QUEST-EXPANDED ACCESS (MEDICAID), MEDICARE,

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1 QUEST-EXPANDED ACCESS (MEDICAID), MEDICARE, & OTHER MEDICAL ASSISTANCE OPTIONS for those over age 65, blind, or disabled For more information on your matter, please call The Legal Aid Society of Hawai i hotline at (800) Copyright April 2006, Legal Aid Society of Hawai i All rights reserved. These materials may not be reproduced without the written permission of the Legal Aid Society of Hawai i. Under no circumstances are persons receiving these brochures to be charged for copies without written permission of the Legal Aid Society of Hawai i. This is meant to be an informational brochure, and is not intended to take the place of legal counsel. It is not intended to be a complete statement of law nor intended to fully describe or evaluate your options. The distribution of this brochure by the Legal Aid Society of Hawai i does not imply that an attorney-client relationship has been formed. Revised 11/2012. W 22 Medicaid Medicare and Other Medical Assistance Options

2 QUEST-Expanded Access (MEDICAID) What is QUEST-Expanded Access (Medicaid)? QUEST Expanded-Access (QExA) is a needs-based program that provides health insurance to individuals who are aged, blind, or disabled. It is administered by the Department of Human Services (DHS) Med-QUEST Division (MQD). QExA covers a wide range of services including: medical and behavioral health for adults and children, emergency dental for adults, full dental for children, and prescription drugs. DHS provides QExA coverage through two health managed organizations: Ohana Health Plan and United Healthcare Community Plan. This means that once you pick one of the plans, you will need to see a primary care physician under the plan who will refer you to other specialists who use the same plan. Please note that DHS has other medical assistance programs for individuals who may not qualify for QExA. When you apply for medical benefits, you do not need to pick the program. You only need to complete the application. There are two applications: one application for adults and another application for pregnant women and children. Important note: Medicaid is also often used to pay for nursing home expenses. There are special eligibility rules for nursing home coverage. Please contact the Med-QUEST Division for more information. Who is eligible for QExA (Medicaid)? The main eligibility requirements are: (1) Age 65 or over OR have been certified blind or disabled, and (2) Financially needy. How is income calculated for QExA (Medicaid) coverage? The basic income limit for QExA is 0% of the Federal Poverty Level (FPL). Income generally includes any money that the household receives in a particular month from any source. Monthly Income Limits for Medicaid Eligibility (as of October 2012) Household Size 0% FPL 185% FPL 300% FPL 1 $72 $1983 $ $1461 $2684 $ $1830 $3385 $ $2209 $4086 $ $2588 $4787 $ $2968 $5490 $ $3347 $6191 $041 8 $3726 $6893 $11178

3 What can I own and still qualify for QExA (Medicaid)? QExA (Medicaid) limits the assets you can have and still be eligible for coverage. Assets include cash, stocks, bonds, the equity value of life insurance policies, and land. Some assets are not counted and do not affect Medicaid eligibility. QExA (Medicaid) Asset Limits $2,000 per individual $3,000 per couple plus $250 for each additional household member Exempt Assets (Examples) the house in which you live, except for long-term care services if the home is placed in a trust basic maintenance items (clothing, furniture, stove, etc.) automobiles one burial plot per person MEDICARE What is Medicare? Medicare is a federally-funded health insurance program that provides coverage for hospital visits, some home health care, doctors appointments, physical and occupational therapy, some medically-necessary supplies, and prescription drugs. Medicare has several different parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (HMO Plans like Kaiser Senior Advantage or HMSA Akamai Advantage), and Part D (Prescription Drug Plans). Who is eligible for Medicare? Medicare is available to people who are age 65 or older, younger people who have been entitled to SSDI or Railroad Retirement Board disability benefits for 24 months, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant). There are no income or asset limits for Medicare. What is Medicare Part A? Part A helps pay for hospital expenses, some home health care, skilled nursing facility care, and hospice care. If you or your spouse worked for at least years at a job that deducted taxes for Medicare payments, then there is no charge for Part A coverage. What is Medicare Part B? Part B helps pay for other medical expenses such as medically necessary doctors visits, x-rays and other tests, outpatient hospital care, medical equipment, and some home heath care. Part B coverage is available to all applicants, but there is a monthly premium for most people. People who qualify for Medicaid or other Special Medical Assistance programs can have their Part B premium paid for by the state. What is Medicare Part C? For individuals who would like to pay for a more comprehensive health insurance from an HMO, there are several options they can choose from. These plans, called Medicare Advantage plans, take the place of a person s Part A and Part B. Contact the plans directly for more information. There are plans offered by Aloha Care, Kaiser, and HMSA as well as others.

4 What is Medicare Part D? Prescription drug coverage is available to anyone who has either Part A or Part B. There are many different private drug plans that offer this benefit, and you should read their information carefully before signing up. Be sure to check that the plan covers all of your medications and that you know about any restrictions and what the plan costs. Most plans have a monthly premium, a deductible, and co-payments. If your income is below 150% of Federal Poverty Level, and you have assets below $13,070 (single) or $26,120 (couple), you may be eligible for a Low-Income Subsidy that will help pay for these costs. Contact Social Security for more assistance ( ). How do I enroll in Medicare? If you are receiving Social Security Retirement or Railroad Retirement Board benefits and have at least forty quarters of work, then you are automatically enrolled in Medicare starting the first day of the month you turn age 65. If you do not have forty quarters of work and receive Social Security Retirement or Railroad Retirement Board benefits, you will need to apply for Medicare at age 65. If you are under age 65 and are receiving SSDI or Railroad Retirement Board disability benefits, then you will be automatically enrolled in Medicare Part A and Part B in the 25 th month that you are entitled to disability benefits. All others should apply through the Social Security Administration ( ). Can I get help paying for Medicare expenses? If you receive Medicare, have a limited income, and have countable assets below $6940 for an individual and $4 for a couple, then you may qualify for help with Medicare-related expenses including premiums, deductibles, and co-payments. Contact your nearest Med-QUEST office. SPENDDOWN What if my income is too high? If you are aged, blind, or disabled, but you are over the Medicaid income limit, then you may still qualify for medical coverage through spenddown. To receive coverage, you must share medical expenses with the state. Your cost-share the amount you must pay each month is the difference between your household s income and the medically needy standard of assistance for your household size. Each month, the amount you spend on medical expenses, such as doctors bills and prescription medication, must equal your cost-share. After you pay the cost-share, Medicaid will pay your remaining medical expenses for that month. For example, assume that the medically needy standard is $418 (for 1). A single person has $1600 in income. The person s cost share is $1600-$418 = $1182. Once the person spends or incurs $1182 for medical expenses, DHS will cover the remaining expenses.

5 Tips for Meeting Your Cost-Share Amount Schedule appointments together Try to schedule all necessary non-emergency medical visits for all household members in the same month. Use unpaid medical bills You can use unpaid medical or pharmacy bills from previous months to meet your costshare amount for the current month. Expenses from several months may be combined to meet the cost-share amount in any month. Get health insurance or a supplemental medical plan Premiums, deductibles and co-payments are allowable expenses for meeting your costshare, as are subscription fees for other supplemental medical programs, like prescription drug cards. Additionally, health insurance or a supplemental plan may reduce your outof-pocket expenses for health services, thus saving you money. OTHER MEDICAL ASSISTANCE OPTIONS What if Medicare does not provide enough coverage? Some supplemental insurance programs are designed for Medicare recipients who want coverage beyond what Medicare provides. Please contact private insurance companies for more information on Medicare Gap and/or Medicare Supplemental Insurance. What if I can't get Medicare or Medicaid and need help paying for prescription drugs? Several programs provide discounts on prescription drugs. Some charge a fee to join, and some are only for drugs made by a specific company. Please ask your doctor about prescription assistance programs. What if I need medical services, but I do not have health insurance? Some community health centers and medical clinics charge for services on a sliding scale based on your income. Call Aloha United Way's statewide hotline for information on programs in your area. DEFINITIONS SSI/SSDI Supplemental Security Income and Social Security Disability Insurance. Cash assistance programs, administered by the Social Security Administration, for individuals with long-term disabilities. Income Includes earned income (e.g., the salary from a job or income related to work) and unearned income (e.g., government financial benefits, cash settlements, pensions, and child support). Assets Valuable property that can be converted to cash and used to meet current living needs, including things like land, a house, jewelry, and automobiles.

6 CONTACT INFORMATION: Med-QUEST Offices (for QExA program) Oahu Applications Section Kauai Unit 801 Dillingham Blvd., 3rd Floor 4473 Pahee St., Suite A Honolulu, HI 96817; Lihue, HI 96766; West Hawaii Section Maui Section Lanihau Professional Center Mallyard Plaza Palani Rd., Ste Imi Kala St., Ste. 1 Kailua-Kona, HI 96740; Wailuku, HI 96793; East Hawaii Section Molokai Unit 88 Kanoelehua Ave., Rm. #7 P.O. Box 1619 Hilo, HI 96720; Kaunakakai, HI 96748; Lanai Unit P.O. Box Lanai City, HI 96763; Social Security Administration Offices (for Medicare applications) National Toll-Free Number TTY: For Additional Medicare Information Centers for Medicare and Medicaid Services (CMS) MEDICARE ( ) SAGE PLUS Health insurance information for people age 60 or older O ahu : Statewide: Legal Aid Society of Hawai i 924 Bethel Street Honolulu, HI Legal Aid s Hotline: O ahu: Neighbor Islands: REMEMBER: This brochure is meant to provide general information, and does not provide specific legal advice about your individual case. The law often changes. Each case is different.