Help With Medical Bills: A Guide for Senior CitizensIf you are a senior citizen, you may be spending too much of your income on health insurance and on health care. This pamphlet provides a brief description of several programs that offer help with medical bills. These programs can have very complex rules which we have not attempted to explain in this guide. We have provided the names of the agencies which administer these programs. You may wish to contact these agencies for additional information. For specific legal advice or assistance, or for copies of related publications, contact Prairie State Legal Services or Land of Lincoln Legal Assistance Foundation. Medicare
Medicare is the medical insurance program administered by the Social Security Administration. Medicare was not designed to cover the full cost of care and does not cover medications, unless you are in the hospital, or most nursing home care. Medicare has two parts. Part A covers hospital care, skilled nursing home care and some home health care. Part B covers a portion of many services provided by doctors or hospitals on an outpatient basis, medical equipment and certain other medical expenses. Medicare has premiums, deductibles and co-pays (a share which you pay of each bill). These expenses can add up. There may be ways you can reduce the amounts you must pay for these Medicare costs. Here are two important ways to reduce your Medicare costs:
Medicaid BackThe Illinois Department of Human Services/ Department of Public Aid offers the Medicaid program for persons who do not qualify for Medicare, persons who have Medicare, but have additional medical expenses that they cannot afford to pay, and persons with income and assets are below certain limits. The advantage to the Medicaid program is that if a doctor, clinic, hospital, or pharmacy accepts Medicaid, they agree to accept the Medicaid determined payment rate as payment in full. Medical providers are not required to accept Medicaid payment, so you should clarify whether the provider accepts Medicaid before you get services. Medicaid generally pays for doctor, hospital, nursing home care, and prescription drugs which have been approved by the Illinois Department of Human Services, and which are reasonable and medically necessary. Your medical provider and the caseworkers at the Department of Human Services can tell you whether a procedure or drug is covered by Medicaid. Some people, with low income and assets, automatically receive a Medicaid card each month. People with higher income and assets are responsible for paying a portion of their medical expenses before they receive a Medicaid card. This is called the "spend-down", which is like an insurance deductible. Prairie State Legal Services has prepared a booklet on the Medicaid spend-down program, "Questions and Answers About Medicaid Spend-Down", which provides detailed information about spend-down. If you are assigned a spend-down by the Department of Human Services, but are eligible for the State Supplemental Payments Program (SSP) you can receive Medicaid without a spend-down. SSP is a cash grant. Because it usually is a small amount, it is often overlooked, but its importance is that if you are eligible for it, you would not have a spend-down. SSP may be an option if you have very low income and high expenses such as expenses for a medically necessary special diet. The cost of nursing home care is covered by the Medicaid program. Generally, a person is eligible for coverage if his or her monthly income is not sufficient to pay the nursing home and his or her cash assets are less than $2,000. Illinois tries to protect some of the income and assets of spouses when one spouse must enter a nursing home. Under this program, the spouse remaining at home can keep up to $80,760 (1998 amount) of the marital assets, and $2,019 (1998 amount) of the marital monthly income. Prairie State Legal Services has prepared a booklet on Medicaid eligibility for nursing home costs, "Financial Help for In-Home Care and Nursing Home Care for Married Couples in Illinois", which explains the rules of eligibility in greater detail.
Community Care Program BackFinancial assistance is also available for in-home health care through the Illinois Department on Aging through the Community Care Program. For married persons, the Department on Aging uses the same eligibility rules as Medicaid uses for nursing home care, which are described in "Financial Help for In-Home Care and Nursing Home Care for Married Couples in Illinois".
Medication Card ProgramMedicare generally does not pay for prescription drugs. Some Medicare HMOs now cover prescription medications. If you do not have Medicaid or other insurance for your medication and you have prescriptions for cardiovascular problems, diabetes, or arthritis, you may be able to receive assistance through the Circuit Breaker Pharmaceutical Card program. This program pays for a portion of the drugs for these ailments, after you pay a small amount to "purchase" a card, and a monthly deductible. It is for persons whose yearly incomes are below $16,000 (1998 limit). You can get details about the program and obtain an application by calling the Illinois Department of Revenue at 1-800/356-6302.
Other Medication Help BackMany pharmaceutical manufacturing companies have Low Income Medication Assistance programs for persons who need medications, but cannot afford them, and who are not otherwise eligible for insurance or governmental medical assistance in paying for their medications. These assistance programs vary somewhat from company to company, and are subject to change. Generally, the prescribing physician initiates the application process by completing a form supplied to him or her by the pharmaceutical company. Eligibility is determined on a case by case basis. Supplies are sent to the prescribing physician to give to the patient. A directory of Prescription Drug Patient Assistance Programs (PhRMA) is available on the Internet at http://www.phrma.org/patients/index.html. The Senior Health Insurance Program (SHIP) at the Illinois Department of Insurance at 1-800/548-9034 will send a PhRMA directory if requested. A person may also obtain information by contacting Elder Care Locators at 1-800/677-1116, or by contacting their local Area Agency on Aging.
If you have medical bills that you are unable to pay and would like legal advice about your options, call the legal services office serving your county. If you are denied Medicare or Medicaid assistance, you have the right to appeal. There are time limits for such appeals. If you need legal advice or assistance, Prairie State Legal Services and Land of Lincoln Legal Assistance Foundation offer such help at no charge.
Land of Lincoln Legal Assistance Foundation BackChampaign Office - Serving:Champaign, Ford & Vermillion Counties 217/356-1351 / 217/442-4141 / 800/747-5523 Decatur Office - Serving: Mattoon Office - Serving:
Prairie State Legal Services Offices BackBloomington - Serving Carol Stream - Serving Kankakee - Serving Ottawa - Serving Peoria - Serving Rockford - Serving Rock Island - Serving St. Charles - Serving Waukegan - Serving The dollar amounts in this brochure are correct as of January, 1998. This publication was prepared by Prairie State Legal Services, Inc. through special funding under Title III F of the Older Americans Act from East Central Illinois Area Agency on Aging and through special funding from the Central Illinois Agency on Aging. Funding for the printing of this publication was provided by East Central Illinois Area Agency on Aging, Central Illinois Agency on Aging, the Illinois Bar Foundation, and the Laurie J. Cohen Memorial Fund of Prairie State Legal Services. Prairie State Legal Services, Inc. does not discriminate in admission to programs or treatment of employment in programs or activities in compliance with the Illinois Human Rights Act, the U.S. Civil Rights Act, Section 504 of the Rehabilitation Act, the Age Discrimination Act, the Age Discrimination in Employment Act, and the U.S. and Illinois Constitutions. If you feel you have been discriminated against, you have a right to file a complaint. For information, contact the Managing Attorney of your local Prairie State Legal Services office. |