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+)
The Red Tape Cutters: Elder Benefit Specialists (State Brochure)
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.
General Benefit Information
The Affordable Care Act (ACA) is a health care reform law that was developed so health insurance will be available for everyone in the United States. If you are covered under Medicare (Disabled or 65 and older) your insurance coverage does NOT change and you do NOT need to go to the Health Insurance Marketplace for coverage.
YouToons Video Explains Health Insurance -- from the Kaiser Family Foundation
In the 5-minute animated video produced by the Kaiser Family Foundation, Health Insurance Explained – The YouToons Have It Covered, the YouToons break down important insurance concepts, such as premiums, deductibles and provider networks. The video explains how individuals pay for coverage and obtain medical care and prescription drugs when enrolled in various types of health insurance, including HMOs and PPOs. You can request to download a copy to show at in-person events or meetings.
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. They have a new option called Economic Check Up to help older adults to find work, budget their money, and save on daily expenses.
Benefits Check up Guide –Wisconsin Benefit Specialists "Nutshell"
Prescription Drug, Dental and Health Discounts:
Need assistance with your prescription drug costs? Check out Racine County's NACo Free Prescription drug discount card at: http://www.nacorx.org/. For plans that offer discounted dental and Medical services go to: https://www.nacohealth.org/
Medicare: To Your Good Health
Medicare Costs 2017
2016 &2017 costs at a glance Part A premium Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you do buy Part A, you'll pay up to $411 each month ($413 in 2017). Calculate my premium. Part A hospital inpatient deductible and coinsurance
·$1,316 deductible for each benefit period
·Days 1-60: $0 coinsurance for each benefit period
·Days 61-90: $329 coinsurance per day of each benefit period
·Days 91 and beyond: $658 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
·Beyond lifetime reserve days: all costs
Part B premium: The standard Part B premium amount in 2017 will be $134 (or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount ($109 on average). Part B deductible and coinsurance $183 per year. After your deductible is met, you typically pay 20% of the In Original Medicare; this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you are responsible for the difference.
Nursing Home days 21-100 $164.50 per day
News from Our Benefits Specialists – Click on an article to read.
The Costs of Medicare Advantage Plans
Extra Help for Part D: Medicare Part D Low Income Subsidy (LIS)
Those with incomes under 150% ($1,471.25 monthly for single or $1,991.25 couple) of poverty can apply for the LIS through the Social Security Administration. Available assets must be less than $13,640.00 single and $27,250 couples. Assets do not include the home, car, personal possessions and certain cash values to life insurance policies. Apply on-line by calling your local SSA office.
More Preventive Services are Now Available Through Medicare - Be sure to check your "Medicare and You" publication See information about your annual Wellness Checkup . It's different than you think.
Medicare and Hospitalization Hosptialization, are you in-patient or out-patient?
Medicare Issue: Self-Administered Drugs While in Observation Status at the Hospital
Medicare Annual Enrollment Period Begins October 15th; Ends December 7th
Other Benefits and Information:
Energy Assistance Program Information for the upcoming season
Denied FoodShare or Medicaid benefits? - you can request a Fair Hearing Access the form here
The Importance of Appeal Rights
The Medicaid Purchase Plan Can Help Disabled Seniors with Medical Costs
The Medicare Savings Program can help pay the cost of your Medicare premium
Prescription Drug Program - Senior Care
Senior Care is a Wisconsin Program for prescription Drugs that is a creditable Part D plan. It can also supplement a Part D plan when you reach the donut hole. You must be 65 or older. Call the ADRC if you have further questions.
Help With the Cost of Food
People often talk about receiving Food Stamps. In Wisconsin , the name of the program that issues funds for low-income people and families to purchase food is called FoodShare. People receiving this benefit use a Quest card (like a credit card) to make their purchases. The federal government also uses the acronym SNAP for the same program. If possible, please use the FoodShare name when requesting this benefit, or simply ask for help with paying for food.
Racine County Information:
SNAP (Supplemental Nutrition Assistance) program website:
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
Foreign Money and other Scams
Here are the top consumer complaints in Wisconsin
There have been postcards 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 SMPis 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:
Kevin Brown, SMP Project Coordinator
Coalition of Wisconsin Aging Groups Elder Law Center
2850 Dairy Drive, Suite 100
Madison WI 53718-6742