NAP- Neighborhood Alliance of Pawtucket

Affordable Healthcare - Dental,Medicaid, Part D; the Disability BuyIn

Affordable Health Care for all

Global Waiver-Medicaid hearings in Jan/Feb 2013 for 1115 Waiver for 5 years from US

http://www.neighborhoodlink.com/NAP-_Neighborhood_Alliance_of_Pawtucket/topics/308202

Twelve wonderful commandments

Urban Health Watch for many bits of information

CCRI offers low cost dental care at their Lincoln Campus 333-7250 from $10 for dental hygiene etc. Dental Clinic

Also, CCRI Dental Clinic offers cleaning, exams, x-rays, and sealants at their Lincoln campus for a $10 fee. Services are by appointment on weekdays from September to May and are provided by dental hygiene students under professional supervision. Appointment are two hours in duration. For more information or appointment call 333-7250

Individuals without health insurance, those who have high-deductible
plans, or immigrants without documents have an option to access
affordable primary care by becoming members of Health Access RI. Health
Access RI is a collection of independent doctors and medical practices
throughout RI that charge a monthly membership fee (usually $25 to $30
per month). There is also a one-time enrollment fee to join. Members
receive a complete office-based primary care services for a low cost for
each visit, usually $5 to $10. Each practice operates its own program
and sets its fees.
Complete primary care includes physical exams, well child care, sick
visits, routine women's care, immunization, management of chronic
conditions, and 24/7 access to an on-call physician for emergencies
after hours.
Health Access RI does not cover prescription drugs, labs, x-rays,
imaging, or physical therapy, however, members of Health Access RI
received significant discounts on the those services from participating
medical service providers. For more information, participating
practices and fees, visit www.healthaccessri.com


Finally, the PARI Independent Living Center in Pawtucket administers an
affordable assistive technology program that maintains an inventory of
medical and adaptive equipment for people with disabilities. Items are
sold at greatly reduced and affordable rates. Individuals and
businesses donate equipment which is inspected, cleaned and refurbished
to be utilized once again. Items available includes: wheelchairs,
walkers, canes, crutches, lap boards, slide boards, tub transfer
benches, geriatric chairs, beside tables, commodes frames, shower
chairs, bathroom safety equipment, lift chairs and scooters. For more
information, call 725-1966 extension 28

Note: information taken from the Ocean State Center for Independent
Living 's December newsletter.

Medicaid and Part D questions

DHS FREQUENTLY ASKED QUESTIONS ABOUT MEDICARE PART D FOR MEDICAID CLIENTS WITH MEDICARE

What is Medicare Part D?
As of 1/1/06, Part D is that part of the Medicare Modernization Act that provides prescription drug coverage to Medicare beneficiaries. Shortly, Medicaid clients will be notified that they have been enrolled in 1 of 9 Prescription Drug Plans.

ENROLLMENT QUESTIONS:

Do I have to enroll in Medicare Part D if I have Medicaid?
As of 1/1/2006, all individuals currently on Medicare and Medicaid will be auto- enrolled in Part D. You will be assigned to a prescription drug plan, but you can change plans at any time.

If I want to change plans, when can I do so?
You may change plans at any time. There is no specific enrollment period for dual eligibles. Any change in plans takes effect the first of the following month. We encourage you to make changes early in the month.

How do I change my plan?
Changing plans is a two-step process. First, you will contact your current plan to
disenroll and then you will contact the new plan to enroll for the following month. CMS requires that the request for disenrollment be sent or faxed in writing to the prescription drug plan . The member may also change enrollment by calling 1-800-MEDICARE.


PREMIUM and CO-PAY QUESTIONS:

Will I have to pay a monthly premium for Part D, if I am on Medical Assistance or Medicaid?
Dual eligibles, those individuals eligible for both Medicare and Medicaid will have no premiums, deductibles or coverage gaps.

Will I have a co-payment for my prescriptions?
Depending on your prescription drug plan, you will have $1 (generic)/ $3 (brand name) or $2 (generic)/ $5 (brand name) co-payment.

What is the income breakdown for determining the amount of my co-payment?
Single individual with income below $797.50 will pay a $1/$3 co-pay. Anyone with income over that amount will pay a $2/$5 co-pay.

Will I have a co-payment if I am a Medicaid waiver beneficiary?
Yes. Waiver beneficiaries will have a co-pay based on the above noted income limits.




Will I have co-payment if I am Medicaid eligible and live in an assisted living facility?
Yes. Medicaid beneficiaries living in assisted living will also have a co-payment, based on the income limits noted above.

Can I still use my Medicaid card for prescriptions?
You will need to use your Medicaid card for medications not covered by Part D such as barbiturates, benzodiazepines, cough and cold meds, vitamins and over the counter medications. There is no co-payment for prescriptions covered by Medicaid.


QUESTIONS FOR SPECIAL COVERAGE GROUPS:

If the state pays for my Medicare Part B premium ($78.20), do I have to apply for help with my Part D premium?
If the state pays for your Medicare Part B premium (QMB, SLMB, Q1), you will not have a Part D premium.

If I have Medicare A and /or B and I receive Medicaid through Rite Care, should I enroll in Part D?
Rite Care beneficiaries who also have Medicare coverage will be automatically enrolled in a prescription drug plan.

After 1/1/06, if I meet my spend down and become eligible for Medicaid, will Medicaid continue to pay for my Part D premiums and deductibles?
After 1/1/06, when you become Medicaid eligible by meeting a spend down, you will no longer pay Part D premiums and deductibles, however, you will have a co-pay of $2/$5 per prescription obtained through your prescription drug plan.

OTHER QUESTIONS:

What happens if I am no longer eligible for Medical Assistance?
You will continue to retain your Low Income Subsidy status with Medicare for the remainder of the calendar year. You will then need to reapply for a low income subsidy to continue to retain your low income status which provides help with Part D premiums and deductibles.

Where do I apply if I need a low-income subsidy?
You can apply through your local SSA office or through the Medicare website, www.medicare.gov. Decisions regarding eligibility are completed within 15 days. Additionally, applications can be processed through the RI Department of Human Services and decisions on eligibility may take from 30-60 days.