senior citizens guide to health care services

7/31/2019 Senior Citizens Guide to Health Care Services

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Senior Citizen Guide toHealth Care Services


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Dear Friend,

Obtaining aordable health insurance and other

health-related services can be a daunting chal-

lenge or many senior citizens. Thats why I am

pleased to report there are a number o ederal,

state, and community programs designed to help

elders access the health care services they needand deserve.

This brochure provides basic details about many o

these important programs and contains additionalhealth-related inormation, including such matters

as health care proxies, respite care and long-term

care insurance.

Sincerely,

Senator Shirley L. Huntley10th Senatorial District


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Insurance

Medicare

Medicare is a health insurance program administered by the ederal

government through the Social Security Administration. It is designedor persons aged 65 and older and or some severely disabled persons

under age 65. Medicare only provides coverage or care it determines

to be medically necessary and has two basic parts:

Part A applies to most seniors and provides hospital coverage,

which is subject to a deductible and co-insurance (the percentage

you are responsible or paying). Part A may provide complete orpartial coverage or care in a variety o settings that include: your

home, hospitals, nursing acilities and psychiatric hospitals.

Part B is optional medical coverage (or an additional monthly

premium) oered when you enroll or Part A benefts. Medicare

Part B may prove helpul in paying or doctor visits, mental health

services, X-rays, laboratory tests, wheelchairs and various typeso therapy. State law limits the amount that doctors may charge

or most physicians services provided under Medicare Part B. For

more inormation call your local County Ofce or the Aging.

Part D Medicare Prescription Drug CoverageMedicare now

oers prescription drug coverage. Most people will be able to get

this coverage through Medicare prescription drug plans. For more

inormation visit www.medicare.gov. To fnd out about eligibility

and to ensure protection begins when you reach 65, contact the

Social Security ofce at 1-800-772-1213 three months beore your

65th birthday. I you are planning to retire, check with the person-

nel ofce at your place o employment about this program. Some

senior citizens on limited income may be eligible to have Medicare

Part B premiums and other co-payments covered by the state. For

more inormation, call the Medicare Hot Line at 1-800-633-4227

(TTY-TTD 1-877-486-2048).


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Medigap

Medigap is a supplemental insurance, sold in 10 standard plan ormats, that

may help fll gaps in Medicare coverage (certain instances, services, treat-

ments, tests, equipment and settings are only partly covered or not covered

by Medicare). Talk with a counselor to fnd out i a Medigap policy is right

or you. Contact the State Ofce or the Aging or inormation on counseling

services and the State Insurance Department or a listing o Medigap carri-

ers. For health insurance inormation call 1-800-701-0501 rom 9am to 3pm

Mon.Thurs. You can also visit the State Ofce or the Aging or inormation

regarding Medigap and much more at: www.aging.ny.gov.

MedicaidMedicaid is a joint ederal and state program or senior citizens and

others with income or resources below a certain level. Some senior citi-

zens are eligible to receive both Medicare and Medicaid benefts. State

law protects some o the assets o a married couple should one require

nursing home care. I you have any questions, or i you wish to apply or


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Medicaid assistance, contact your County Ofce or the Aging. I you

cant go there in person, someone else may go on your behal. More in-

ormation is available by clicking on the Medicaid link on the New YorkState Department o Health web site at: www.health.state.ny.us.

EPIC

The Elderly Pharmaceutical Insurance Coverage Plan (EPIC) helps New

York senior citizens pay or their prescriptions. New York State residents

aged 65 or older who have little or no prescription drug coverage througha private insurer or Medicaid can qualiy i their incomes are below the

established limits.

Depending upon annual income, seniors are enrolled in either the ee

plan or the deductible plan. Under EPIC+, all single seniors with incomes

below $20,000, and all married seniors with incomes below $26,000,

will go into the ee program. Seniors with higher incomes, up to $35,000or singles and $50,000 or married couples, will enroll in the deductible

plan. Under both plans, co-payments or specifc drugs are based on the

list price o the prescriptions you need, and range between $3 and $20.

Applications are available at a variety o locations throughout the

State, including pharmacies, doctors ofces, senior centers and county

Ofces or the Aging. Seniors can also call EPICs Helpline at 1-800-332-

3742 to request an application. More inormation and a copy o the ap-

plication is also available by clicking on the EPIC link on the New York

State Department o Health web site at: www.health.state.ny.us.

#566 Revised: 6/2010


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Long Term Care

Nursing Home Without Walls

This program is an alternative or patients who medically qualiy or

nursing home care but who preer to remain at home. Now available inmany communities, the Nursing Home Without Walls program provides

both Medicaid and private-pay patients with extensive in-home health

services administered by health agencies, residential health care acili-

ties, certain adult homes and hospitals. For more inormation about this

program, contact your local County Health Department.

Hospices

Hospices provide care or the terminally ill at home, which helps pre-

serve the comort and dignity o the patient while involving the patients

amily. They may be operated by home care agencies, hospitals, nursing

homes or other health care providers or community groups. Hospices

may provide doctors, nurses and home health aides 24 hours a day, 7days a week. Counseling is also available to assist amilies in bereave-

ment and other stressul periods. The cost o hospice care generally is

reimbursed by private insurance companies, Medicaid and Medicare. Go

to www.hpcanys.orgor more inormation about hospice services.

Expanded In-Home Services or the Elderly Program (EISEP)

The need or institutional or nursing home care can in part be prevented

when certain nonmedical services are provided in the home. EISEP pro-

vides unding or a uniorm system o in-home case management, non-

institutional respite and other services or seniors who need long-term

care but are not eligible or Medicaid. Those who are able, share costs

or services based on their ability to pay. More inormation can be ound

by visiting www.health.state.ny.us and clicking on the Medicaid link.


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Long Term Care Insurance

Through the New York State Partnership or Long Term Care, the Medicaid

program can help you or a amily member pay or nursing home or home

health care costs without exhausting all your lie savings. I you purchase

aordable private long term care insurance that has been specifcally ap-

proved or the Partnership program, the insurance must cover at least 3

years o nursing home or 6 years o home health care or an equivalent

combination o both. Once the minimum beneft duration is reached, an in-

come eligible policy holder will qualiy or Medicaid extended coverage or

the remainder o his or her lie without consideration o his or her assets.

For more inormation, contact the Partnership program at 1-888-697-

7582. You can also visit the NYS Insurance Department on the Internet at:

www.ins.state.ny.us. You may also be eligible or a state and ederal tax

deduction i you purchase private long term care insurance. Contact the

State Insurance Department at 1-800-342-3736 to fnd out more.


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Respite Care

Respite provides temporary rest periods or amilies who care or elderly

or disabled relatives.Temporary in-home and out-o-home health services can be provided

by qualifed community and public agencies, nursing homes and other

health care providers or amilies who need a time-out rom the stress o

ull-time care o the elderly or disabled.

Alzheimers Disease Assistance CentersThere are nine centers in New York State that provide services to Al-

zheimers victims and their amilies, including disease identifcation, care

planning and counseling. A listing o these centers is available through

the NYS Health Departments web site at: www.health.state.ny.us or

contact the department in writing at:

Bureau o Chronic Disease ServicesNew York State Department o Health, ESP

Corning Tower, Albany, NY 12237-0678

Nursing Homes

Nursing homes are licensed by New York State. I a nursing home is not

state licensed, or i the license is not current, dont consider it. All nurs-

ing homes receiving Medicare and Medicaid unds are required to make

copies o the fndings o their most recent inspections available to the

public. Ask to see these reports and all licenses and certifcates. Its your

right by law. It is also important to know that a married person requiring

nursing home care can be eligible or Medicaid without impoverishing his

or her spouse. State law allows the marriage partner remaining at home

to retain a set amount o assets and monthly income. The home itsel, i

it is the primary residence, is an exempt resource.


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Nutrition

State Ofce or the Aging Nutrition Program or the Elderly

(NPE)

This program helps provide hot, balanced meals to senior citizens in ev-

ery county and Indian nation o the state. The meals are served at local

community gathering places. Eorts are made to identiy persons unable

to reach these meal sites and to provide them with transportation. In ad-

dition, senior citizens who are unable to leave their homes can have their

meals delivered to them. Anyone over 60 years o age and their spouses

and disabled dependents are eligible to take part in the program, and no

one is turned away because o inability to pay. The services provided by the

NPE are made available through local Ofces or the Aging, which serve all

New York State counties. These local ofces are listed in the community

services or local government pages o most telephone books. On the Inter-

net, visit the Ofce or the Aging at: www.aging.ny.gov.


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Living Insurance

Benefts

People with a lie expectancy o 12

months or less or a medical conditionthat requires extraordinary care can

opt to make use o lie insurance ben-

efts beore they die. Living insurance

benefts enable policy holders to apply

or part o the value that would nor-

mally be available upon their death.This money is not subject to State or

New York City income tax. For inor-

mation about this option, contact the

New York State Department o Insur-

ance at 1-800-342-3736.

Health Care Proxy

I you ill out a Health Care Proxy

orm, you empower someone else

to make medical treatment choices

or you when you are no longer able

to make them or yoursel. Health

Care Proxy orms and other inor-

mation about this law are available

rom my oice. The Health Care

Proxy orm is also available at:

www.health.state.ny.us/forms.

Third Party Notifcation

Under state law, insurance compa-

nies may be requested to send in-

surance payment notices to a third

party. This includes payment notices

or Medigap policies.


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Shirley L. HuntleyNEW YORK STATE SENATOR

10TH SENATORIAL DISTRICT

HUNTLEY.NYSENATE.GOV

[email protected]

SENATE

NEWYORKSTAT

E NEW YORK

STATE SENATENYSENATE.GOV

District Office Albany Office

161-10 Jamaica Avenue, Suite 504 508 Legislative Office Building

Jamaica, New York 11432 Albany, New Y ork 12247Phone: (718) 523-3069 Phone: (518) 455-3531

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