Medicaid and Senior Health Insurance -
Questions & Answers
Click to jump
down to questions & answers on:
Social Security Assistance| Medicare
& Medicaid: What's the Difference? | Medicaid
Details | Medicare Details |
with Medicare Expenses |
Information/ Choosing a Medicare Supplement |
to Stop Medicare & Medicaid Fraud
Social Security Administration. Where do I go for help?
Q: How do I find answers to my questions on Social Security?
A: Social Security Administration - The official site for questions related to Social Security retirement, disability and Supplemental Security Income (SSI), widow, widowers and other survivors benefits. This site allows for online application, listing of eligibility, planning, and your rights if you already receive benefits.
Q: How do I contact Social Security?
A: Click here for way to contact Social Security.
Q: Where is my local Social Security office?
A: Click here to find your local Social Security Office.
& Medicaid: What's the Difference?
hear people talk about Medicare and Medicaid. Are these different
created both Medicare and Medicaid in 1965. The programs have different
eligibility requirements and different benefits. Many people confuse
Medicare with Medicaid because the names sound alike and the programs
are available to some of the same groups of people.
does eligibility for two programs differ?
Medicare and Medicaid are directed to those age 65 or older and
many younger people with disabilities. Medicare is available regardless
of income and resources. Medicaid eligibility is available only
to individuals who meet certain income and resource limits. Medicaid
has many different programs. Each has its own income and resource
limits. A Medicare beneficiary with limited income and resources
may also be eligible for Medicaid assistance.
is covered by Medicaid?
is an assistance program that pays certain medical and health care
cost of persons who qualify. Medicaid has many different programs.
Benefits vary depending on the program. Some Medicaid programs pay
for services not covered by Medicare such as prescription drugs,
dental care, eyeglasses, hearing aids, and long-term care. Other
Medicaid programs are more limited and pay only for Medicare premiums,
deductibles and coinsurance. Generally, someone eligible for Medicaid
does not need Medicare supplement insurance.
need help and think I qualify for Medicaid. Where do I go to apply?
Medicaid program is funded by the federal and state government and
is managed by the Iowa Department of Human Services (DHS). To determine
if you qualify for Medicaid, contact your local county office of
human services. A listing of local offices can be found on the Internet
The phone number for your local office is available in the "local
government" section of your telephone directory. To receive assistance
in completing the paperwork, contact your local Area
Agency on Aging.
are the benefits under Medicare?
consists of two parts, Part A and Part B. Medicare Part A is hospital
insurance and is free to most who are eligible for Medicare. Medicare
Part B is medical insurance and costs $58.70 per month for 2003.
Medicare covers medically necessary services for illnesses and injuries.
Medicare rules determine how much can be charged for covered services.
A Medicare beneficiary is responsible for $100 deductible per calendar
year, 20% coinsurance of Medicare approved amount (except the coinsurance
is waived for clinical lab services and flu and pneumonia vaccines),
and services not covered such as prescription drugs, annual physicals,
routine vision services or hearing exams. Most Medicare beneficiaries
have supplemental insurance to cover some of these costs.
do I get answers to questions about Medicare?
you are new to Medicare or have had Medicare for a long time, you
may have questions about what is covered. Much information is available
on the Internet at http://www.medicare.gov.
You can also get a free copy of the Medicare Handbook by calling
the Social Security Administration at 1-800-772-1213. For coverage
and claims questions on Medicare Part A (hospital insurance), which
covers hospitals, skilled nursing facilities, home health visits,
or hospice services, contact (1-877-910-8139) Cahaba Government
Benefit Administrators (GBA). For questions on Medicare Part B,
which covers such things as doctors' services, ambulances and lab
tests, call Noridian Government Services, Inc. at 1-800-532-1285.
Part B also covers durable medical equipment, such as a walker or
oxygen equipment. For more information, call CIGNA at 1-800-899-7095.
I appeal a Medicare decision?
An appeal must be filed within 120 days after Medicare makes
a decision on a claim. The Senior
Health Insurance Information Program (SHIIP) is available to
assist you in filing an appeal.
with Medicare & Other Medical Expenses
can I get help with Medicare expenses?
is a Medicaid program for people who need help with Medicare expenses
called the Qualified Medicare Beneficiary (QMB) Program. This program
is for people who are elderly or disabled and who have a low income
-- this includes Social Security, wages, pensions, interest payments
and dividends and few resources -- including cash and other things
they own. Some things like a home, (including the property and furnishings)
may not count. Under the QMB Program, Medicaid pays Medicare premiums,
deductibles and co-insurance for persons who are qualified Medicare
beneficiaries. For more information regarding the QMB program, contact
the Senior Health Insurance
Information Program (SHIIP).
if my income is too high to qualify for the QMB Program?
may qualify for the "Specified Low-Income Medicare Beneficiary Program"
"SLMB" for short. SLMB pays your Medicare Part B premium only. It
has the same qualifications as the QMB program, except is has higher
monthly income limits. For more information on the SLMB program,
contact the Senior Health Insurance
Information Program (SHIIP).
I have high medical expenses, what can I do?
Medically Needy Program might be an option. This is a Medicaid program
designed to provide medical coverage for you if you have limited
income or high medical expenses that use up most of the income.
For more information, contact your local County
Department of Human Services.
I have questions about medical bills and insurance claims, where
can I get help?
need help figuring out what type of Medicare supplement or long
term care insurance is right from me. Is there anyone who can help
retired, but not yet eligible for Medicare. What are my health insurance
the Senior Health Insurance
Information Program (SHIIP) when you need information on health
insurance issues. SHIIP is a service of the State of Iowa Insurance
Division and has trained insurance counselors/volunteers. No one
associated with SHIIP sells insurance and all assistance is free.
Especially of interest may be the SHIIP fact sheet "Getting
Ready to Retire: Health Insurance Issues", which is available
on-line. Follow the link above for more details.
I suspect Medicare fraud but don't know how to report it.
can I protect my Medicare/Medicaid numbers from persons who want
to scam these programs?
you want to report suspected Medicare waste, fraud, or abuse, or
to learn about identity protection, call the Iowa SMP
hotline at 1-800-423-2449. The hotline is available statewide. More
information on this program is available in the Iowa SMP section of the advocacy page.