Medicare and State Health Insurance Program (SHIP)
Medicare and State Health Insurance Program (SHIP)
SHIP counselors provide accurate and objective health insurance information to help Medicare beneficiaries or their caregiver to make informed health coverage decisions and understand their related rights and protections.
Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities and people of any age with End-Stage Renal Disease. There are four parts to Medicare Part A, Part B, Part C and Part D. The different parts of Medicare help cover specific services if you meet certain conditions. MyMedicare.gov is part of the Medicare.gov website. MyMedicare.gov is an optional, free, and secure site designed to help you check the status of your eligibility, enrollment, and other Medicare benefits. It also lets you access your claims information almost immediately after your claims are processed by Medicare and provides your preventive health information 24 hours a day, seven days a week.
Medicare Part A (Hospital Insurance) - Helps cover inpatient care in hospitals (includes critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals), Helps cover skilled nursing facility (not custodial or long-term care), hospice, and home health care services, and Free to most people.
Medicare Part C (Medicare Advantage Plans) - A way to get Medicare benefits through private companies approved by and under contract with Medicare, Includes Part A, Part B, and usually includes Medicare prescription drug coverage (Part D), May include benefits Medicare doesn’t cover (dental, vision and hearing aid, Monthly Premium, and Annual Deductible
Medicare Part B (Medical Insurance) - Helps cover doctor services and outpatient care, Helps cover some preventive services to help maintain a person’s health and to keep certain illnesses from getting worse, Generally, pays 80% of the Medicare-approved amount for covered services, Covers medical equipment and supplies, Month Premium, and Annual deductible.
Medicare Part D (Prescription Drug Coverage) - Run by private companies approved by Medicare, Helps cover the cost of prescription drugs, Each plan can vary in cost and drugs covered, Monthly Premium, and Annual Deductible.
Medicare’s Annual Open Enrollment
Medicare health and drug plans can make changes each year—things like cost, coverage, and which providers and pharmacies are in their networks. Trident Area Agency on Aging has trained SHIP Specialists that can assist you with the comparison, enrollment and general information and resources you need to gain the best access to healthcare. Open Enrollment is the time you can compare plans and make changes to your Medicare Health or Prescription drug coverage. Open Enrollment is October 15 – December 7, 2021. Your coverage will begin January 1, 2022.
Low Income Subsidy (LIS) or “Extra Help”
and Medicare Saving Program
Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also may be able to get Extra Help to pay for the costs—monthly premiums, annual deductibles, and prescription co-payments—related to a Medicare prescription drug plan. The Extra Help is estimated to be worth about $4,000 per year. Many people qualify for these important savings and don’t even know it.
Some people are automatically eligible for the LIS. Examples are: People on Medicaid, who receive Social Security Income or people who get help from the state Medicaid program paying your Part B premium (in a Medicare Savings Program).
Qualified Medicare Beneficiary
This program may help pay your Medicare Part “B” Premiums. Healthy Connections will make a QMB determination for a Medicaid-eligible individual in any full benefits category if that individual is covered under Medicare Part A. Benefits: QMB coverage offers payment of Medicare premiums, co-pays and deductibles.
Specified Low-Income Medicare Beneficiary (SLMB) / (QI) Qualified Individual Program
These programs may help pay your Medicare Part “B” Premiums.
Eligibility for A Specified Low Income Medicare Beneficiary is an individual who: Is entitled to Medicare Part A hospital insurance or has countable income greater than 100% and less than or equal to 120% of the Federal Poverty Level.
Eligibility for A Qualified Individual is an individual who: Is entitled to Medicare Part A hospital insurance, has countable income between 120% and 135% of the Federal Poverty Level, or is not otherwise eligible for full Medicaid benefits.
Benefits: For a SLMB or a QI, Healthy Connections is required to pay the Medicare Part B premium only. These individuals are not entitled to any other Medicaid benefits; therefore, they do not receive a Medicaid card.
Trident Area Agency on Aging is a not-for -profit, 501C3 organization that provides assistance, advocacy and answers on aging. As a private, non-governmental organization, we receive grants and donations to fund our services. The organization serves as an Aging and Disability Resource Center for older Americans. Trident Area Agency on Aging promotes and supports the health and wellness of current and future generations of older adults in our communities. They focus on the overall well-being of these older citizens so that they may enjoy lives of dignity, confidence, along with personal and family fulfillment. 4450 Leeds Place West, Suite B, North Charleston, SC 29405, Phone: (843) 554-2275, www.trident aaa.org