Accessing affordable healthcare is important to all residents in the state and seniors are no exception. A number of state and federal programs are in place to assist you.

Medicare
Medicare is for older citizens and those with a disability. If you are 65 years or older; under the age of 65 with certain disabilities or have permanent kidney failure which requires dialysis or a transplant, than you are eligible for Medicare.

Medicare has two main parts – one that covers hospital costs and another that handles some related expenses.

Medicare Part A is hospital insurance and it helps people pay for inpatient hospitalizations, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care.

Medicare Part B is medical insurance that people pay a monthly premium for. It helps people pay for doctors' services, outpatient hospital care, and some other medical services that Part A doesn't cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Extra Help is Available for Medicare Costs
Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited income and resources also 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. The program is called "Extra Help" and it is estimated to be worth an average of $3,900 per year to eligible individuals. Many people qualify for these big savings and don't even know it. To find out if you qualify, Social Security will need to know your income and the value of your savings, investments, and real estate (other than your home). If you are married and living with your spouse, you will need to provide this information about both of you.

Beginning January 1, 2010, changes in the law will make it easier for some people to qualify for Extra Help with their Medicare prescription drug plan costs.

Under the Medicare Improvements for Patients and Providers Act:


• Life insurance policies will no longer count as a resource
• The help you may receive regularly from someone else to pay your household expenses—food, mortgage, rent, heating fuel or gas, electricity, water, and property taxes, will no longer count as income

To find out if you meet the eligibility requirements, you may apply online or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request that an application be mailed to you. You may also apply in person at your local
Social Security office. Find your local Social Security office.

After you apply, Social Security will review your application and send you a letter to let you know if you qualify for the program. Once you qualify, you can select the Medicare prescription plan of your choice. If you do not select a plan, the Centers for Medicare & Medicaid Services will do it for you. Learn more about Extra Help.

To enroll in Medicare, contact your local Social Security office or call 800-772-1213 or use this online enrollment tool.

Learn more about Medicare including the different types of plans and coverage details here.

Medicare will pay for the administration of the H1N1 vaccine even if you have had a traditional flu shot already this year. Details here.

Federally Qualified Health Centers (FQHCs)
Medicare benefits have been expanded to include payment for certain preventive health-care services provided in federally qualified health centers (FQHCs). In addition, FQHCs may waive the deductible normally required under Medicare Part B and may limit the out-of-pocket costs by applying the co-pay responsibility of the Medicare beneficiary to a sliding scale based upon the beneficiary's ability to pay. Under any circumstance, FQHCs do not charge consumers for any service that is paid for through the Medicare program.

In New Jersey, FQHCs are located in Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Salem, Sussex, Union, and Warren Counties. Information on these centers is available from the New Jersey Primary Care Association (NJPCA), which can be reached toll-free at 800-328-3838 or by dialing 609-689-9930. Learn more >

Understanding Medicare

State Health Insurance Assistance Program (SHIP)
SHIP is a statewide program that provides free help to New Jersey Medicare beneficiaries who have problems with, or questions about their health insurance. It is sponsored by the state and federal dollars and designed to answer questions about benefits and claims, supplement policies, and long-term care insurance.

Volunteer counselors, trained in areas of health insurance coverage and benefits that affect Medicare beneficiaries, provide information and assistance for dealing with claims and in evaluating health insurance needs. Counseling is free of charge.

SHIP produces and regularly updates charts detailing the various Medigap and Medicare HMO, PPO and PFFS plans offered in New Jersey. Access these charts here to help you compare plans and make an informed decision about which plan best fits your needs and budget.

To speak with a SHIP volunteer counselor call 800-792-8820. To find a SHIP Counseling site in your area click here.

If you would like to become a SHIP volunteer and help people in your community better understand their Medicare-related insurance options, please call 609-943-3378.

Medicare Rights Center
Further help in understanding Medicare is available through Essential Answers on Medicare Interactive (MI) Counselor, a free, independent, public resource from the Medicare Rights Center. MI Counselor offers easy-to-understand information and advice on a full range of Medicare topics.

The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.

Medicaid

This medical assistance program was created to pay medical bills for individuals of any age with low income and limited resources. To be eligible you must be:

• A resident of NJ
• U.S. Citizen or qualified alien (most immigrant who arrived after August 22, 1996 are barred from the program for five years)
• Meet specific standards for financial income and resources
  

To find out if you are eligible or to apply for Medicaid, contact your County Board of Social Services.

Pick up the phone and dial 2-1-1 when you need help.
You are encouraged to dial “2-1-1” 24 hours a day, seven days a week if you need help in understanding and finding available assistance services.  Language translation and TTY services are offered to any caller.  You can also search the database of services in your local community or Chat Live with an experienced community resource specialist. 2-1-1 will help identify with you the best local resources to fit your individual needs during times of financial distress or for life’s everyday situations.

If you know of additional resources that would be appropriate to include, please let us know by contacting us via e-mail at info@nj211.org.

Research Sources Included:
http://www.medicarerights.org/
http://www.socialsecurity.gov/prescriptionhelp/
http://www.state.nj.us/health/senior/sashipsite.shtml
http://www.state.nj.us/health/senior/ship.shtml
http://www.state.nj.us/health/senior/federalbenefits/health.shtml

Page last modified 11.30.09