Understanding and Accessing Public Healthcare Programs

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, then you are eligible for Medicare.

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. Medicare Part B now pays for preventive care and annual well-care visits to help you stay healthy.

Programs for Low-Income Seniors Cut Medicare Costs 

There are a number of assistance programs for Medicare recipients who are struggling to make ends meet.

Extra Help
Medicare beneficiaries may qualify for a federal program called Extra Help. Estimated to be worth about $4,000 per year to recipients, you may qualify if you are on Medicare; meet eligibility requirements and reside in one of the 50 states or the District of Columbia.

When you file your application for Extra Help, you also can start your application process for New Jersey's Medicare savings programs (see below) that provide help with other Medicare costs. Social Security will send information to New Jersey officials unless you tell them not to on the Extra Help application. New Jersey officials will contact you to help you apply for these programs if you qualify.

To apply for Extra Help, complete the Social Security's Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020):

    • You can apply online
    • Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an application
    • Apply at your local Social Security office

Learn more about this prescription drug savings program.

Medicare Savings Program

If Medicare premiums are difficult to afford, you may be able to take advantage of the Medicare Savings Program (MSP). This program, designed for low-income Medicare recipients who fall within income eligibility guidelines (noted in the table below), will cover the cost of Part B premiums, which are typically deducted from the recipients Social Security check each month. The savings from this program could amount to over $1,000 in one year.

Low Income Subsidy

The Low Income Subsidy (LIS) program offers further savings on Medicare Part D premiums and prescription drugs to those who satisfy income eligibility requirements noted below. If eligible, the state of New Jersey will pay your Part D premium, and enable you to maintain the lower prescription co-pay amounts throughout the year. This program averages annual savings of $3,900.

Program Income (Single) Income (Couple) Allowable
Assets (Single)
Allowable
Assets (Couple)
Extra Help $13,640      $27.250
Medicare Savings Program $16,038      $21,627     $7,280 $10,930     
Low Income 
Subsidy
$17,820 $24,030 $13,640     $27,250

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Learn more about these Medicare Savings Programs.

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.

Learn how new health care laws affect Medicare by downloading this FREE ConsumerReports' Medicare: Six Things You Need to Know Now.

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

Research Sources Included:
http://www.medicarerights.org/
http://www.state.nj.us/health/senior/get_help_medicarecosts.shtml
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/reviewed on July 21, 2016

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

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