State Health Insurance Assistance Program (SHIAP)

State Health Insurance Assistance Program (SHIAP)

Trident Area Agency on Aging SHIAP counselors provide accurate and objective health insurance information to help Medicare beneficiaries or their caregiver to make informed health coverage decisions and understand their related rights and protections.

Medicare Basics

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities and people of any age with End-Stage Renal Disease. There are four parts to Medicare Part A, Part B, Part C and Part D. The different parts of Medicare help cover specific services if you meet certain conditions. MyMedicare.gov is part of the Medicare.gov website. MyMedicare.gov is an optional, free, and secure site designed to help you check the status of your eligibility, enrollment, and other Medicare benefits. It also lets you access your claims information almost immediately after your claims are processed by Medicare and provides your preventive health information 24 hours a day, seven days a week.

Medicare Part A (Hospital Insurance)
Medicare Part C (Medicare Advantage Plans)
Medicare Part B (Medical Insurance)
Medicare Part D (Prescription Drug Coverage)

 

Medicare’s Annual Open Enrollment

Medicare health and drug plans can make changes each year—things like cost, coverage, and which providers and pharmacies are in their networks. Trident Area Agency on Aging has trained SHIAP Specialists that can assist you with the comparison, enrollment and general information and resources you need to gain the best access to healthcare.

October 1  

Start comparing your coverage with other options. You may be able to save money by comparing all of your options.

October 15 – December 7  

Change your Medicare Health or prescription drug coverage for 2015.

January 1  

New coverage begins if you make a change during Open Enrollment. If you’re satisfied that your current plan will meet your needs for next year and it’s still being offered, you don’t need to do anything.

 

Low Income Subsidy (LIS) or “Extra Help” and Medicare Saving Program

Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also may be able to get Extra Help to pay for the costs—monthly premiums, annual deductibles and prescription co-payments—related to a Medicare prescription drug plan. The Extra Help is estimated to be worth about $4,000 per year. Many people qualify for these important savings and don’t even know it.

Some people are automatically eligible for the LIS:

  • Medicaid
  • Social Security Income
  • You get help from the state Medicaid program paying your Part B premium (in a Medicare Savings Program).

 

Qualified Medicare Beneficiary (QMB) Program

This program may help pay your Medicare Part “B” Premiums. Healthy Connections will make a QMB determination for a Medicaid-eligible individual in any full benefits category if that individual is covered under Medicare Part A.

Benefits: 

  • QMB coverage offers payment of Medicare premiums, co-pays and deductibles.

For more eligibility and income information, click here.

Specified Low-Income Medicare Beneficiary (SLMB) / (QI) Program

These programs may help pay your Medicare Part “B” Premiums.

Eligibility: 

A Specified Low Income Medicare Beneficiary is an individual who:

  • Is entitled to Medicare Part A hospital insurance.
  • Has countable income greater than 100% and less than or equal to 120% of the Federal Poverty Level.

A Qualified Individual is an individual who:

  • Is entitled to Medicare Part A hospital insurance.
  • Has countable income between 120% and 135% of the Federal Poverty Level.
  • Is not otherwise eligible for full Medicaid benefits.

Benefits: 

  • For a SLMB or a QI, Healthy Connections is required to pay the Medicare Part B premium only. These individuals are not entitled to any other Medicaid benefits; therefore, they do not receive a Medicaid card.

For more eligibility and income information, click here.

 

We can help your apply for these programs:

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Your Medicare Rights

If you have Medicare, you have basic rights and protections that include the following:

  • To be treated with dignity and respect at all times
  • Be protected from discrimination
  • Get information about Medicare that you can understand to help you make health care decisions
  • Have your questions about the Medicare Program answered
  • Receive culturally competent services
  • Learn about all of your treatment choices in clear language that you can understand
  • Appeal a healthcare decision or report a complaint

Help Stop Medicare Fraud

Health care error, fraud and abuse affect everyone.

Last year alone, Medicare lost billions of dollars to improper claims. This affects beneficiaries by wasting Medicare money that could be used to increase and improve health care services AND it affects everyone who pays by wasting billions of taxpayer dollars.

Prevention Tips

To help prevent Medicare from losing valuable funds, and to prevent inappropriate care, it is important to report all suspected instances of error, fraud and abuse and instruct all Medicare beneficiaries on the following dos and don’ts.

DO:

  • Keep record of the dates of Medicare services received
  • Review your Medicare Summary Notice (MSN)
  • Did you receive the service or the product?
  • Did the doctor order this service or the product or test?
  • Were you billed for the same service more than one time?
  • Is the charge or service related to your condition or treatment?

DON’T:

  • Give out your Medicare number except to your doctor or other Medicare provider
  • Accept “free” medical or other services in exchange for your Medicare or Social Security number
  • Give your Medicare number to callers or door-to-door solicitors (Medicare does not call or go door-to-door)

State Health Insurance Assistance Program/Senior Medicare Patrol Volunteer

Become a State Health Insurance Assistance Volunteer and help Medicare and Medicaid beneficiaries avoid, detect, and prevent health care fraud. As a volunteer you will provide unbiased, personalized counseling about Medicare, including Medicare benefits and rights, billing problems, health and prescription coverage options and enrollment assistance. SHIAP staff and their highly trained volunteers conduct outreach to Medicare beneficiaries in their communities through group presentations, exhibiting at community events, and one-on-one counseling. Their primary goal is to teach Medicare beneficiaries how to protect their personal identity, identify and report errors on their health care bills and identify deceptive health care practices, such as illegal marketing, providing unnecessary or inappropriate services and charging for services that were never provided. Call us at 843-554-2275 or email aedwards@tridentaaa.org.