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If you don't want to do it yourself, get some information on care managers from:
The National Association of Geriatric Care at www.caremanager.org
The National Office on Aging www.aoa.dhhs.gov
Both will list all kinds of care managment services |
Financial worries only compound the fear and confusion of serious illness. Financial constraints can also dictate which methods of care are available to you and which ones are denied. If you have limited resources, paying for some treatments may seem impossible. However, there are an assortment of standardized public programs and specialized private foundations and associations that can help. While the following is not a comprehensive list, it will familiarize you with some of the programs available and help you search for alternatives for yourself or someone you know. There are also many locally based programs, so contact care administrators and social workers in your area for advice.
Click on the links below to jump down to these topics:
What federal healthcare programs are there?
Medicare and Medicaid are both state and federally funded programs.
Medicare:
This federally funded medical insurance program is available to retired persons who have worked ten years or more in a job that contributes to Medicare and who are over the age of 65. It is also available to people with certain types of qualifying disabilities. Medicare coverage contains two parts:
- Part A: Hospitalization (No fee): Generally, if you are over 65 and you or your spouse has paid Medicare taxes while working, you are eligible for Medicare Part A free of charge. People who have certain types of disabilities are also eligible. Part A will pay for most care in hospitals, skilled nursing facilities, hospice, and some home health care.
- Part B: Health Insurance (Fee-based):
The Part B fee is usually less than $50 a month, and covers certain doctors' services, outpatient hospital care, blood transfusions medical equipment and some home health services. Not covered are routine medical exams, custodial care and most prescription drugs. Individuals and couples with low incomes (usually defined as less than $6,000 in savings and a monthly income of $960 or less) can qualify for subsidized Part B Medicare coverage. To learn more about standard Medicare, go to: Medicare FAQ
www.medicare.gov/FAQs/Top20.asp.
You can extend the coverage offered by standard Medicare Parts A and B by using:
- Medigap, Medicare + Choice and Medicare Managed Care:
These plans are offered by private health insurance companies, and will cover services not covered under Medicare, often including prescription drugs. All will cost extra depending upon the level of coverage you elect. To find out more on these services, go to: The Medicare Contacts Page www.medicare.gov/contacts/home.asp.
- Prescription Plans:You may also enroll in a private prescription drug plan such as the one offered by the American Association of Retired People (A.A.R.P.) at www.rpspharmacy.com or the for-profit fee-based plan from Pro-Care www.procarecard.com.
Medicaid:
Medicaid ensures that low-income individuals and families will be able to seek medical care. Available nationwide and funded by state, local and federal funds, it is administered through state agencies who determine eligibility based upon income and asset assessments. Many hospital and physician services are covered at no cost, while others require a small co-payment.
For more information on Medicaid guidelines in your state, you may contact your local area agency on aging (even if you're not a senior citizen) or go to:
The Health Care Financing Administration web site at:
www.hcfa.gov.
What if I'm under 65 and need financial help due to illness?
The Social Security Administration isn't just for older people. Certain low income people under 65 may be eligible for a variety of Social Security programs. To find out more, go to the Social Security Administration on the Web at www.ssa.gov/,
or call 1-800-772-1213. Ask about:
- Supplemental Security Income:
S.S.I. is a national program that will award qualifying individuals (those who are blind, aged, or disabled and who meet certain income guidelines) a set monthly payment. The Social Security Administration generally defines disability as a physical or mental problem that keeps you from working and that is expected to last at least a year, or to result in death. The application process is relatively short: you can receive notification of S.S.I. awards within 30 days. Some states also offer additional supplemental funds. People who get SSI usually receive food stamps and Medicaid, too. S.S.I. is also available to children with disabilities.
Social Security Disability:
If you have worked and become disabled, or are terminally ill and are deemed unable to continue gainful employment for longer than 12 months, you may qualify for disabled workers' benefits through the Social Security Administration. These are monthly cash benefits that will commence once you have completed the application process and waiting period.
Qualified disabled people will become eligible for Medicare Part A after they have been disabled for two years. There is a lengthy review process within the Social Security Administration to obtain these benefits. Contact your local Social Security office if you have a chronic ailment or a long-term illness to see whether you might qualify.
I'm in a tough financial spot. I don't have insurance and will have large medical bills . I need help now. What can I do?
- Hill Burton: Find out about facilities that offer services under the "Hill Burton" program. There are over 600 of them across the nation. Also known as charity care, discount care or indigent care, the program provides free or reduced-cost hospital care, nursing care, outpatient services and prescription drugs for people under certain income limits. The Health Resources and Services Administration has more information on these programs: www.institute-dc.org.
- State and Local programs:
The Hill-Burton program is only for people who have very low incomes, and may not apply to people who are an uninsured or underinsured workers. People who don't meet the maximum income cut-offs for Hill Burton benefits should speak to social services administrators in the hospital or facility where they receive care, there may be special state or local-municipal programs available. Note: There may not be any public programs for which you are eligible. However, there may be private or community-based care programs that can help.
- Hospital Programs: You may also check on what special low or no cost services are available in hospitals nationwide by using the database provided by the American Hospital Directory
www.ahd.com.
- Prescription assistance:
Some pharmaceutical companies have special programs that make certain drugs available to those in need at low or no cost. Pharmaceutical research and Manufacturers of America (PhRMA) puts together a yearly compendium of all companies that offer free or low cost medications. You can browse the list or download the publication in PDF form from their web site at: www.phrma.org.
I can pay for insurance, but I want to make sure I'm getting the right kind of coverage. What do I do?
Contact the Health Insurance Association of America at: www.hiaa.org, or the National Coalition for Health Care at: www.americashealth.org. Both offer information on how to navigate your way through the health insurance maze. Statistics show that average premiums for an employer-subsidized HMO are from $935 to $1778 per year, per family. Individual policies that are not employer-sponsored can run anywhere from $3,500 to $7,500.
Check your policy: Call your insurance company and ask them to walk you through any and all special care-programs they may offer. Make sure to ask about hospice benefits and home care. Find out if there are any special treatments that are not covered.
I've heard a lot about long-term care insurance. How will it help me pay for an illness?
If you are still healthy, but want to insure yourself or someone in your family against long-term care costs, you may wish to explore long-term care insurance. It generally costs between $250 and $4,000 a year, and offers daily payments for extended care. These can range from daily at-home care payments to long-term care in a nursing home. These policies will offset long-term care costs that might not be covered by your regular insurance, or for people who are not eligible for federal aid, or who would prefer private care. Like any other insurance, however, this is something that should be explored before there is an illness. To find out more, check with the Health Insurance Association of America: www.hiaa.org
I'm already sick and I have health insurance, but I'm not sure I can pay for some of the additional expenses related to my illness. What are some options?
If you have a house or a life insurance policy, you might be able to use them for cash now.
A viatical settlement allows you to sell all or part of a life insurance death benefit, before death. Depending upon the type of policy, the "settlement" can result in a cash payment of 50 percent to 90 percent of the policy value. Depending upon individual policies and income some or all of the proceeds may be non-taxable. To learn more, go to the Viatical and Life Settlements Association of America at www.viatical.org.
Reverse Mortgage:
A reverse mortgage is similar to a home equity loan wherein a loan in the form of cash payments is made, using the home as collateral. However while a home equity loan requires that the applicant pass certain credit qualifications, the reverse mortgage is based upon age (must be over 62) and percentage of ownership in the house. Unlike a home equity loan, the reverse mortgage generally does not have to be repaid until the home owner has died, permanently moved out or sold the house. There are a variety of reverse mortgages available from a wide array of institutions. The National Reverse Mortgage Lenders Association at www.reversemortgage.org
has a listing of reverse mortgages and the institutions where they are available.
I just need some extra help with care and support; what other free or low cost programs and services are there?
The Administration on Aging has a service called the Eldercare Locator, which is a comprehensive referral service not just limited to seniors providing you and your family with contact information for home care to support groups. Just call 1-800-677-1116, Monday through Friday from 9am to 8pm ET. www.aoa.dhhs.gov
Volunteer organizations:
There are a vast array of volunteer programs and organizations across the country. Finding them can sometimes be tricky, but chances are you have a community based volunteer program right in your area.
- Meals on Wheels is one of the most well-known among these, and isn't just for older people. The Eldercare Locator and put you in touch with your area meals-on-wheels quickly.
- Action Without Borders has a listing of other volunteer based organizations that might be able to help. Check the list at: www.idealist.org to search for a group specializing in health matters near you.
Non-profit/subsidized and for-profit home care:
The National Association for Home Care has a database of home care and hospice care providers. You may search by type of care and type of payment accepted to find out the best and most affordable: www.nahc.org/Tango/HClocator/locator.html.
You should also check with your local community center, mayor's office or senior citizen's center. Any of these offices should be able to direct you to community care programs in your area, some of which may provide low-cost or free services.
Additional Resources:
Your doctor may recommend specialized equipment to help you cope with the effects of your illness. But depending on your insurance coverage status, obtaining such equipment can be very expensive. You may wish to search on the Web for the particular piece of equipment you need, and then see if the manufacturer or retailer has used models available. Or check to see if there is a national association related to your illness that might help defray the costs of specialized equipment.
Illness-specific care programs:
There are hundreds of organizations and associations whose goal is to provide support and information for people afflicted by a particular illness. You can find them by doing a simple search on the Web or by accessing the National Institute of Health Medline index at: www.nlm.nih.gov/medlineplus.
Fee-based Care Management:
- The National Association of Geriatric Care Managers has a database for finding a professional care-manager in your area. Generally trained in social work and familiar with public and private care facilities and organizations these individuals can help you set up an affordable care-plan
www.caremanager.org.
- CareThere.com is a for-profit company that provides comprehensive solutions for family caregivers. Included are a host of tools from home-care support to financial planning. Go to:
www.carethere.com.
Copyright 2000, Educational Broadcasting Corporation/Public Affairs Television, Inc.
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