Financial Affairs

Emergency Financial Assistance

Energy assistance is available for Lewis County residents when funds are available. Rental, energy and utility assistance when funds are available in Mason and Thurston counties.

Limited emergency funds for rent, utility and prescription costs. Also houses a food pantry. Contact the outreach for hours of operation and eligibility requirements. Services provided for Thurston County residents only.

Information and referral for community services.

Federal Programs

Social Security

Social Security (SS) provides benefits to you and your (eligible) family. Benefits originate from the money you (or your spouse) paid during the years worked. To request a Social Security statement over the Internet go to www.ssa.gov.

You may apply for Social Security benefits about three months before your retirement. Full Benefits may be rewarded to persons 65 and over (depending on the year you were born). Reduced benefits can be obtained at age 62.

Contact the Social Security office if you lose your Social Security card, become disabled, change your name or address, and at least every three years throughout your employment
years to ensure accuracy of records.

Supplemental Security Income is a Federal program that pays monthly checks to people who are 65 or older, or are disabled or blind, and have limited income and assets. Eligibility is determined by amount of income, savings and property.

Medicare

Medicare is a comprehensive federal health care insurance program administered by the Health Care Financing Administration, providing hospital and medical insurance to persons entitled to Social Security (SS) benefits. To be eligible you must be 65 or older (and have received SS); have permanent kidney failure (at any age); or be under 65 years and have been on SS for 24 months. Apply three months before you need the coverage.

The original purpose of Medicare was to increase access to health care and reduce its financial burden on older, retired, or disabled Americans. Medicare was never intended to pay 100 percent of all medical expenses, but is a benefit that will cover some of the services you may need as you age.

Ensure any services you use are with Medicare-certified providers. Another valuable resource
is to contact the billing clerk at the hospital or skilled nursing facility providing services to clarify your benefits.

As a Medicare beneficiary, you have certain guaranteed rights –
 

1. The right to receive emergency care when and where you need it, without prior approval.

2. The right to information about all treatment options from your health care provider in language clear to you.

3. The right to appeal if Medicare does not pay for a covered service you have been given, or if your doctor or hospital does not give you a service that you believe should be covered.

4. The right to know how your Medicare health plan pays its doctors (you must request this information).

5. The right to have any personal information that Medicare collects kept private, and to know why Medicare needs it.

6. The right to choose a women’s health specialist from your plan’s list of doctors.

7. The right, if you have a complex or serious medical condition, to have enough visits to a specialist to deal with your need.

8. The right to file a grievance if you have concerns or problems with your plan which are not about payment or service requests.

If you believe that your rights have been violated in any way call the Office of the Insurance
Commissioner at 800-562-6900.

Medicare Part A – Hospital Insurance

Part A of Medicare is free for people who have 40 or more quarters of Medicare covered employment. For those with 30-39 quarters of Medicare covered employment, the premium is $226.00 per month. People who have less than 30 quarters of covered employment can pay a premium of $410.00 per month for coverage.

If you are not sure if you have Part A, look on your red, white and blue Medicare card. It will show Part A (Hospital Insurance) on the lower left corner of your card. You can also call Social Security.

Benefits begin when you enter the hospital and end when you have been out of the hospital or facility with skilled nursing care for 60 consecutive days. If you are re-admitted within that 60 days, you are still in the same benefit period and would not pay another deductible. If you are admitted to a hospital after that benefit period ends, an entirely new benefit period begins and a new deductible is owed.

Cost:
For 2007, Part A pays for all hospital-covered services up to 60 days per benefit period except for the first $992 for which you are responsible. For 61-90 days, the co-payment is $248 per day. For 91-150 days, the beneficiary pays $496 per day.

In a skilled nursing facility, (if your doctor has certified you need skilled nursing), the beneficiary pays nothing days 1-20; days 21-100 cost the beneficiary $124 per day; after 100 days, the patient pays all costs. Covered services can include semi-private rooms, all meals, regular nursing services, rehabilitation services, blood transfusions (except the first three pints of blood), drugs and medical supplies, and equipment (e.g., wheelchairs).

Medicare Home Health Care can be covered under Part A or Part B, but under most circumstances there is no deductible, co-pay, or difference in covered services under either coverage. You need physician certification and a home health care plan to access these benefits. Home health care services can include part-time skilled nursing care, physical therapy, speech-language therapy, home health aide services, durable medical equipment, and other services.

MEDICARE PART B – MEDICAL INSURANCE

Part B helps pay for doctors, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health services. Part B helps pay for covered doctor services that are medically necessary.

Cost:

You pay the Medicare Part B premium of $93.50 per month (plus a $131 deductible fee one time per calendar year). You also pay 20% of the Medicare approved amount after you meet the deductible. This is the 2007 amount and may change January 1, 2008. This amount may be higher if you did not choose Part B when you were first eligible. The cost of Part B may go up ten percent for each 12-month period that you could have had Part B but did not take it.
If your income exceeds $80,000 for a single person and $160,000 for a couple, your Medicare Part B Premium may be higher than $93.50 per month.

Enrolling in Part B is your choice. If you choose to have Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. Otherwise Medicare sends you a bill for your Part B premium every three months. You should get your Medicare premium bill by the tenth of the month. If you have not received your bill by the tenth of the month, call Social Security.

Medicare Preventive Screening
Welcome to Medicare Exam

A one-time Welcome to Medicare Exam is now provided within the first 6 months after you sign up for Medicare Part B. (After 6 months, Medicare will not pay for this check-up). You pay 20% of the Medicare approved amount after you meet the Part B deductible. If seeing a new doctor be sure to bring your health records including immunizations, your family history and the list of prescriptions as well as a schedule of when the prescribed medications are taken. The exam will cover a review of your medical history, blood pressure, vision and other preventative screenings. The doctor will also provide you with a checklist explaining a schedule of preventative screenings that you should receive.

Other Preventive Services
Covered By Medicare
Other preventive services covered either in part or in full by Medicare include cardiovascular screenings, various types of cancer screenings, some immunizations, bone mass measurements (screenings for osteoporosis), diabetes screenings, and glaucoma tests. There are specific guidelines including frequency and types of testing. For more specific information about preventive services covered by Medicare you may call Medicare Customer Service at 800-633-4227 or access the information online at www.medicare.gov.

medicare advantage Plans

The Medicare Advantage Program is an updated version of the Medicare + Choice Plan Program. The Modernization Act of 2003 provides more options for Medicare beneficiaries to enroll in private plans.

For a monthly fee (in addition to your Medicare premium) you can choose features that more specifically meet your needs.Features that are provided through Medicare Advantage Plans include:

Managed Care Plans – A network of doctors is available through the plan. A primary doctor coordinates your care and referrals are required to see doctors out of the network.

Preferred Provider Organization Plans – Typically the doctors and specialists are predetermined through this plan. If you choose a doctor or specialist not covered through the plan you may have to pay additional costs. No referrals are necessary.

Private Fee For Service Plans – You may visit any doctor of your choice that will accept the plan’s payment.

Specialty Plans – These are designed to meet special needs for people with certain health issues.

Anyone who receives Medicare Part A and Part B may join a Medicare Advantage Plan. Please check with the plan provider to find out what plan is best for your needs.

The Medicare Personal Plan Finder is a service provided through the Medicare website to assist you in comparing services available in your area. To access this information, visit www.medicare.gov.

Medicare Claim Accuracy

Be sure you are billed only for the care you received. If you have tried to correct a bill with the health care provider or supplier who submitted the claim and suspect fraud or abuse has occurred, call the Office of the Inspector General Fraud Hotline at 800-447-8477.

Do You Still Have Questions
About Medicare?
If you have further questions about Medicare, call SHIBA at 800-981-2123 or Medicare Cus-tomer Service at 800-633-4227 for information regarding Medicare rights.

MEDICAID

This federal assistance program provides funding for low-income people (including many people who never imagined they would qualify for Medicaid, but have had their savings drained because of health expenses, and thereby are eligible) to pay for medical and long-term care in-home services. Medicaid standards differ from state to state, but types of medical assistance coverage that may be included are inpatient and outpatient hospital services, periodic diagnostic tests, laboratory services, physician services, rural health clinic services, x-ray services and skilled nursing facility care.

Eligibility for services is assessed through the Department of Social and Health Services (DSHS) Community Service Office (CSO).

Department of Social and Health Services
Community Services Division Region 6
PO Box 45448, Olympia WA 98504
www.onlinecso.dshs.wa.gov

Medicaid Service Plans

If you are eligible for Medicaid, Washington State offers two ways to help you maintain your home or move into your own home or apartment –

• A one-time discharge allowance can be paid to help you find a place to live if you
  are discharging from the hospital, nursing home or residential facility to a home in
  the community.

• If you are are currently in a nursing home are likely to return home within six months, you may keep some part of your income to retain your home or apartment. To get this income exemption your probable return must be certified by a physician.

Department of Social and Health Services
(DSHS) – Home and Community Services (HCS) will determine your eligibility for these programs.

Department of Social and Health Services (DSHS) – Home and Community Services (HCS)

Community Options Program Entry System (COPES)

COPES offers personal care, assistance with essential household tasks, and case management. Services available under this program are in-home services, services available at adult family homes, and services at boarding homes with an Enhanced Adult Residential Care (EARC) or assisted living facilities (AL) contract. Adult day health and home health care may be included in the COPES service plan. Persons eligible for COPES are aged, blind or disabled persons that meet functional eligibility and Medicaid income and resource requirements.

Medicaid Personal Care Services

This program may provide personal care to individuals who receive SSI or are approved for
other CN medical programs such as TANF, GAX, and SSI-related medical. Services are available in your own home, adult family homes, and boarding homes with an Adult Residential Care (ARC) contract.

Continued case management

If HCS determines you are medically eligible for in-home services through COPES or MPC according to DSHS requirements, your file will be forwarded to the Area Agency on Aging (AAOA) office in your county for continued case management, reauthorization and/or reassessment.

These three offices provide emergency assistance including assistance with food, rent, utilities and help with burial costs for veterans who meet eligibility requirements.

Call for benefits and assistance (counseling, filing claims, burial and death, disability). Services are free to veterans, spouses and their dependents.
 

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