Benefits Specialists
At the ADRC we have two Benefits Specialists on staff. Our Benefits Specialists are available to disabled persons ages 18 to 59, and those over the age of 60 to appeal Social Security decisions and navigate the complex systems of public and private health insurance.
Disability Benefit Specialist Brochure (Ages 18-59)
Elderly Benefit Specialist Brochure (Ages 60+)
There are numerous programs such as Medicaid Purchase Plan (MAPP), Medicare Part A, B, C, and D, and Senior Care that can be overwhelming and our Benefits Specialists are available by appointment to assist in these matters. If you require this type of assistance please visit our contact page. If you are unsure if this is the person that can potentially assist you, our Information and Assistance Specialists will be able to connect you with the appropriate resource.
Benefits Checkup - a Service of the National Council on Aging
http://www.benefitscheckup.org/ There are benefits you may be missing! BenefitsCheckUp helps you find and enroll in public and private benefits programs. You can also find an online application for Medicare's Extra Help. It's simple and free and always includes the most up-to-date information.
Medicare: To Your Good Health
More Preventive Services are Now Available Through Medicare
Several new preventive services are now available for Medicare beneficiaries. These services should generally result in no cost to beneficiaries, if they are provided within the appropriate guidelines and if your provider accepts assignment. Starting in 2012, if your Medicare benefits are provided by a Medicare Advantage plan, there should be no cost to you if your provider is part of the network. These new services join previously introduced preventive services such as the Welcome to Medicare Physical and the Annual Wellness Visit. See your Medicare And You 2012 Handbook for additional information. Some of the new services are:
Depression Screening
Medicare beneficiaries can be screened annually for depression. There should be no cost for this service. The screening must be performed in a primary care office. A depression questionnaire must be completed during the visit. Further evaluation will be conducted if the questionnaire shows that you might have depression. You might then be referred to a therapist or be treated by your physician, if it appears that you need treatment.
Obesity Screening and Behavioral Counseling
This service must also be provided by your primary care physician in order for it to be covered by Medicare. Your doctor will determine whether you are obese, which is defined as having a Body Mass Index of more than 30. People who meet the requirements will be able to receive a limited number of behavioral counseling sessions and dietary assessment to assist them in meeting their weight loss goals. People who are able to lose at least 6.6 pounds of weight in the first 6 months of the counseling period will be granted more counseling sessions; those who are unable to lose at least 6.6 pounds during the first six months will not qualify for more counseling.
Cardiovascular Disease Risk Reduction Screening
Your primary care doctor can do this assessment once per year. During the visit, your doctor should check your blood pressure, assess your risk factors for heart disease, discuss whether you would benefit from a daily dose of aspirin, and discuss a heart healthy diet. You and your doctor should agree on treatment goals and ways to reach these goals.
Alcohol Misuse Screening
You can be screened annually to determine whether or not you are misusing alcohol. This screening must occur at your primary care provider’s office. If your doctor determines that you have a problem with alcohol, you will be able to get some brief counseling related to the issue.
Since changes to Medicare as of January 1, 2011, a national average of 2,800 people with Medicare have received a free annual wellness visit per day. Although not a comprehensive physical, the wellness visit allows for risk assessment and the development of a plan for additional free health screenings. It is covered by Medicare free of charge when obtained by a participating health care professional. There were also many preventive services offered free beginning in 2011. See the Flyer.
Medicare Guide - Consumer reports offers a free, downloadable guide addressing the basics of the Medicare program. It is factual and easy to read. It can be found at http://www.consumerreports.org/health/resources/pdf/MedicareMiniGuide.pdf
News from Our Benefits Specialists - Interesting Updates for 2012!
The Medicare Part A (Hospital) deductible will increase from $1,132.00 to $1,156 (days 1-60) per benefit period $289.00 (days 61-90) per day $578.00 (days 91-150) This is the deductible that you pay when you are admitted into the hospital. See fact sheet
Medicare Part B deductible- $140.00 per year
Medicare Part B premium $99.90 This is the monthly premium that you pay for Medicare Part B medical insurance.
The Medicare Premium Assistance Program (QMB, SLMB & SLMB+) increased the asset limit beginning 1/1/10. See fact sheet The asset limits for the program are $6,940 for a single person and $10,410 for a group of two. If eligible, the State of Wisconsin may pay your Medicare Part B premium and in some cases, your deductibles and coinsurance.
Help With The Cost of Food
Assistance you may qualify for food resources
Medicare Issue: Self-Administered Drugs While in Observation Status at the Hospital
Most people assume that they are an inpatient at a hospital when they stay overnight. But increasingly, that may not be true. Recently, hospitals have been coding more patients as outpatients (in observation status) for overnight stays. Sometimes hospitalized patients stay in observation status for many days. You might be an outpatient even if you stayed overnight in a regular hospital bed. Whether you are an inpatient or outpatient can affect how your hospital bill is paid. Observation status is supposed to be used temporarily while the doctor decides if a person should be admitted to the hospital. But more and more, hospitals are keeping people in observation status for long periods of time.
This can result in larger bills than expected. Many outpatient stays in a hospital may be covered under Part B of Medicare. But some things, like prescription drugs received while an outpatient will not be covered. On the Medicare Summary Notice, these medications will appear as “self-administered drugs.” They will not be covered if your hospital stay is listed as observation or outpatient. The hospital will bill you for these medications. However, it is possible that you can recoup payment from your Medicare Part D plan. You can also try to appeal the denial, especially if you were kept in observation status for many days.
When you get a hospital bill for self-administered drugs you should contact your Part D plan or consult your plan’s handbook. If the drugs you received are part of your plan’s formulary, you may be able to get reimbursed for the medications. You might have to pay the hospital for the medications first and then file for reimbursement from your Part D plan. You should contact your Part D plan for information. Generally, you will need to submit a claim form for an out of network claim. Your Part D plan may also ask you to submit a copy of the hospital bill that shows which drugs you received. It is wise to provide an explanation of why you were hospitalized.
If the drugs are not on the formulary of your plan, you can apply for an exception. In order to get an exception, it will be necessary to get the prescribing physician to write a letter explaining why other similar drugs that are already on the formulary are not acceptable. You and your doctor must prove that the use of this particular drug is “medically necessary.” If an exception is granted, the plan will pay for drugs that are not on its formulary.
It is important to ask your doctor or the hospital staff if you are an inpatient or outpatient anytime you are in the hospital for more than a few hours. It is even more important to find out your status if you are being transferred to a skilled nursing facility after your hospital stay because Medicare will not cover your stay in a nursing home if you were on observation status. Also, always ask the skilled nursing facility if your stay will be covered by Medicare. Pay attention to your bills and statements. Remember that you have appeal rights when Medicare denies payment for your care. Pay attention to the appeal deadlines that are included with the appeal information on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) statements. You must file your appeals before the deadline or you will lose your right to object to the denial of payment.
How to Prevent Identity Theft
The Wisconsin Office of Privacy Protection (OPP) provides information to consumers about preventing identity theft. They can also assist people who are victims of identity theft. A variety of information related to that topic is available at the website of the Wisconsin Department of Agriculture, Trade, and Consumer Protection (privacy.wi.gov). Some of those tips are summarized here: Identity Theft
Beware of Scams
There is currently a postcard going out to seniors offering information about Medicare. It is a marketing tool for additional insurance, but the concern comes in because they are asking seniors to provide their signature on this card. Be aware of signing anything that is going to a post office box. For additional resources check out the Senior Medicare Patrol: http://www.wisconsinsmp.org/. The Wisconsin SMP is one of the oldest federally funded “fraud buster” programs in the country. The project is dedicated to stopping healthcare fraud, waste and abuse.
You can also contact:
Elizabeth Conrad, SMP Project Coordinator
Coalition of Wisconsin Aging Groups Elder Law Center
2850 Dairy Drive, Suite 100
Madison WI 53718-6742
Phone: 800/488-2596 608/224/0606
Email: econrad@cwag.org
Direct Deposit Rules Change for Social Security, Railroad Retirement, and VA Benefits
A new Social Security rule requires that any person who applies for Social Security benefits on or after May 1, 2011 will have to receive their benefits through direct deposit. This also applies to VA and Railroad Retirement benefits.
Direct Deposit is a system by which your Social Security, Railroad Retirement, or Veteran’s Administration benefits are deposited directly into your bank account, instead of receiving a paper check in the mail. It is an electronic transfer of funds. You can still use the money in your account to pay bills or get cash as usual. The deposit will be made, and should be available to you, on the day that you are scheduled to receive your money
Another option for beneficiaries, especially those that do not have a bank account, is to have their money put on a special debit card. These debit cards, called “Direct Express” do not have monthly fees or any fees for overdrafts. There is a fee of 90 cents for all but the first cash withdrawal from an ATM within the network.
It is also expected that Direct Deposit will save the government money because it eliminates the need to pay for postage and envelopes. Talk to your local Social Security office if you prefer to receive a paper check because some waivers are available.
If you would like to receive your check through Direct Deposit, but are still getting a paper check, information is available on the Social Security website; you can also get information at your local Social Security office. You will be asked to fill out a Direct Deposit Sign-up form.
Questions? Contact the ADRC at 262-638-6800