Facts for Seniors

Agencies on Aging

These state-run agencies help seniors over 60 years old and their families deal with issues such as housing, food, nursing home care, diseases and other issues that many come up. Their goal is to allow older adults individual choices in their care process in order to remain safe and independent in their homes. Area Agencies on Aging also have counselors that will meet with your family and talk about any questions or problems you are having. To learn more about these agencies in Iowa, you may go here: https://www.iowaaging.gov/area-agencies-aging

Iowa Department on Aging

This is a good resource for seniors and families who are helping take care of them. You will find information on nursing home inspections, healthy eating and programs that help seniors with meals, housing and care options and more. Go to https://www.iowaaging.gov/

Senior Centers/Meal Sites

Many towns have Senior Centers, which are places for seniors to socialize and have a meal. Many Senior Centers also have health care clinics and exercise activities. Here is a list of Senior Centers in Iowa- choose the town closest to you: http://www.careiowa.org/list11_iowa_senior_centers.htm

Medicaid and Medicare

Medicaid and Medicare are two governmental programs that provide medical and health-related services to specific groups of people in the United States. Although the two programs are very different, they are both managed by the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services. Medicade has one program, but Medicare has four; Part A, Part B, Part C and Part D, the details on each are listed below.

Medicaid

Medicaid is health insurance that helps many people who can’t afford medical care pay for some or all of their medical bills.

Good health is important to everyone. If you can’t afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.

Medicaid is available only to people with limited income. You must meet certain requirements in order to be eligible for Medicaid. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state’s rules, you may also be asked to pay a small part of the cost (co payment) for some medical services.

To learn about the Medicaid program in Iowa, go to http://dhs.iowa.gov/ime/about

Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.

Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not (however, there is a 5-year limit that applies to lawful permanent residents). Eligibility for children is based on the child’s status, not the parent’s. Also, if someone else’s child lives with you, the child may be eligible even if you are not because your income and resources will not count for the child.

In general, you should apply for Medicaid if your income is limited and you match one of the descriptions of the Eligibility Groups. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)

Services with Medicaid vary from state to state, but there are some basic services that every state must provide:

• Inpatient hospital services
• Outpatient hospital services
• Prenatal care
• Vaccines for children
• Physician services
• Nursing facility services for persons aged 21 or older
• Family planning services and supplies
• Rural health clinic services
• Home health care for persons eligible for skilled-nursing services
• Laboratory and x-ray services
• Pediatric and family nurse practitioner services
• Nurse-midwife services
• Federally qualified health-center (FQHC) services and ambulatory services
• Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21

Medicare

Federal health insurance program that pays for hospital and medical care for elderly and certain disabled Americans. To receive Medicare, you must have worked at least 10 years at a job that pays the tax (FICA) that covers Medicare, and be a U.S. citizen or a legal resident of the U.S. for at least 5 years.

The program consists of two main parts for hospital and medical insurance (Part A and Part B) and two additional parts that provide flexibility and prescription drugs (Part C and Part D).

Medicare Part A, or Hospital Insurance (HI)

Helps pay for hospital stays, which includes meals, supplies, testing, and a semi-private room. This part also pays for home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary. Care in a skilled nursing facility as well as certain medical equipment for the aged and disabled such as walkers and wheelchairs are also covered by Part A. Part A is generally available without having to pay a monthly premium since payroll taxes are used to cover these costs.

Medicare Part B

Also called Supplementary Medical Insurance (SMI). It helps pay for medically necessary physician visits, outpatient hospital visits, home health care costs, and other services for the aged and disabled. For example, Part B covers:
• Durable medical equipment (canes, walkers, scooters, wheelchairs, etc.)
• Physician and nursing services
• X-rays, laboratory and diagnostic tests
• Certain vaccinations
• Blood transfusions
• Renal dialysis
• Outpatient hospital procedures
• Some ambulance transportation
• Immunosuppressive drugs after organ transplants
• Chemotherapy
• Certain hormonal treatments
• Prosthetic devices and eyeglasses.

Part B requires a monthly premium, and patients must meet an annual deductible before coverage actually begins. Enrollment in Part B is voluntary. Check with your local hospital for exact prices regarding these services.

Medicare Advantage Plans (Medicare Part C)

Sometimes known as or Medicare + Choice. It allow users to design a custom plan that can be more closely aligned with their medical needs. These plans enlist private insurance companies to provide some of the coverage, but details vary based on the program and eligibility of the patient. Some Advantage Plans team up with health maintenance organizations (HMOs) or preferred provider organizations (PPOs) to provide preventive health care or specialist services. Others focus on patients with special needs such as diabetes.

Medicare Part D

Part D is administered by one of several private insurance companies, each offering a plan with different costs and lists of drugs that are covered. Some services are not provided through Medicare but are offered through MediGap plans. MediGap consists of 12 plans that the Centers for Medicare and Medicaid Services have authorized private companies to sell and administer. Since the availability of Medicare Part D, MediGap plans are no longer able to include drug coverage. You may find out more about Medicare here: http://www.medicare.gov/default.aspx


Pharmaceutical Assistance

Prescriptions, or medicine your doctor will prescribe for you, may be taken just a little while, or your whole life, depending on what is making you sick. Prescriptions can be very expensive, but there are some programs that help. Ask your doctor if the company that makes your prescription has a program for free or low-cost medicines.

Some groups manage prescription assistance programs:

Partnership for Prescription Assistance: http://www.pparx.org/

Rx Assist: http://www.rxassist.org/patients

Iowa Drug Card (for legal residents only): http://www.iowadrugcard.com/index.php

Facts for Seniors

Agencies on Aging

These state-run agencies help seniors over 60 years old and their families deal with issues such as housing, food, nursing home care, diseases and other issues that many come up. Their goal is to allow older adults individual choices in their care process in order to remain safe and independent in their homes. Area Agencies on Aging also have counselors that will meet with your family and talk about any questions or problems you are having. To learn more about these agencies in Iowa, you may go here: https://www.iowaaging.gov/area-agencies-aging

Iowa Department on Aging

This is a good resource for seniors and families who are helping take care of them. You will find information on nursing home inspections, healthy eating and programs that help seniors with meals, housing and care options and more. Go to https://www.iowaaging.gov/

Senior Centers/Meal Sites

Many towns have Senior Centers, which are places for seniors to socialize and have a meal. Many Senior Centers also have health care clinics and exercise activities. Here is a list of Senior Centers in Iowa- choose the town closest to you: http://www.careiowa.org/list11_iowa_senior_centers.htm

Medicaid and Medicare

Medicaid and Medicare are two governmental programs that provide medical and health-related services to specific groups of people in the United States. Although the two programs are very different, they are both managed by the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services. Medicade has one program, but Medicare has four; Part A, Part B, Part C and Part D, the details on each are listed below.

Medicaid

Medicaid is health insurance that helps many people who can’t afford medical care pay for some or all of their medical bills.

Good health is important to everyone. If you can’t afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.

Medicaid is available only to people with limited income. You must meet certain requirements in order to be eligible for Medicaid. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state’s rules, you may also be asked to pay a small part of the cost (co payment) for some medical services.

To learn about the Medicaid program in Iowa, go to http://dhs.iowa.gov/ime/about

Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.

Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not (however, there is a 5-year limit that applies to lawful permanent residents). Eligibility for children is based on the child’s status, not the parent’s. Also, if someone else’s child lives with you, the child may be eligible even if you are not because your income and resources will not count for the child.

In general, you should apply for Medicaid if your income is limited and you match one of the descriptions of the Eligibility Groups. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)

Services with Medicaid vary from state to state, but there are some basic services that every state must provide:

• Inpatient hospital services
• Outpatient hospital services
• Prenatal care
• Vaccines for children
• Physician services
• Nursing facility services for persons aged 21 or older
• Family planning services and supplies
• Rural health clinic services
• Home health care for persons eligible for skilled-nursing services
• Laboratory and x-ray services
• Pediatric and family nurse practitioner services
• Nurse-midwife services
• Federally qualified health-center (FQHC) services and ambulatory services
• Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21

Medicare

Federal health insurance program that pays for hospital and medical care for elderly and certain disabled Americans. To receive Medicare, you must have worked at least 10 years at a job that pays the tax (FICA) that covers Medicare, and be a U.S. citizen or a legal resident of the U.S. for at least 5 years.

The program consists of two main parts for hospital and medical insurance (Part A and Part B) and two additional parts that provide flexibility and prescription drugs (Part C and Part D).

Medicare Part A, or Hospital Insurance (HI)

Helps pay for hospital stays, which includes meals, supplies, testing, and a semi-private room. This part also pays for home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary. Care in a skilled nursing facility as well as certain medical equipment for the aged and disabled such as walkers and wheelchairs are also covered by Part A. Part A is generally available without having to pay a monthly premium since payroll taxes are used to cover these costs.

Medicare Part B

Also called Supplementary Medical Insurance (SMI). It helps pay for medically necessary physician visits, outpatient hospital visits, home health care costs, and other services for the aged and disabled. For example, Part B covers:
• Durable medical equipment (canes, walkers, scooters, wheelchairs, etc.)
• Physician and nursing services
• X-rays, laboratory and diagnostic tests
• Certain vaccinations
• Blood transfusions
• Renal dialysis
• Outpatient hospital procedures
• Some ambulance transportation
• Immunosuppressive drugs after organ transplants
• Chemotherapy
• Certain hormonal treatments
• Prosthetic devices and eyeglasses.

Part B requires a monthly premium, and patients must meet an annual deductible before coverage actually begins. Enrollment in Part B is voluntary. Check with your local hospital for exact prices regarding these services.

Medicare Advantage Plans (Medicare Part C)

Sometimes known as or Medicare + Choice. It allow users to design a custom plan that can be more closely aligned with their medical needs. These plans enlist private insurance companies to provide some of the coverage, but details vary based on the program and eligibility of the patient. Some Advantage Plans team up with health maintenance organizations (HMOs) or preferred provider organizations (PPOs) to provide preventive health care or specialist services. Others focus on patients with special needs such as diabetes.

Medicare Part D

Part D is administered by one of several private insurance companies, each offering a plan with different costs and lists of drugs that are covered. Some services are not provided through Medicare but are offered through MediGap plans. MediGap consists of 12 plans that the Centers for Medicare and Medicaid Services have authorized private companies to sell and administer. Since the availability of Medicare Part D, MediGap plans are no longer able to include drug coverage. You may find out more about Medicare here: http://www.medicare.gov/default.aspx


Pharmaceutical Assistance

Prescriptions, or medicine your doctor will prescribe for you, may be taken just a little while, or your whole life, depending on what is making you sick. Prescriptions can be very expensive, but there are some programs that help. Ask your doctor if the company that makes your prescription has a program for free or low-cost medicines.

Some groups manage prescription assistance programs:

Partnership for Prescription Assistance: http://www.pparx.org/

Rx Assist: http://www.rxassist.org/patients

Iowa Drug Card (for legal residents only): http://www.iowadrugcard.com/index.php