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Stretching Your Health Care Dollars

The CLAIM Program is a part of the State Health Insurance Assistance Program (SHIP) in Missouri, designed to help Medicare beneficiaries understand their benefits, make informed decisions, and resolve issues. Funding is provided by the Missouri Department of Insurance, Financial Institutions & Professional Registration (DIFP). The program serves a diverse range of individuals, including retirees, caregivers, and those in need of assistance with healthcare costs. It offers resources such as the Low Income Subsidy (LIS), Medicare Savings Programs, and Manufacture Assistance Programs. For more information, visit the CLAIM Program website.

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Stretching Your Health Care Dollars

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  1. Stretching Your Health Care Dollars CLAIM Program Missouri State Health Insurance Assistance Program (SHIP)

  2. What is CLAIM? Community Leaders Assisting the Insured of Missouri • Part of the State Health Insurance Assistance Program (SHIP), a national network • A state-based program to meet local needs of the Medicare population

  3. Why SHIPs were Created • To help consumers: • understand Medicare • make informed decisions about benefits • resolve issues in navigating the Medicare program • To provide feedback on state and local problems to the Centers for Medicare & Medicaid Services (CMS)

  4. Funding • Missouri Department of Insurance Financial Institutions & Professional Registration (DIFP) received the first federal grant in 1993. • Primaris Foundation has been awarded the contract through the DIFP since 1993.

  5. Examples of Who We Serve • A Medicare beneficiary and their family • A social worker helping a very sick client • A 64-year-old retiring in three months • Someone who just lost his/her benefits • A professional caregiver who needs information • A person who needs help enrolling in Part D • Someone needing help to pay healthcare costs

  6. Low Income Subsidy (LIS) Extra Help through Social Security Administration: • May qualify for zero or reduced premium for a basic Part D Drug Plan • Reduced co-payments/co-insurance for medication • Qualify for continuous open enrollment to change plans • Eligibility and level of help determined by both, income and resources • Application available through Social Security or CLAIM • Apply online at www.socialsecurity.gov

  7. Medicare Savings Programs • Federal and State funding through MO HealthNet to assist with: • Medicare premiums • May pay deductibles and coinsurance • Qualifies for extra help with Part D • Enrollment - Missouri Family Support Division • Three Different Levels of Assistance

  8. Qualified Medicare Beneficiary (QMB) • Pays Medicare Part A and Part B Premiums • Pays co-insurance & deductibles Part A and B • Pays premiums for Part D basic plans, reduces co-pays, eliminates deductibles and coverage gap • Qualify for a continuous open enrollment to change Part D plans (includes Advantage plans) • Eligibility based on income and resources

  9. Specified Low-Income Medicare Beneficiary (SLMB) • Pays Medicare Part B premium • Pays for Medicare Part D basic plan premium, reduces co-pays, eliminates deductibles and coverage gap • Qualify for a continuous open enrollment to change Part D plans (includes Advantage plans) • Eligibility based on income and resources

  10. Qualifying Individual (QI-1 or SLMB Group 2) • Pays Medicare Part B premium • Pays for Medicare Part D basic plan premium, reduces co-pays, eliminates deductibles and coverage gap • Qualify for a continuous open enrollment to change Part D plans (includes Advantage plans) • Eligibility based on Income and Resources

  11. MO HealthNet • MO HealthNet acts as a supplement to Medicare - pays co-insurance and deductibles for Part A & B • Eligibility for Low Income Subsidy for Part D (Extra Help) • Qualify for continuous open enrollment period to change Part D plan (includes Advantage Plans) • Eligibility based on Income and Resources

  12. Manufacture Assistance Programs • Company Assistance Programs • www.rxassist.org • www.needymeds.com • www.rxoutreach.org – discount program • Income and/or resource based • Will need your doctor to complete required forms • Programs vary on coverage and requirements

  13. Pharmacies Help

  14. Other Considerations • Always compare health care coverage • Ask questions • Do not sign papers if you do not understand • Just say “no thank you” • Always ask for information in writing • Don’t be afraid to appeal or to file a grievance

  15. Resources • CLAIM Program 1-800-390-3330 • www.missouriclaim.org • Local Social Security Administration office • www.socialsecurity.gov • Local Division of Family Support • www.dss.mo.gov/fsd • Local Area Agencies on Aging • http://moaging.com

  16. myMedicare.gov View claim status(excluding Part D claims) Order a duplicate Medicare Summary Notice or replacement Medicare card View eligibility, entitlement and preventive service info View or modify your drug list & pharmacy info View address of record with Medicare & Part B deductible status Access online forms, publications & messages sent to you by CMS

  17. Join Our Team! Counselors, Leaders in Outreach, Administrative Support, Interest Specialists, Mentoring, and AmeriCorps Members

  18. Thank You!

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