Consumer Resource Directory - Medicare & Medicaid

Medicare & Medicaid

- Medicare/Medicaid Assistance Program (MMAP)
- MPRO
- Medicare
- Help for People with Limited Income & Resources

Medicare/Medicaid Assistance Program

Medicare/Medicaid Assistance Program (MMAP) counselors are specialists trained in Medicare and Medicaid law and regulations, health insurance counseling and relevant insurance products. MMAP counselors are not affiliated with any insurance company, nor are they licensed to sell insurance. MMAP's mission is to educate, counsel and empower individuals to make informed benefit decisions by serving them objectively and confidently. MMAP counselors also conduct public presentations on Medicare, Medicaid, and Medicare supplemental insurance. MMAP is the State Health Insurance Assistance Program (SHIP) for Michigan. The Senior Alliance manages the MMAP site for western and southern Wayne County communities.
Medicare/Medicaid Assistance Program
(800) 803-7174
Automatically routed to Michigan MMAP site in the caller’s region. Cell phones are directed to the State office in Lansing.
www.mymmap.org

Counselors can help you:

Provide a personalized Medicare Part Drug Plan report to assist you in determining the plan that best meets your needs.
Understand doctor bills, hospital bills and Medicare Summary Notices.
Understand Medicare/Medicaid eligibility, enrollment, coverage, claims and appeals.
Review your Medicare supplemental insurance needs, compare policies and pursue claims and refunds.
Explore long term care financing options, including long term care insurance.
Identify and report Medicare/Medicaid fraud and abuse.

If you are an out-of-state family member, you can work with a MMAP counselor for residents of western and southern Wayne County by calling TSA at (734) 722-2830. For other regions of Michigan, call (517) 886-1242.

Medicaid pays for many types of medical care for low-income individuals and families. *For additional information, go to the Department of Human Services section of this directory.

MPRO

MPRO is Michigan's Medicare Quality Improvement Organization contracted by the Centers for Medicare & Medicaid Services (CMS) to ensure that Medicare beneficiaries are getting the best possible care from their Medicare health care provider. The MPRO Information Line assists Medicare beneficiaries who feel that their rights under Medicare have been denied, are concerned about the quality of care they have received, or have other areas of concern.

MPRO
22670 Haggerty Road, Suite 100
Farmington Hills, MI 48335
(248) 465-7300
(800) 365-5899 - Information Line
Website: www.mpro.org

Medicare

Medicare is health insurance for people age 65 or older; under age 65 with certain disabilities if receiving Social Security disability benefits for over 24 months; and any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) or Lou Gehrig’s Disease.

If you are not currently receiving Social Security benefits when you turn 65, you must enroll in Medicare to receive benefits. You should contact Social Security at (800) 772-1213 or visit a Social Security office during the 3 months period prior to the month of your birthday. If you wait until after your 65th birthday to contact Social Security, your coverage start date may be delayed.

If you are already receiving Social Security benefits before age 65, you’ll automatically be enrolled in Medicare Parts A and B. You will receive a Welcome to Medicare package approximately three months prior to your 65th birthday along with your Medicare card. However, because you must pay a premium for Part B coverage, you have the option of canceling Part B coverage.

You can choose different ways to get the services covered by Medicare. Most people get their Medicare health care coverage in one of two ways – Original Medicare Plan or a Medicare Advantage Plan. Costs vary depending on the plan, coverage, and services used. The Original Medicare Plan is a fee-for-service plan that is managed by the Federal Government. You may have a Medigap policy or other supplemental coverage that may pay deductibles, coinsurance, or other costs. Medicare Advantage Plans are health plan options that are approved by Medicare and are run by private companies. They provide all of the Part A and Part B benefits, often including Part D drug coverage. Medicare pays an amount of money for your care every month to these private health plans, whether or not you use services. Plans include: Preferred Provider Organizations (PPO), Health Maintenance Organizations (HMO), Private Fee-for-Service (PFFS), Special Needs Plans, and Medicare Savings Account (MSA).

Medicare Part A helps cover inpatient care in hospitals. This also includes skilled nursing facilities (not custodial care), hospice, and home health care. You must meet certain conditions to get these benefits. Most people automatically get Part A coverage without having to pay a monthly payment (premium) because they or a spouse paid Medicare taxes while working. You may be able to buy Part A coverage if you (or your spouse) are not entitled to Social Security because you didn’t work or didn’t pay enough Medicare taxes while working AND your are age 65 or older; or if you are disabled but no longer get premium-free Part A because you returned to work.

Medicare Part B helps cover medical services, such as doctors’ services, outpatient care and other medical services that Part A doesn’t cover. Part B is optional, though if you decide not to enroll when first eligible, you may pay a penalty if you choose to join later. You pay a monthly Part B premium and annual deductible. Beneficiaries may be eligible to receive help to pay the premium and deductible costs. See the Help for People with Limited Income & Resources at the end of this section.

Medicare Part D, Medicare Prescription Drug Coverage, is available to Medicare beneficiaries who have either Part A or B. Medicare drug plans are offered by insurance companies and other private companies approved by Medicare. Part D is optional, though if you decide not to enroll when first eligible, you may pay a penalty if you choose to join later. You will usually pay a monthly premium and deductible. If you have limited income and resources, you may qualify for extra help to cover costs. See information at end of this section. Beneficiaries could receive Part D coverage by joining a stand-alone drug plan or an Advantage plan that includes prescription drug coverage. On Medicare’s website, www.medicare.gov, the Medicare Prescription Drug Plan Finder is an online tool to help you compare drug plans in your area. This process can become overwhelming at times – you are encouraged to discuss options with family, a Medicare/Medicaid Assistance counselor, or by calling 1-800-MEDICARE.

Many Preventive Services benefits are available under Medicare, including a Welcome to Medicare physical exam (a one-time exam performed within the first six months that you have Part B coverage), cardiovascular screening; flu, pneumococcal, and Hepatitis B shots; glaucoma testing; bone mass measurements; tests for breast, cervical, vaginal, colorectal, and prostate cancers; and diabetes screening and self-management.

MyMedicare.gov is an online service where you can see your health care claims, track which preventive services you need, and get the most current details about how to get the most out of your Medicare benefits. If you do not have access to the web, the same information is available by calling (800) MEDICARE (800-633-4227).

Medicare.gov offers numerous comparison tools to provide decision support to beneficiaries and families.

Medicare Options Compare: Search includes Original Medicare, Medicare Health Plans, and Medigap policies
Nursing Home Compare: Information about the past performance of every Medicare and Medicaid certified nursing homes
Compare Medicare Prescription Drug Plans
Home Health Agency Compare: Information about skilled Medicare certified agencies
Hospital Compare
Dialysis Facility Compare
Medicare Eligibility Tool
Find Medical Equipment supplier in your area

Medicare: 1-800-MEDICARE (800-633-4227)
www.medicare.gov
TDD (877) 486-2048
This helpline is a speech-automated system available 24 hours a day, 7 days a week.
The system will ask you questions to direct your call automatically.

Part A claims, say “Hospital Stay”
Part B claims, say “Doctor Services”
Durable Medical Equipment claims, say “Medical Supplies”
If you need help, you can say “agent” at any time to talk to a customer service
representative.
Coordination of Medicare Benefits Call Center
(800) 999-1118
www.cms.hhs.gov/medicare/cob
To Report Medicare Fraud (800) 447-8477
*See Identity Theft & Fraud Prevention section of this directory
TRICARE (888) 363-5433
TRICARE for Life (866) 773-0404.

Help for People with Limited Income & Resources

Medicare Savings Programs
Medicare beneficiaries may be able to get help paying for the Medicare Part A and/or Part B premiums. Countable assets are limited to $4,000 for individuals and $6,000 for couples. Homestead, car, personal property are not counted. Eligibility cannot be retroactive.

Apply at your local Michigan Department of Human Services (DHS) office. DHS office locations are listed in the Department of Human Services section of this directory.

Qualified Medicare Beneficiary (QMB)
This program will pay the Medicare Parts A (hospital) & B (medical) premiums, deductibles, and co-insurance amounts for persons whose incomes are at or below 100% of the Federal Poverty guidelines (plus $20/month that is disregarded) and who have limited resources.

Specified Low-income Medicare Beneficiary (SLMB)
The Specified Low-Income Medicare Beneficiary (SLMB) program helps pay the Part B (medical insurance) premiums for persons whose income is at or below 120% of the Federal Poverty guidelines (plus $20/month that is disregarded).

Qualified Individual Program (QI)
The Qualified Individual Program only pays the Medicare Part B premium. Income must be at or below 135% of the Federal Poverty guidelines (plus $20/month that is disregarded).

Extra Help – Medicare Prescription Drug Coverage
Medicare provides “Extra Help” to pay prescription drug coverage costs for people whose income is at or below 150% of the Federal Poverty guidelines and countable assets do not exceed the resource limits. If eligible, you will receive help paying for the Medicare drug plan’s monthly premium, yearly deductible, and prescription co-payments. Beneficiaries receiving Medicaid benefits may automatically qualify for this assistance. To apply for the “Extra Help” coverage, you can contact: Social Security Administration: (800) 772-1213, go to a Social Security office, or visit www.socialsecurity.gov; or contact the Medicare/Medicaid Assistance Program at (800) 803-7174.