TAUNTON COUNCIL ON AGING, 30 OLNEY STREET, TAUNTON, MA
TELEPHONE: 508-821-1425
HEALTH COVERAGE ISSUES
MEDICARE - Medicare is a federal health insurance program for people 65 or older and some disabled people under 65. Medicare is not a comprehensive health insurance program. It was never intended to pay 100% of health care costs. Medicare will only pay for services that are reasonable and medically necessary for the treatment and diagnosis of an accident or illness. These are services Medicare determines are safe, effective, and medically appropriate. Persons are eligible for Medicare if he/she is eligible to receive a Social Security pension and are aged 65 years of age or older, of if he/she receives Social Security disability payments for 24 months, or if he/she develops end stage renal disease (ESRD).
Payment for Medicare coverage is deducted from your Social Security check. Seniors must enroll in Medicare Part A and B when they turn sixty-five (65). Enrollment in the Medicare program is handled through the Social Security office.
MEDICAID/MASS HEALTH - The Medicaid Program was created in 1965 by Congress. Medicaid, or medical assistance, is administered by state Medicaid agencies within broad parameters established by federal regulations. Medicaid is a health care program designed primarily to help certain categories of low-income individuals with few financial resources. The federal government helps fund each state's Medicaid program. Medicaid is a needs based program. Applicants must prove that their income and financial resources are below certain defined levels to be eligible for benefits. The federal government and each state government jointly fund Medicaid. Payment for health services is made by the state Medicaid program directly to health care providers. The Medicaid/MassHealth enrollment center for our
area is located at 21 Spring Street in Taunton. Their local telephone number is 508-884-5300 or the regional number is 1-800-841-2900.
MEDICARE SUPPLEMENT INSURANCE - Medicare Supplement Insurance, also know as Medigap Insurance, is a special kind of health insurance coverage developed to provide extra protection beyond Medicare by filling some of the gaps in Medicare coverage. Medicare Supplement Insurance is available only to people who are eligible for Medicare Parts A and B and enrolled in Medicare A and B. Private insurance companies, not the federal government, sell Medigap insurance.
HMO/PPO- Medicare Health Maintenance Organizations (HMOs) are a form of managed care. Each HMO plan has its own network of hospitals, skilled nursing facilities, doctors and other health care professionals to provide services to its members. Medicare HMOs are an alternative choice to traditional health insurance for Medicare beneficiaries who meet the HMO eligibility requirements. HMOs contracting with the Medicare program must provide or arrange for the full range of Medicare Part A and Part B services including hospitalization, physician services, skilled nursing and home health care. Some HMOs also provide benefits beyond what Medicare covers, such as routine services, prescription drugs, dental care, hearing aids and eyeglasses. Preferred Provider Organizations (PPOs) also provide services
through a select group of doctors, hospitals and providers. The PPO agrees to provide the care needed for the cost of the Medicare premium. PPO plans allow the enrollee to choose to see a doctor outside the plan network at a higher cost. The enrollee will need to meet the Part B deductible and pay any part of the fee Medicare does not cover when he/she goes out of network.
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HEALTH COVERAGE ISSUES
PRESCRIPTION ADVANTAGE - Prescription Advantage is a prescription drug insurance plan that is available to all Massachusetts residents age 65 and older, as well as younger individuals with disabilities who meet income and employment guidelines. Individuals who are eligible for Medicare must also be enrolled in a Medicare Prescription Drug Plan or a plan offering creditable coverage and must not have a gross annual household income exceeding 500% of the Federal Poverty Level. Seniors sixty-six years of age or older must wait for Prescription Advantage open enrollment unless you fall into one of the exception categories.
MEDICARE PRESCRIPTION MEDICATION PROGRAM - (Medicare Part D) - Medicare's prescription drug coverage is available for anyone with Medicare, regardless of income. People new to Medicare have seven months to enroll in a drug plan (three months before, the month of, and three months after they become eligible for Medicare.) Drug plans are approved by Medicare, but administered by private companies. Medicare prescription drug plans hold an open enrollment once a year.
The Taunton Council on Aging has "SHINE" (Serving the Health Information Needs of Elders) Counselors on staff to help answer any questions regarding these programs. Seniors need to call the Council on Aging at 508-821-1425 to schedule an appointment.
Employees of Department of Human Services/Taunton Council on Aging are available to assist residents of Taunton with the completion of program applications. This assistance is available in the languages of English and Portuguese.
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