URBAN CALL — HEALTHY LIVING EVERY DAY!
Get extra help! How Medicare & Medicaid work together Reviewed by Richard N. Fogoros, MD
Although they may sound similar, Medicare and Medicaid are two very different programs. One is intended to provide health care to the elderly and/or disabled while the other offers healthcare to the poor. Millions of Americans are eligible for both programs, 8.3 million according to the Centers for Medicare and Medicaid Services. These beneficiaries are referred to as dual eligible. Understanding how the programs work together will help you make the most of your healthcare experience. Medicare eligibility is the same regardless of where you
live. It is set by the federal government. To be eligible for Medicare, you need to be 65 years or older or have a qualifying disability. In addition, you must also meet U.S. citizenship or permanent legal residency requirements. Medicaid eligibility, on the other hand, varies geographically. Although the federal government sets the minimal program requirements, the program itself is run by the individual states. Each state has the option to adjust their eligibility standards. Medicaid is intended to offer health care to individuals with low income across various categories: children, pregnant women, parents, seniors, and individuals with disabilities. With the passage of the Affordable
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Lafayette Jones
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Care Act, adults without children could also be covered if their state accepted the terms of Medicaid Expansion. Some people with limited resources and income also may be able to get Extra Help with the costs
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Eating Healthy
Dual Eligibility
Member ID: HXXXXXXXX
CARD ISSUED: MM/DD/YYYY
Patrick Farley
A Medicare Health Plan with Prescription Drug Coverage
MEMBER NAME
Patti LaBelle
Carrying these cards? Humana Gold Plus (HMO SNP)
— monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan.The Extra Help is estimated to be worth about $4,900 per year. Many people qualify for these big savings and don’t even know it.
Medicare Plan to Complement Veterans Benefits...3
Medicare Assistance
SHIIP
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Sandra Miller Jones
Then you may also be able to carry this card and get even more benefits!
4 Carrying These Cards?
By Tanya Feke, MD
Medicare
Welcome to another Urban Call special edition helping you to learn about your Medicare and Medicaid options. There are many most people don’t know about. For example, individuals who receive both Medicare and Medicaid coverage could receive up to $300 every quarter in over-the-counter vitamins, pain relievers and other products, at no cost to them. There is also extra help for individuals and families with limited income. SMSi Community Ambassadors & Partners are spreading the word on these opportunities.Contact us at 336-759-7477 or SMSiPartners@SMSi-Net.com.
Medicare & You
THE OFFICIAL U.S. GOVERNMENT MEDICARE HANDBOOK
MEDICARE
& YOU CMS (Centers for Medicare & Medicaid Services) publishes the official U.S. government handbook, “Medicare & You.” It answers many detailed questions. To get a printed 2019 copy visit your nearest Social Security office. You can view the handbook online at (medicare. gov/sites/default/files/2018-09/10050-medicare-andyou.pdf). Medicare’s toll free telephone number is (800) 633-4227.
PAGE 2 URBAN CALL — HEALTHY LIVING EVERY DAY!
SilverSneakers health tip: Plan a monthly date with accountability buddies
“For the past few years, a group of friends and I have chosen a fun activity like going for a walk, seeing a movie, or attending a yoga class together to do first, and then we each make a promise to the group that we will work on one behavior for the four weeks that follow,” says Katie A. Rickel, Ph.D., a clinical psychologist based in Durham, North Carolina. It’s important that everyone selects a behavior over which they have complete control (“I will walk for 10 minutes at least three times each week,” for example) rather than
an outcome (“I will lose 10 pounds”), she says. “Before we part ways, we make a plan to repeat the same activity exactly four weeks from now and promise to share our experience,” Rickel says. “It’s a given that we’ll all encounter obstacles and struggles, so we always return to the follow-up confident that we will be embraced, accepted, and encouraged regardless of our success in meeting our stated goals.” Reprinted with permission from SilverSneakers and Tivity Health. For more health and wellness tips, visit www.silversneakers.com.
Sandra Miller Jones SMSi Health Insurance Solutions (336) 414-0905 smjones@smsi-net.com Sharon Lyles SMSi Lead Agent Ambassador (336) 451-1328 SharonKayLyles@gmail.com
This image is the sole property of Humana, Inc. and is made available for editorial use only.
LIS program provides subsidies
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SMSi & Urban Call Community Outreach Office Goler CDC Center 899 North Liberty Street Winston Salem, NC 27101 Office: (336) 759-7477
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SMSi-Urban Call Marketing, Inc. Warehouse and Shipping: President and CEO; Urban Call Publisher: Lafayette Jones Donevan K. Cherry Lead Ambassadors: Executive Editor: Alan Cronk Donevan Cherry, Rick Wood, Gerry Editorial Director: Rose M. Walsh Patton, Vernon Jones, Ervin Baker, Production Manager: Jodi S. Sarver Patricia Degraffinreaidt Financial Services: Wanda Courts
If you have limited income and resources, you may qualify for help to pay for some health care and prescription drug costs. Extra Help, also called low-income subsidy (LIS), is a Medicare program to help people with limited income and resources pay a portion of Medicare costs. Who qualifies for LIS? Annual income • > $18,210 (Individual)/$24,690 (Married) • May still qualify if annual income is higher in special cases Assets/Resources • > $14,100 (Individual)/$28,150 (Married Couple Living Together) • Includes: checking/savings accounts, stocks, bonds • Does not include: primary residence, one car, any life insurance policy, up to $1,500 savings toward burial expenses, burial plot, furniture/household/personal items Must have original Medicare Parts A and B and reside in one of the 50 states or District of Columbia. Seniors’ Health Insurance Information Program has answers
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Licensed Medicare Agent Team
Seniors’ Health Insurance Information Program (SHIIP) is a consumer information division of the North Carolina Department of Insurance that assists people with Medicare and long-term care insurance questions. The organization also helps people recognize
and prevent Medicare billing fraud and abuse. Trained SHIIP volunteers are in existing human services agencies such as the Council on Aging or Cooperative Extension offices. Nationwide toll-free number (800) 443-9354, North Carolina toll-free number: (855) 408-1212 www.ncshiip.com ncshiip@ncdoi.gov
Alvin Borders SMSi Health Insurance Solutions (336) 987-1256 bordersalvin@yahoo.com Marjorie Rorie SMSi Health Insurance Solutions (336) 403-1193 Mrorie2003@gmail.com Talaya Loyd SMSi Health Insurance Solutions (336) 734-9196 taloyd5@gmail.com John Wall SMSi Health Insurance Solutions (704) 905-4451 jfwall50@hotmail.com Constance Baker Harris Authorized Agent (336) 965-4140 constanceharris@live.com Debra Shore Authorized Agent (336) 813-2049 shoreweb@bellsouth.net Natalie Nicholson Authorized Agent (336) 624-3183 natnic25@gmail.com Sandra McCauley Authorized Agent (336) 988-1506 sandramccauleyinsurance@gmail.com
URBAN CALL — HEALTHY LIVING EVERY DAY!
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Dual Eligible Special Needs Plan may make sense if you have both Medicare, Medicaid By Patrick Farley, NC Medicare Sales Director, Humana
Health benefits can be confusing to navigate, particularly as you become eligible for additional support services. While most Americans 65 and older—or those who qualify due to disability— are eligible for Medicare, some may also be eligible Patrick Farley, NC for NC Medicaid, Medicare Sales North Carolina’s Director, Humana Medicaid program, based primarily on financial need. Individuals who fit into both categories are known as dual eligible, according to the Centers for Medicare & Medicaid Services (CMS). How do I know if I’m dual eligible? While dual eligibility does not apply to every Medicare beneficiary, 10.8 million people nationwide are fully or partially dual eligible. It’s important to note that eligibility for Medicare and NC Medicaid are determined separately. When it comes to Medicare, according to CMS, of the more than 1.7 million Medicare beneficiaries in North Carolina, 82 percent are eligible due to age (65 and older), while the remaining 18 percent are eligible due to disability. When it comes to Medicaid, the income qualifications for NC Medicaid assistance vary, so visit Medicaid.gov or contact your local office at 1-888-245-0179 to see if you might be eligible. Why would a Dual Eligible Special Needs Plan be a good option if I am dual eligible?
If you are dual eligible, you should consider signing up for a Dual Eligible Special Needs Plan, which is a type of Medicare Advantage plan for people who have both Medicare and Medicaid. These plans may make receiving care more accessible than having traditional Medicare, alone. Dual Eligible Special Needs Plans are administered by private insurance companies like Humana and often offer additional benefits sometimes at no extra premium. A reminder that you still have to pay your Medicare Part B premium. The amount you pay (cost share), however, may be different depending on how much extra help you receive. And, if you are dual eligible, you can sign up for a Medicare Advantage plan once per calendar quarter between January and September, not just during the Medicare Annual Election Period (Oct. 15-Dec. 7). Here’s how having a Dual Eligible Special Needs Plan over traditional Medicare can help dual eligible individuals make the most of their benefits: 1. Access to dedicated doctor/ provider network. Having a Dual Eligible Special Needs Plan means the Medicare Advantage plan becomes your primary health plan for receiving care. These plans typically provide you with a network of doctors and health care providers. Doctors and health care providers know that working with Medicare Advantage plans means their patients will have care coordination and other services available through the plan. It’s important to note that Medicare and NC Medicaid are two entirely different programs that operate under different guidelines; they were not designed to work
If you are within three months of turning 65, you are eligible for the Medicare Initial Enrollment Period (IEP) and can enroll in a Medicare plan to complement your veterans benefits.
together. Because of this, your doctor and health care providers may need to coordinate payment for services with both your Medicare Advantage plan and NC Medicaid. 2. The availability of additional benefits. Dual Eligible Special Needs Plans often include extra benefits as part of the plan such as dental, vision, and an over-thecounter drug allowance. Many times you will also have access to a fitness benefit that offers free gym membership and access to fitness classes. At the same time, these plans may have simplistic benefit designs that may minimize costs. For example, some Dual Eligible Special Needs Plans have a $0 copay for primary care doctor visits and affordable or $0 copays for specialist visits. 3. Care coordination. A Dual Eligible Special Needs Plan can offer coordination of your care. This may be especially important if you have one or more chronic conditions, such as
diabetes or congestive heart failure. As an example, plans may offer skilled care managers who can help you get the care or services you need at the right time and place. This can include services such as helping you understand and follow your physician’s recommended treatment plan, managing transitions between hospital visits and home, connecting you to resources for food, and helping you get access to necessary prescription drugs and medical equipment. Receiving the care you deserve as a dual eligible individual may be challenging. Signing up for a Dual Eligible Special Needs Plan is one way to potentially help you get the care coordination and additional benefits you need, all in one plan. Humana is a Coordinated Care Plan with a Medicare contract and a contract with the North Carolina Medicaid program. Enrollment in any Humana plan depends on plan renewal.
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Type 2 diabetes can be managed
Singer LaBelle has diabetes and enjoys good food.
Type 2 (formerly called adultonset diabetes) has increased 30 percent in the last decade and accounts for 90 to 95 percent of the 16 million Americans with diabetes. Even more alarming, type 2 diabetes is being diagnosed more frequently in adolescents and young adults. Among people aged 30-39, diabetes increased
a staggering 70 percent. AfricanAmericans are more than one and a half times as likely as whites to get diabetes. For more information about controlling diabetes, call (800) 8608747 or visit the National Diabetes Education Program website at ndep. nih.gov.
Carrying these cards? Humana Gold Plus (HMO SNP)
A Medicare Health Plan with Prescription Drug Coverage
CARD ISSUED: MM/DD/YYYY
MEMBER NAME
Member ID: HXXXXXXXX Plan (80840) 9140461101 RxBIN: XXXXXX RxPCN: XXXXXXXX RxGRP: XXXXX
Copayments OFFICE VISIT: $XX SPECIALIST: $XX HOSPITAL EMERGENCY: $XX
Then you may also be able to carry this card and get even more benefits!
CMS XXXXX XXX
A Humana Dual Eligible Medicare Advantage plan includes Medicare coverage and works with your Medicaid benefits so you can get the benefits you need and more, like: • • • • • •
Prescription drug coverage 24-hour nurse advice line Rewards for completing preventive health screenings and activities Maximum annual out-of-pocket protection Doctor’s office visits and hospital coverage And more we haven’t listed!
Call a licensed sales agent today to find out more about the Humana Gold Plus® designed with you and your needs in mind. Humana Cary Office
Humana Charlotte Office
Humana Greensboro Office
Monday – Friday, 8 a.m. – 5 p.m.
Monday – Friday, 8 a.m. – 5 p.m.
Monday – Friday, 8 a.m. – 5 p.m.
919-465-1367 (TTY: 711)
704-643-1009 (TTY: 711)
336-547-2701 (TTY: 711)
Humana is a Coordinated Care plan with a Medicare contract and a contract with the Medicaid program. Enrollment in this Humana plan depends on contract renewal. If you currently have an EPIC Plan you may be eligible for help from the state paying your Humana Medicare Advantage plan premiums. For accommodations of persons with special needs at meetings call 1-800-457-4708 (TTY: 711), 8 a.m. – 8 p.m., seven days a week. Applicable to Humana Gold Plus (HMO) H1036-167, -168. At Humana, it is important you are treated fairly. Humana Inc. and its subsidiaries comply with applicable Federal Civil Rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. English: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-877-320-1235 (TTY: 711). Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-320-1235 (TTY: 711). 繁體中文 (Chinese): 注意：如果您使用繁體中文 ，您可以免費獲得語言援助服務 。請致電 1-877-320-1235 (TTY：711)。 Y0040_GHHJJ8AEN_19_M 0219