Insurance and Benefits

    Results: 9

  • Benefits Assistance (6)
    FT-1000

    Benefits Assistance

    FT-1000

    Programs that provide assistance for people who are having difficulty understanding and/or obtaining grants, payments, services or other benefits to which they are entitled by law. The programs may help people understand the eligibility criteria for benefits, the benefits provided by the program, the payment process and the rights of beneficiaries; provide consultation and advice; help them complete benefits application forms; negotiate on their behalf with benefits administration staff; and/or represent them in administrative processes or judicial litigation. Included are benefits counseling organizations that offer a range of advocacy services and legal aid programs that offer more formalized legal assistance.
  • Health Insurance Information/Counseling (4)
    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.
  • Long Term Care Ombudsman Programs (1)
    FT-4950

    Long Term Care Ombudsman Programs

    FT-4950

    Programs that investigate and attempt to resolve complaints made by or on behalf of residents of nursing facilities, residential care homes, assisted living facilities and other supervised living facilities for older adults. The program also promotes policies and practices that improve the quality of life, health, safety, welfare and rights of residents; monitors laws, regulations and policies that affect those who live in long-term care facilities; provides the public with information about long-term care options; and promotes the development of consumer organizations concerned about long-term care. Under the federal Older Americans Act, every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long term care system.
  • Medicaid Applications (2)
    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 Estate Recovery Programs (1)
    NL-5000.5000-560

    Medicaid Estate Recovery Programs

    NL-5000.5000-560

    Programs that are responsible for implementing the 1993 federal legislation that makes it mandatory for states to attempt to recover Medicaid payments for recipients from their estates after they die; and/or which provide information about the program. Since most tangible assets are spent through Medicaid spend down, estate recovery focuses on real property, personal property or business ownership that the deceased had an interest in just prior to receiving Medicaid. Recovery applies to individuals who were age 55 or older when they received Medicaid or to permanently institutionalized adults younger than age 55. Recovery can also occur from the estate of living recipients who are in a nursing home and who have been certified that they cannot reasonably be expected to be discharged and return home. The property is exempt from estate recovery if the recipient's spouse is living there, a blind or permanently disabled child lives there, or if as a result of a state lien, additional protection for siblings and adult children can be satisfied.
  • Medicaid Fraud Reporting (1)
    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 (2)
    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.
  • SSI (5)
    NL-1000.8100

    SSI

    NL-1000.8100

    A federal income maintenance program administered by the Social Security Administration that provides basic financial assistance in the form of monthly checks for people who are age 65 and older, blind or have a disability and who have little or no income and resources. Some states supplement SSI checks for certain categories of recipients. If the state's supplemental payment is federally administered, individuals are automatically assessed for SSP eligibility when they apply for SSI and the supplemental payment is included in their SSI check. If a state administers its own supplemental payments, individuals must apply separately at the state agency.
  • Veteran Benefits Assistance (2)
    FT-1000.9000

    Veteran Benefits Assistance

    FT-1000.9000

    Programs that provide assistance for veterans who are having difficulty understanding and/or obtaining the full benefits and services to which they are entitled by law based on service to their country. The programs may help veterans understand the eligibility criteria for benefits, the benefits provided by the program, the payment process and the rights of beneficiaries; provide consultation and advice; help them complete benefits application forms; negotiate on their behalf with U.S. Department of Veterans Affairs staff; and/or represent them in administrative processes or judicial litigation. Included are veteran rights organizations that offer a range of advocacy services as well as legal aid programs that offer more formalized legal assistance.