Guide 2002 to benefit programs for the elderly [Jan. 2002]

GUIDE 2002 To
BENEFITS PROGRAMS
FOR THE ELDERLY January 2002

MEDICARE Eligible Persons: Age 65 or on disability for 2 years

Part A Coverage: Hospitalization through Blue Cross/Blue Shield

Part B Coverage: Medical Coverage for Doctors, Equipment and Supplies through Cahaba Government Benefits

DEDUCTIBLES: Part A: Part B:

Jan. 2002 $812.00 $100.00

Part A: Uninsured and certain disabled individuals must pay a monthly premium of: $319.00 for the uninsured and for certain disabled individuals who have exhausted other entitlements; $175.00 for those credited with 30 ~arters of coverage.
~o Part B: A person can choose not carry this coverage, but if
they accept it, there is a monthly prcmuum of: $54.00

Appeal Time: 180 days on initial appeal and 60 days for a request for reconsideration.
PRESCRIPTION DRUGS: Not C vered ~y Medicare

HOSPlTAL ~DICARE

I
Medicare pays up to 90 days for each spell ~f illness. For the fIrst

60 days, Medicare pays 100% of cpvered hospital services. For

the 61st through the 90th day, Medfcare pays all but $203.00 per

d~

I.

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Lifetime Reserve Days: Every Medicare beneficiary has 60 days that they may use in their lifetime to cover days in the hospital that exceed the Medicare limit of 90. Once these 60 days have been used, they are not replaced. When one of these days is used, Medicare will pay everything except the first $406.00 per day.

NURSING HOME MEDICARE

Medicare pays for Skilled Care. Only. One must have been hospitalized for 3 consecutive days before entering the nursing home. For the first 20 days, Medicare pays all of the covered costs. For the 21st-100th day, there is a co-insurance payment of $101.50 per day and Medicare pays the rest. After 100 days, Medicare pays nothing.

MEDICAID

If one is eligible for SSVfANF, then one is eligibJe for Medicaid.

The Dept. of Community Health's Division of Medical Assistance: 1-800-282-4536 (administers GA Medicaid) Medi~al

Assistance Only: DFCS takes application. If you lose your

TANF/SSI, you do not necessarily lose Medicaid. The State must

make an independent determination.

MEDICAID COVERS

Emergency ambulance

Prosthetic

Home health

Nursing Home

Cataract eye exams Family Planning

Psychological

Some dental

Lab/ x-ray

Retroactive Medicaid (3 mos.)

Non-emergency transportation

12 doct~rs visits per year unless more medically

. justifIed

5 prescription drugs (prior approval required for

others)

Rental of hospital beds, wheelchairs, crutches and walkers

prescribed by doctors

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COMMUNITY CARE SERVICES PROGRAM This is a program that provides Medicaid Coverage and in-home services for persons who are nursing home etigible but who choose to stay in their own homes. If a person's income level exceeds the Federal Benefit Rate for SSI recipients, there is a cost share to participate in the program. The cost share is based upon the amount of income over the SSI amount. Some of the services available include Homemaker, Adult Day Rehabilitation, Emergency Response System, Nursing Services, etc. For more infOimation, contact the Community Care Services Program Office for your area through the Area Agency on Aging.
NURSING HOME MEDICAID This is a progranl that enables those people who need nursing home care but are unable to afford it a means by w~ich to receive care through the Medicaid program. Income limits: Not more than $1,590.00 income per month and not more than $3,180.00 for a couple if they are in the same nursing home.
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Allowable Resources: home $5,000.00 burial account for each spouse, burial plots, caskets, vaults (and other preneeds items), $2,000.00 savings, household furnishings, automobiles, and
some other items.

SPOUSAL IMPOVERISHMENT This is a program that can prevent a married couple from having to spenddown all of their resources. The program allows the spouse who remains at home, the Community Spouse, who is not receiving Medicaid, to keep up to $2,232:00 of the couple's income and $89,280.00 of the couple's resources.

Example: For a Nursing Home bill of $2,000/month, where the community spouse has $800.00 income and the nursing home resident has $1,200 income, the calculations will be as follows:
Step 1: The Nursing Home Resident receives income in the amount of$I,200:

$1,200 income (minus) $30.00 Personal Needs Allowance (minus) $130.00 in excess medical expenses (equals) $1,040 available income

Step 2: The Community Spouse receives $1,000.00 income:

$1,000.00 income (Plus) $1,040.00 from NIl resident

(equals) $2040.00 total income which is less than

$2,232.00, therefore community spouse keeps $2,040.00

income, leaving $0.00 for the resident's contribution to

the nursing home bill and the Medicaid payment is

..

$2,000.

Incurred medical expenses not covered by Medicaid: dentures,

some medications, and chiropractic care. Expenses such as these

may be deducted from the NIl resident's income. DFCS must

be notified.

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SUPPLEMENTAL SECURITY INCOME (SSI)

For: Those age 65 or older, Blind or Disabled with income below:
Jan. 2002

Individual: Couple: Essential Person:

$545.00 per month $817.00 per month $273.00 per month

There is a resource limit of $2,000.00 for an individual and $3,000.00 for a couple. Resources include things like cash, savings, CDs, etc. Certain things are excluded from resources. Examples of things excluded from resources are: home, car up to $4,500, prepaid burial plots, caskets, vaults etc. and up to $1,500 in a burial account, household goods up to $2,000, tradelbusiness, life insurance face value up to $1,500. Appeal Time: 60 days. Application by phone 1-800-772-1213

Pickle People: If you. received SS/SSI in the same month and SSI was canceled due to cost of living increase, you may be eligible for continued Medicaid if you are eligible but for cost of living increase. Apply at DFCS.

MEDICARE BUY-IN PROGRAMS
There are four programs outlined that enable a person with limited income to assist with paying for the cost of having Medicare. Income limits change every year when the Poverty Levels change.
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1. Qualified Medicare Beneficiary (QMB)

Covers Part B Premium, Co-insurance and Part A & B

Deductibles. (Does not PAY for prescriptions).

Income Limits:

$736.00 individual

$988.00 couple

2. Specified Low Income Medicare Beneficiary (SLIMBl only

covers the Part B Premium

Income Limits:

$879.00 individual

$1181.00 couple

3. Q-l pays the Part B premium: $ Income Limits: $ 987.00 individual
$1,327.00 couple

4. Q-2 pays part ofthe Part B premium: Income Limits: $1,273.00 individual
$1,714.00 couple

Resources: $4,000 individual & $6,000 couple Appeal Time: 30 days (10 days for continued benefits) Transfer of Assets For Nursing Home Admission: In nursing home Medicaid cases where assets are transferred for less than the Fair Market Value within 36 months before application for Medicaid is filed, person may be disqualified for a period of time equal to the value transferred.

Adult Medically Needy "Spend Down"

Aged (65), Blind or Disabled with high medical bills and

income too high for other categories of Medicaid. Total unpaid

bills must bring income below: Appeal Time: 30 days

Jan. 2002

$337.00

$395.00

Resources: $2,000 individual

$4.000 couple

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Food Stamps

HH Elderly Size Max. Gross

Non-Elderly Max. Gross

Max. Allotment

1 $1,182

$ 931

$135

2

1,597

1,258

248

3

2,012

1,585

356

4

2,421

1,913

452

5

2,843

2,240

537

6

3,258

2,567

644

7

3,673

2,894

712

8

4,088

3,221

814

each

add'l +$416

+$328

+$102

person

The food stamp allotment is based upon a person's net food

stamp income. One must meet the maximum gross income to

even be considered eligible for the program.

Resources:

$3,000 elderly (60 and over) . $2,000 non-elderly

Exempt Resources: Home and lot; household goods; cars with FMV under $4,650 or cars exempt because used for income production, long distance work, as home or for transporting disabled. Appeal Time: 90 days (10 days continued benefits).

Medical expenses in excess of $35.00 can be used to increase food stamp allotments for the elderly.

Otber Food Stamp Bud2et Allowances Standard Deduction: $134.00 Shelter Deduction: $354.00 maximum Dependent Care Per Dependent: $175.00 ($200 up to age 2)
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For Assistance with the Programs Discussed In This Brochure See The Following: . DEPARTMENT OF FAMILY AND CHILDREl\ SERVICES (Contact the office in your county) 1. Nursing Home Medicaid
2. Spousal Impoverishment
3. QMB 4. SLIMB 5. Adult Medically Needy "Spend Down" 6. Food Stamps SOCIAL SECURITY ADMINISTRATION
(1-800-772-1213) 1. Medicare 2. Social Security 3. Supplemental Security Income
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C:\HABA GOVERNMENT BENEFITS
P.o. Box 3018, Savannah, GA 31402-3018 (1-800-727-0827)
Medicare Part B Claims
BLUE CROSSIBLUE SHIELD P.O. Box 7368, Columbus, GA 31908
(706) 322-4082
Medicare Part A Claims
DEPARTMENT OF COMMUNITY HEALTH Division of Medical Assistance 2 Peachtree Street Atlanta, GA 30303 (1-800-282-4536) Medicaid
COMMUNITY CARE SERVICES PROGRAM Area Agency on Aging Office for you area Check your local directory
Natalie K. Thomas Attorney at Law
State Legal Services Developer Division of Aging Services
2 Peachtree Street, Suite 9.398 Atlanta, Georgia 30303-3142 (404) 657-5258 or (404) 657-5328
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NOTES -10-