified Medicare Beneficiary (QMB) |
$891* for an individual or $1,181 for a couple |
Medicare premiums, deductibles and coinsurance |
Specified Low Income Medicare Beneficiary (SLMB) |
$1,061* for an individual or $1,409 for a couple |
Medicare Part B premiums |
Qualifying Individual - 1 (QI-1) ** |
$1,189* for an individual or $1,580 for a couple |
Medicare Part B premiums |
* These are the income guidelines for 2007. Each April the amount is increased.
** The QI-1 program is available on a limited basis, based on state funding availability.
The Ohio Department of Job and Family Services makes it easy to enroll in QMB, SLMB, QI-1 and QI-2. Persons interested in applying for the programs may complete the form AApplication for Help with Medicare Expenses (ODHS 7103)@ and mail the form with appropriate documentation to their local DJFS office. An in-person interview is not required for this program. The application form can be accessed by calling the Medicaid Consumer Hotline at 1-800-324-8680, or by visiting the Department web site at www.odjfs.state.oh.us/forms/interfind.asp?formnum=07103. For additional information about these programs, you can also contact the Department of Job and Family Services in your county.
- Ashtabula: 440-998-1110
- Columbiana: 330-424-1471
- Mahoning: 330-740-2305
- Trumbull: 330-675-2000
VETERAN'S BENEFITS
Eligibility for benefits through the Veteran's Administration (VA) is based upon discharge from active military service under honorable conditions. Honorable and general discharge qualify a veteran for most VA benefits, although certain VA benefits and medical care require wartime service. Those seeking health care benefits through the VA must enroll at a VA health-care facility.
All service connected veterans are rated based on their degree of disability, and whether the disability is service related or not. The veteran=s rating then determines how much, if any, they pay for medical care received through a VA facility. Non-service connected veterans and veterans with a 0% disability rating are required to complete an annual means test. This test is a measure of the veteran=s income and assets and helps determine the co-payment the veteran will be required to make when receiving services. The VA is required by law to bill health insurance carriers for treatment received for non-service related conditions. The VA will ask about health insurance coverage when the veteran is seen for treatment.
One of the best benefits the VA offers is a prescription drug program that charges veterans just a small co-payment per prescription for treatment of non-service connected conditions. The veteran pays nothing if the medication is to treat a service connected condition. There are medication co-payment exceptions made for veterans with 50% or higher disability rating, for those receiving a VA pension and for veterans with a low income. These exempted groups pay nothing for their medications. The medications must be prescribed by a doctor at a VA clinic.
To get additional information about benefits and programs available to Veterans, call The VA Connection at 1-216-231-3260 or 1-888-350-3100 (toll free number). This a service available to all of Ohio and surrounding states.
The State of Ohio funds Veteran=s Service offices in each county around the state. These offices are designed to help veterans access benefits and programs available to them. Contact the Veteran=s Service Commission in your county for additional information:
- Ashtabula: 440-992-6014 (Ashtabula city)
- Columbiana: 330-424-7214 (Lisbon)
- Mahoning: 330-740-2452 (Youngstown)
- Trumbull: 330-675-2585 (Warren)
For more information about Veteran's Benefits in Ohio, visit the web site for the Governor's Office of Veterans Affairs at www.ohio.gov/gova.
For more information about the U.S. Department of Veteran's Affairs and the benefits available to veterans, visit the VA web site at www.va.gov.
OHIO'S BENEFITS CHECKUP
Individuals who are confused by the benefits available to older adults can access a unique services that helps determine for what individual might be eligible. The services, Benefits CheckUp is a service of the National Council on Aging.
Benefits Check Up asks a series of questions from the individual inquiring about programs and services, and based on the information provided, can identify programs from which an individual may be eligible to receive service. Check out Benefits Check Up on line at www.BenefitsCheckUp.org.
Benefits Check Up is free and confidential and may identify programs that could help an older individual in need find some financial assistance.
PHARMACEUTICAL MANUFACTURER'S PRESCRIPTION DRUG PATIENT ASSISTANCE PROGRAMS
Prescription drugs play such an important role in health care, and yet remain one of the most costly expenses incurred by older adults. Now that Medicare offers prescription drug coverage through Part D, drugs are available to a many more older adults. In addition, there are programs put in place by the Pharmaceutical Manufacturers that may provide drugs at no-cost or lower costs.
Ashtabula, Trumbull, Mahoning and Columbiana counties offer Prescription Drug Assistance Programs which help low-income seniors complete the necessary applications for prescription assistance programs offered by pharmaceutical companies and help older adults navigate the many options available under Part D of Medicare.
Income and insurance requirements vary for each company's program. Each pharmaceutical company determines the amount and duration of medication received. There is no guarantee that an individual will receive the medications for which he applies. The individual's doctor must sign the necessary forms and will receive the drugs at his/her office to dispense them to the patient.
Basic eligibility criteria are:
- Individual must be age 60 and over;
- A resident of the county served by the program;
- Individual has no other prescription drug coverage;
- Individual is not eligible for Medicaid;
- Individual must agree to conditions of participation.
Contact the appropriate county agency for additional information:
Ashtabula County
Contact ACQIRE for the agency closest to you - 440-997-5957
Trumbull County
Contact SCOPE- 330-399-8846
Mahoning County
Contact Senior Center- 330-744-5071; or, HMHP- 330-740-0477; or,
VNA-330-782-5606
Columbiana County
Contact RSVP- 330-424-7877
The Pharmaceutical Research and Manufacturer=s of America (PhRMA) publishes a directory of patient assistance programs offered by its member companies. Member companies of this association may make available prescription medications free of charge through physicians whose patients otherwise might not have access to necessary medications. Each company has its own requirements and procedures, but all require that the request for medication come from the physician. The Directory of Prescription Drug Patient Assistance Programs is available for downloading from the PhRMA web site at www.phrma.org.
While the Directory of Prescription Drug Assistance programs is helpful, the information it contains can be confusing, because each program operates differently. A new web site, www.needymeds.com, can help simplify the process of locating prescriptions drug assistance programs. This resource is a great source of information, listing nearly 1,000 drugs, both by drug name and by manufacturer. The service explains how each program works, how to apply, and for how long the drug will be supplied. Contact names and phone numbers are conveniently listed for each program. In addition, NeedyMeds also provides an e-mail update service to alert interested parties when new drugs are added to the list. Information is updated regularly, so the site remains a useful resource for individuals and professionals.
RxAssist is a program of Volunteers in Health Care, a Robert Wood Johnson funded health care clearinghouse. Available on the web at www.rxassist.org, RxAssist provide health care providers with information on accessing more than 100 pharmaceutical assistance programs. The site can be searched by brand or generic names, manufacturer or class of drug. The site provides step-by-step instructions on how to apply, contact information, tips and comments. This site is unique in that it provides forms on-line for manufacturers which allow distribution of their forms. The site is continuously updated by the sponsoring organization, Volunteers in Health Care.
