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Medicare & Medicaid

Medicare & Medicaid

Understanding what insurance coverage you have for the care that you need is very important.

Medicare and Medicaid are often confused. 

Medicare=we CARE for our Elders over 65 & people who are disabled.

Medicaid=we AID our poor

Medicare

Medicare is a short-term medical coverage insurance for people over the age of 65 or disabled. Medicare focuses on short-term, acute care for conditions that are expected to improve. Medicare does NOT cover long-term care.

 

Qualifying for Medicare

There are several different ways to qualify for coverage. In general to qualify you:

  • are over age 65
  • or have End Stage Renal Disease
  • or are Disabled

 

Check the Medicare website here for more details on how to qualify. The Centers for Medicare and Medicaid Services (CMS) website also offers information on qualifying for Medicare.

Medicare Coverage Plans

Medicare Part A is usually free for those that have been employed or whose spouse was employed. Medicare Part A is often referred to as hospital coverage. Medicare Part A covers inpatient hospital stays (you must be admitted to the hospital for 3 consecutive days -NOT held for observation), skilled nursing home facilities, skilled home health care and hospice.

Medicare Part B is not free. Medicare Part B helps cover certain doctors’ services, outpatient care, medical supplies, and preventive services. Medicare Part B may provide additional coverage for physical and occupational therapy and some home health care. This additional coverage is dependent on a doctor certifying that the services are medically necessary. You can drop out of Medicare Part B at any time however you can only enroll during specified enrollment periods.

Medicare Part C  (Medicare Advantage Plans) is administered through a regular Health Insurance Company that has a contract with Medicare.

Medicare Part D is prescription drug coverage.

Additional information about Medicare can be found here:

www.Medicare.gov

www.CMS.gov

www.LongTermCare.gov

Medicaid

Medicaid is a Federal and State funded health insurance program that pays for medical and health related services for people with a low income and very few assets. This includes inpatient and outpatient hospital care, preventive services, durable medical equipment, and many more services and benefits.

If you qualify, Medicaid will help pay for:

  • the cost of Medicare premiums
  • home and community based services such as Adult Day Care or Home Care
  • or long term residential care such as Assisted Living Facilities or Nursing Homes.

Qualifying for Medicaid Long Term Services and Supports

You must be a resident of Rhode Island to submit an application for Rhode Island Medicaid. The Medicaid program looks back 5 years to see where your money went. Medicaid has the ability to identify assets (such as property) that you own in another state.

Gather the following documents (if available)

  • Photo ID
  • Social Security Card
  • Medicare Card
  • Health Coverage Card and Proof of monthly premium and amount paid
    Verification of all Monthly Income
  • 6 Months Verification of All Bank Accounts (including checking, savings, CDs, annuities, stocks, bonds, trusts, etc.)
  • Insurance Policies (indicating the cash value)
  • Prepaid Burial- Name of Mortuary, Location of Burial Plot, and Deed
  • Copies of Power of Attorney, Guardianships, Conservators
  • Lease or Property taxes (if living in the community or own a home)
  • Car, Motorcycle, Boat, RV Registration’s
  • Proof of any other property, income or assets
  • If available, receipts for services, medical equipment or home modifications that allowed you to stay home longer,
  • All documents &/or receipts for any money given away, or property sold, transferred, deeded or given away in the last 5 years

The agencies listed below have staff that can help you.

Senior Health Insurance Program (SHIP) program
401-462-0510

SHIP volunteers and trained staff provide free one-to-one counseling on Medicare, Medicare Part D, supplemental insurance, Medicare  Advantage plans,  and other health insurance options. SHIP counselors are also located in the agencies listed below.

Rhode Islands Insurance Consumer Helpline
1-855-747-3224
www.RIReach.org

RI Reach is a free service that can help you with health insurance problems, explain coverage options, deductibles, co-pays, advocate for you with the insurance company and help find other resources you may need.

 

Medicare & Medicaid Fraud & Abuse Reporting

Rhode Island Senior Medicare Patrol (SMP)
401-462-0931

SMP helps beneficiaries recognize and report Medicare and Medicaid fraud, waste, and abuse.

 

RI Attorney General Patient Abuse or Neglect Medicaid Fraud & Drug Diversion Unit

401-222-2566  or  274-4400 x2269

The agencies listed below provide free help to complete the Medicaid application.

The POINT
50 Valley Street,
Providence, RI 02909
401-462-4444

Aging and Disability Resource Center (ADRC) for all of Rhode Island

 

Diocese of Providence, Office of Community Services and Catholic Charities
Serving elders and adults with disabilities in Providence in partnership with:

United Way of Rhode Island
50 Valley Street,
Providence, RI 02909
401-519-0360

St. Martin dePorres Senior Center
260 Cranston Street,
Providence, RI 02907
401-274-6783

 

Tri-County Community Action Agency
1126 Hartford Avenue,
Johnston, RI 02919
401-709-2635

Serving elders and adults with disabilities in the following communities: Burrillville, Glocester, Foster, Scituate, Woonsocket, North Smithfield, Smithfield, Johnston, Cranston, Cumberland, Lincoln, North Providence

Westbay Community Action Program
224 Buttonwoods Avenue,
Warwick, RI 02886
401-732-4660

Serving elders and adults with disabilities in the following communities: Warwick, West Warwick, Coventry, East Greenwich, West Greenwich

 

East Bay Community Action Program
610 Waterman Avenue,
East Providence, RI 02914
401-435-7876

Serving elders and adults with disabilities in the following communities: Central Falls, Pawtucket, East Providence, Barrington, Warren, Bristol

 

Child & Family Services of Newport County
31 John Clark Road,
Middletown, RI 02842
401-849-2300

Serving elders and adults with disabilities in the following communities: Portsmouth, Tiverton, Little Compton, Middletown, Newport, Jamestown

South County Community Action Inc.
1935 Kingstown Road,
South Kingstown, RI 02879
401-789-3016

(*NOTE – this agency is also part of Tri-County CAP)

Serving elders and adults with disabilities in the following communities: Exeter, Hopkinton, Richmond, Westerly, Charlestown, North Kingstown, South Kingstown, Narragansett, New Shoreham ( Block Island)

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