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Health Insurance

    Results: 21

  • Disability Benefits (9)
    NS-1800

    Disability Benefits

    NS-1800

    Public social insurance programs that replace income lost because of a physical or mental impairment severe enough to prevent a previously employed person from working. Monthly cash benefits are paid to the eligible individual with a disability and his or her eligible dependents throughout the period of disability.
  • Health Insurance Information/Counseling (1)
    LH-3500

    Health Insurance Information/Counseling

    LH-3500

    Programs that offer information and guidance for people who need assistance in selecting appropriate health insurance coverage and which may also answer questions about health insurance benefits and help people complete insurance forms.
  • Health Insurance/Dental Coverage (16)
    LH-3000

    Health Insurance/Dental Coverage

    LH-3000

    Organizations that issue insurance policies which reimburse policy holders for all or a portion of the cost of hospital, medical or dental care or lost income arising from an illness or injury.
  • Insurance Claims Assistance (2)
    FT-3900.3300

    Insurance Claims Assistance

    FT-3900.3300

    Programs that provide a variety of supportive services for individuals who need assistance in completing, filing and/or appealing decisions with regard to insurance claims and/or for organizations that need assistance in benefits administration.
  • Insurance Complaints (1)
    DD-1500.4800

    Insurance Complaints

    DD-1500.4800

    Programs that accept and, where possible, attempt to resolve complaints regarding the licensing, services, unethical or improper conduct of personnel or other inappropriate business practices of companies that sell insurance or settle insurance claims.
  • Long Term Care Insurance (15)
    LH-3000.4500

    Long Term Care Insurance

    LH-3000.4500

    Private insurance companies, government programs and public/private partnership programs that issue individual and group insurance plans or policies which pay for nursing facility care, home health care, adult day health care, respite care, hospice care and/or home modifications to eliminate barriers for people who are chronically ill. Long-term care policies cover all levels of care including skilled, intermediate and custodial. Benefits may be triggered when an individual's doctor orders care, when s/he has some cognitive impairment or if s/he is unable to perform certain activities of daily living independently such as bathing, dressing, eating and toileting. A limited number of states participate in public/private partnerships which have provisions to protect participants from becoming impoverished in order to become eligible for Medicaid long-term care benefits.
  • Medicaid (48)
    NL-5000.5000

    Medicaid

    NL-5000.5000

    A combined federal and state program administered by the state that provides medical benefits for individuals and families with limited incomes who fit into an eligibility group that is recognized by federal and state law. Each state sets its own guidelines regarding eligibility and services within parameters established at the federal level. Many people are covered by Medicaid, though within these groups, certain additional requirements must be met. Eligibility factors include people's age, whether they are pregnant, have a disability, are blind, or aged; their income and resources (like bank accounts, real property or other items that can be sold for cash); and whether they are U.S. citizens or lawfully admitted immigrants. Families who are receiving benefits through TANF and individuals who receive SSI as aged, blind and disabled are categorically eligible groups. The rules for counting a person's income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes, for people served under the Medicaid Waiver program, for people served by Program of All-Inclusive Care for the Elderly (PACE) programs and for children with disabilities living at home. Medicaid makes payments directly to a person's health care provider; and some recipients may be asked to pay a small part of the cost (co-payment) for some medical services. Most states have additional "state-only" programs to provide medical assistance for specified low-income persons who do not qualify for the Medicaid program.
  • Medicaid Applications (37)
    NL-5000.5000-520

    Medicaid Applications

    NL-5000.5000-520

    County or state offices that accept applications and determine eligibility for the Medicaid program; and reinstate individuals who have lost their Medicaid benefits due to incarceration, institutionalization, noncompliance or other reasons. Also included are other programs that help people prepare and file Medicaid applications and/or are authorized to do eligibility determinations for the program.
  • Medicaid Fraud Reporting (2)
    FN-1700.9500-500

    Medicaid Fraud Reporting

    FN-1700.9500-500

    Programs that provide a hotline or other mechanisms that Medicaid recipients and the public at large can use to report recipients or health care providers that make false statements or representations which result in an unauthorized payment by the Medicaid program to themselves or another. Examples of fraud include incorrect reporting of diagnoses or procedures to maximize payments; billing for services, medical supplies or equipment not furnished; misrepresentation of the dates and descriptions of services furnished, the identity of the recipient or the individual furnishing services; and billing for noncovered or nonchargeable services as covered items.
  • Medicare (1)
    NS-8000.5000

    Medicare

    NS-8000.5000

    A federally funded health insurance program administered by the Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), for people age 65 and older; for individuals with disabilities younger than age 65 who have received Social Security Disability benefits for at least 24 consecutive months; and for insured workers and their dependents who have end stage renal disease and need dialysis or a kidney transplant. Premiums, deductibles, and co-payments or out-of-pocket costs are required for Medicare coverage. Special programs that assist with paying some or all of these costs are available for low income persons who qualify. Medicare has four parts: Hospital Insurance (Part A), which helps pay for care in a hospital or skilled nursing facility, home health care and hospice care; Supplemental Medical Insurance (Part B), which helps pay for doctors, outpatient hospital care and other medical services including the Medicare Preventive benefits (effective January 1, 2005); Medicare Advantage (Part C, formerly known as Medicare+Choice), which offers a variety of Medicare managed care options, including coordinated care plans and private, unrestricted fee-for-service plans, that are required to provide, at minimum, the same benefits as Part A and B, excluding hospice services; and the Medicare Prescription Drug Benefit (Part D, effective January 1, 2006), a program managed by private plans that assists in covering the cost of prescription drugs for beneficiaries. People who have Medicare Part A and/or Part B need to join a Medicare prescription drug program to obtain insurance coverage for prescription drugs.
  • Medicare Appeals/Complaints (3)
    NS-8000.5000-520

    Medicare Appeals/Complaints

    NS-8000.5000-520

    Programs that are responsible for hearing appeals and resolving grievances that have been filed by people who have applied for or are receiving benefits through the Medicare program (including the Part D Prescription Drug Benefit and the subsidies that are available to low income beneficiaries enrolled in the Part D Benefit) and believe that an adverse action has been wrongly taken, including discrimination, violation of rights and/or failure to take an appropriate action.
  • Medicare Enrollment (14)
    NS-8000.5000-560

    Medicare Enrollment

    NS-8000.5000-560

    Social Security offices that accept applications for enrollment in and determine eligibility for the Medicare program. People who have signed up for early retirement benefits with the Social Security Administration or the Railroad Retirement Board apply for Medicare at that time and receive their Medicare card in the mail automatically prior to their 65th birthday. Individuals who wait for full retirement age to sign up for SSA cash benefits will need to apply for Medicare approximately three months prior to their 65th birthday month at the Social Security office where they will do the paperwork and designate if they want Part A and/or B. They will get their Medicare card in the mail showing their enrollment (Part A and/or B) with an effective date, the first of their birthday month. These people are now enrolled in Original Medicare and can sign up with a supplement or Medicare Prescription Drug Plan (Part D), or have the option of receiving their Medicare benefits through a Medicare Advantage plan (HMOs, PPOs, special needs plans, private fee for service plans). If they choose to enroll in a Medicare Advantage plan, they will have to determine availability and which plan is best for them, and then will need to enroll directly with the plan of their choice. Information about Medicare Advantage plans is available in the Welcome to Medicare handbook people receive when they enroll, by calling 1-800-MEDICARE or by using the personal plan finder on the Medicare website. Also included are other programs that help people prepare and file Medicare enrollment applications and/or are authorized to do eligibility determinations for the program.
  • Medicare Fraud Reporting (1)
    FN-1700.3350-550

    Medicare Fraud Reporting

    FN-1700.3350-550

    Programs that provide a hotline or other mechanisms that persons with Medicare and the public at large can use to report health care providers or beneficiaries who make false statements or representations which result in an unauthorized payment by the Medicare program to themselves or another. Also included are organizations that accept and investigate reports about fraudulent entities that misrepresent themselves as approved Medicare Part D Prescription Drug Plans; approved plans that use aggressive marketing tactics, discriminate against a beneficiary (e.g., prevent them from signing up for a plan based on their age, health status, race or income), entice beneficiaries to enroll in a more costly plan than they require, or erroneously charge beneficiaries for medication provided under the plan they have selected; or pharmacies that provide a different drug than the one prescribed by the physician. Examples of Medicare fraud include incorrect reporting of diagnoses or procedures to maximize payments; billing for services, medical supplies, equipment or medications not provided; misrepresentation of the dates and descriptions of services or medications provided, the identity of the recipient or the individual furnishing services; and billing for noncovered or nonchargeable services as covered items. Also included are programs that provide consumer education, counseling and assistance with the objective of helping people identify instances of fraud.
  • Medicare Information/Counseling (16)
    LH-3500.5000

    Medicare Information/Counseling

    LH-3500.5000

    Programs that offer information and guidance for older adults and people with disabilities regarding their health insurance options with the objective of empowering them to make informed choices. Included is information about the eligibility requirements for Medicare; selection and enrollment in a Medicare prescription drug plan; benefits covered (and not covered) by the program; the payment process; the rights of beneficiaries; the process for determinations, coverage denials and appeals; consumer safeguards; and options for filling the gap in Medicare coverage. These programs also provide counseling and assistance about the subsidies that are available to low income beneficiaries enrolled in the Part D Prescription Drug Benefit; and may also provide information about Medicaid and the linkages between the two programs, referrals to appropriate state and local agencies involved in the Medicaid program, information about other Medicare-related entities (such as peer review organizations, Medicare-approved prescription drug plans, fiscal intermediaries and carriers), and assistance in completing Medicare insurance forms.
  • Medicare Insurance Supplements (24)
    LH-3000.5000

    Medicare Insurance Supplements

    LH-3000.5000

    Organizations that offer insurance policies which pay for some health care costs that are not covered by Medicare. These generally include Medicare deductibles and co-payments, but not long-term care.
  • Medicare Part D Low Income Subsidy Applications (12)
    NS-8000.5000-600

    Medicare Part D Low Income Subsidy Applications

    NS-8000.5000-600

    Social Security offices that accept applications and determine eligibility for the subsidies that are available to low income beneficiaries enrolled in the Medicare Part D Prescription Drug Benefit. Beneficiaries may also apply for the subsidy through the online application available on the Social Security Administration website. Also included are other programs that help people prepare and file Medicare Part D Low Income Subsidy applications and/or are authorized to do eligibility determinations for the program.
  • Medicare Prescription Drug Plan Enrollment (2)
    NS-8000.5000-660

    Medicare Prescription Drug Plan Enrollment

    NS-8000.5000-660

    Medicare Prescription Drug Plans that are approved by the Centers for Medicare & Medicaid Services (CMS) to offer prescription drug coverage and accept applications for enrollment from Medicare beneficiaries. Beneficiaries may also enroll in a plan through the online enrollment application available on the CMS website which also has a tool for comparing different plans. Also included are other programs that help people prepare and file Medicare Prescription Drug Plan enrollment applications and/or are authorized to do eligibility determinations for the program.
  • Medicare Savings Programs (36)
    NL-5000.5000-700

    Medicare Savings Programs

    NL-5000.5000-700

    Programs that pay all or a portion of Medicare costs for low income Medicare beneficiaries with limited resources/assets. The programs are administered by Medicaid medical assistance offices, pay all or a portion of Medicare premiums and may pay Medicare deductibles and co-insurance. Included are the Qualified Medicare Beneficiary (QMB) program that pays Medicare premiums, deductibles and co-payments for people with combined incomes that do not exceed 100 percent of the federal poverty level; the Specified Low-Income Beneficiary (SLMB) program that pays Medicare Part B premiums for people with combined incomes between 100 and 120 percent of the federal poverty level; the Qualifying Individuals (QI) program that pays Medicare Part B premiums for people with combined incomes 120 and 135 percent of the federal poverty level; and the Qualified Disabled and Working Individuals (QDWI) program that helps pay the Part A premium for individuals under age 65 who have a disability and are working, have lost their premium-free Part A when they returned to work, are not receiving medical assistance from their state and meet income and resource limits required by their state. The QI program is available on a first come, first served basis. Asset/resource limits are uniform for the QMB, SLMB and QI programs and are $7,160 for single individuals and $10,750 for married couples. Resource limits for the QDWI are $4000 in countable assets/resources for individuals and $6000 for married couples.
  • PACE Programs (1)
    NL-5000.6800

    PACE Programs

    NL-5000.6800

    A capitated benefit authorized by the Balanced Budget Act of 1997 (BBA) that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than being institutionalized. Capitated financing allows providers to deliver all services participants need rather than being limited to those reimbursable under the Medicare and Medicaid fee-for-service systems. The BBA established the PACE model of care as a permanent entity within the Medicare program and enables States to provide PACE services to Medicaid beneficiaries as a State option. The State plan must include PACE as an optional Medicaid benefit before it can enter into program agreements with PACE providers. Participants must be at least 55 years of age, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant's needs. The care is overseen by an interdisciplinary team, consisting of professional and paraprofessional staff.
  • State/Local Health Insurance Programs (2)
    NL-5000.8000

    State/Local Health Insurance Programs

    NL-5000.8000

    Programs that provide health insurance for people who do not qualify for Medicaid, do not have access to insurance provided by an employer or cannot afford privately purchased health insurance. Services covered by these programs vary by state but generally include hospitalization, physician services, emergency room visits, family planning, immunizations, laboratory and x-ray services, outpatient surgery, chiropractic care, prescriptions, eye exams, eye glasses and dental care. Other services may include alcohol and drug treatment, mental health services, medical and equipment and supplies and rehabilitative therapy. Eligibility requirements also vary. Included are state and/or local government health insurance programs which may be administered by the state or at the local level, and public/private partnerships between state and/or local government entities and health insurance companies or other private organizations. Health care is generally provided through participating managed care plans in the area.
  • Veteran/Military Health Insurance (1)
    NS-8000.9000

    Veteran/Military Health Insurance

    NS-8000.9000

    Programs administered by the Department of Defense (DoD) Health Affairs Office or the U.S. Department of Veterans Affairs that provide health benefits coverage for eligible military personnel, eligible veterans and eligible dependents.
 
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