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Senior Citizen Guide to Health Care Services

Dear Friend, Obtaining affordable health insurance and other health-related services can be a daunting challenge for many senior citizens. Thats why I am pleased to report there are a number of federal, state, and community programs designed to help elders access the health care services they need and deserve. This brochure provides basic details about many of these important programs and contains additional health-related information, including such matters as health care proxies, respite care and long-term care insurance. Sincerely,

Senator Shirley L. Huntley 10th Senatorial District

Medicare Medicare is a health insurance program administered by the federal government through the Social Security Administration. It is designed for persons aged 65 and older and for some severely disabled persons under age 65. Medicare only provides coverage for care it determines to be medically necessary and has two basic parts: Part A applies to most seniors and provides hospital coverage, which is subject to a deductible and co-insurance (the percentage you are responsible for paying). Part A may provide complete or partial coverage for care in a variety of settings that include: your home, hospitals, nursing facilities and psychiatric hospitals. Part B is optional medical coverage (for an additional monthly premium) offered when you enroll for Part A benefits. Medicare Part B may prove helpful in paying for doctor visits, mental health services, X-rays, laboratory tests, wheelchairs and various types of therapy. State law limits the amount that doctors may charge for most physicians services provided under Medicare Part B. For more information call your local County Office for the Aging. Part D Medicare Prescription Drug CoverageMedicare now offers prescription drug coverage. Most people will be able to get this coverage through Medicare prescription drug plans. For more information visit To find out about eligibility and to ensure protection begins when you reach 65, contact the Social Security office at 1-800-772-1213 three months before your 65th birthday. If you are planning to retire, check with the personnel office at your place of employment about this program. Some senior citizens on limited income may be eligible to have Medicare Part B premiums and other co-payments covered by the state. For more information, call the Medicare Hot Line at 1-800-633-4227 (TTY-TTD 1-877-486-2048).

Medigap Medigap is a supplemental insurance, sold in 10 standard plan formats, that may help fill gaps in Medicare coverage (certain instances, services, treatments, tests, equipment and settings are only partly covered or not covered by Medicare). Talk with a counselor to find out if a Medigap policy is right for you. Contact the State Office for the Aging for information on counseling services and the State Insurance Department for a listing of Medigap carriers. For health insurance information call 1-800-701-0501 from 9am to 3pm Mon.Thurs. You can also visit the State Office for the Aging for information regarding Medigap and much more at: Medicaid Medicaid is a joint federal and state program for senior citizens and others with income or resources below a certain level. Some senior citizens are eligible to receive both Medicare and Medicaid benefits. State law protects some of the assets of a married couple should one require nursing home care. If you have any questions, or if you wish to apply for

Medicaid assistance, contact your County Office for the Aging. If you cant go there in person, someone else may go on your behalf. More information is available by clicking on the Medicaid link on the New York State Department of Health web site at: EPIC The Elderly Pharmaceutical Insurance Coverage Plan (EPIC) helps New York senior citizens pay for their prescriptions. New York State residents aged 65 or older who have little or no prescription drug coverage through a private insurer or Medicaid can qualify if their incomes are below the established limits. Depending upon annual income, seniors are enrolled in either the fee plan or the deductible plan. Under EPIC+, all single seniors with incomes below $20,000, and all married seniors with incomes below $26,000, will go into the fee program. Seniors with higher incomes, up to $35,000 for singles and $50,000 for married couples, will enroll in the deductible plan. Under both plans, co-payments for specific drugs are based on the list price of the prescriptions you need, and range between $3 and $20. Applications are available at a variety of locations throughout the State, including pharmacies, doctors offices, senior centers and county Offices for the Aging. Seniors can also call EPICs Helpline at 1-800-3323742 to request an application. More information and a copy of the application is also available by clicking on the EPIC link on the New York State Department of Health web site at:

#566 Revised: 6/2010

Long Term Care

Nursing Home Without Walls This program is an alternative for patients who medically qualify for nursing home care but who prefer to remain at home. Now available in many communities, the Nursing Home Without Walls program provides both Medicaid and private-pay patients with extensive in-home health services administered by health agencies, residential health care facilities, certain adult homes and hospitals. For more information about this program, contact your local County Health Department. Hospices Hospices provide care for the terminally ill at home, which helps preserve the comfort and dignity of the patient while involving the patients family. They may be operated by home care agencies, hospitals, nursing homes or other health care providers or community groups. Hospices may provide doctors, nurses and home health aides 24 hours a day, 7 days a week. Counseling is also available to assist families in bereavement and other stressful periods. The cost of hospice care generally is reimbursed by private insurance companies, Medicaid and Medicare. Go to for more information about hospice services. Expanded In-Home Services for the Elderly Program (EISEP) The need for institutional or nursing home care can in part be prevented when certain nonmedical services are provided in the home. EISEP provides funding for a uniform system of in-home case management, noninstitutional respite and other services for seniors who need long-term care but are not eligible for Medicaid. Those who are able, share costs for services based on their ability to pay. More information can be found by visiting and clicking on the Medicaid link.

Long Term Care Insurance Through the New York State Partnership for Long Term Care, the Medicaid program can help you or a family member pay for nursing home or home health care costs without exhausting all your life savings. If you purchase affordable private long term care insurance that has been specifically approved for the Partnership program, the insurance must cover at least 3 years of nursing home or 6 years of home health care or an equivalent combination of both. Once the minimum benefit duration is reached, an income eligible policy holder will qualify for Medicaid extended coverage for the remainder of his or her life without consideration of his or her assets. For more information, contact the Partnership program at 1-888-6977582. You can also visit the NYS Insurance Department on the Internet at: You may also be eligible for a state and federal tax deduction if you purchase private long term care insurance. Contact the State Insurance Department at 1-800-342-3736 to find out more.

Respite Care Respite provides temporary rest periods for families who care for elderly or disabled relatives. Temporary in-home and out-of-home health services can be provided by qualified community and public agencies, nursing homes and other health care providers for families who need a time-out from the stress of full-time care of the elderly or disabled. Alzheimers Disease Assistance Centers There are nine centers in New York State that provide services to Alzheimers victims and their families, including disease identification, care planning and counseling. A listing of these centers is available through the NYS Health Departments web site at: or contact the department in writing at: Bureau of Chronic Disease Services New York State Department of Health, ESP Corning Tower, Albany, NY 12237-0678 Nursing Homes Nursing homes are licensed by New York State. If a nursing home is not state licensed, or if the license is not current, dont consider it. All nursing homes receiving Medicare and Medicaid funds are required to make copies of the findings of their most recent inspections available to the public. Ask to see these reports and all licenses and certificates. Its your right by law. It is also important to know that a married person requiring nursing home care can be eligible for Medicaid without impoverishing his or her spouse. State law allows the marriage partner remaining at home to retain a set amount of assets and monthly income. The home itself, if it is the primary residence, is an exempt resource.


State Office for the Aging Nutrition Program for the Elderly (NPE) This program helps provide hot, balanced meals to senior citizens in every county and Indian nation of the state. The meals are served at local community gathering places. Efforts are made to identify persons unable to reach these meal sites and to provide them with transportation. In addition, senior citizens who are unable to leave their homes can have their meals delivered to them. Anyone over 60 years of age and their spouses and disabled dependents are eligible to take part in the program, and no one is turned away because of inability to pay. The services provided by the NPE are made available through local Offices for the Aging, which serve all New York State counties. These local offices are listed in the community services or local government pages of most telephone books. On the Internet, visit the Office for the Aging at:

Living Insurance
Benefits People with a life expectancy of 12 months or less or a medical condition that requires extraordinary care can opt to make use of life insurance benefits before they die. Living insurance benefits enable policy holders to apply for part of the value that would normally be available upon their death. This money is not subject to State or New York City income tax. For information about this option, contact the New York State Department of Insurance at 1-800-342-3736. Health Care Proxy If you fill out a Health Care Proxy form, you empower someone else to make medical treatment choices for you when you are no longer able to make them for yourself. Health Care Proxy forms and other information about this law are available from my office. The Health Care Proxy form is also available at: Third Party Notification Under state law, insurance companies may be requested to send insurance payment notices to a third party. This includes payment notices for Medigap policies.


Shirley L. Huntley

District Ofce 161-10 Jamaica Avenue, Suite 504 Jamaica, New York 11432 Phone: (718) 523-3069 You can find me on

Albany Ofce 508 Legislative Ofce Building Albany, New Y ork 12247 Phone: (518) 455-3531