CLAIM. Missouri s State Health Insurance Assistance Program. Local Counseling about Medicare
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1 CLAIM Missouri s State Health Insurance Assistance Program Local Counseling about Medicare MO CLAIM February 2010 This material has been created or produced by CLAIM with financial assistance, in whole or part, through a grant from the Centers for Medicare and Medicaid Services, the Federal Medicare agency. Funding is administered through the Missouri Department of Insurance Financial Institutions and Professional Registration and service is provided by Primaris.
2 What Is CLAIM? Part of a nationwide network State Health Insurance Assistance Program (SHIP) Missouri s SHIP is called CLAIM Community Leaders Assisting the Insured of Missouri A state-based program to meet local needs of Medicare population
3 Why SHIPs were Created To help Medicare beneficiaries, caregivers and professionals understand Medicare To counsel individuals, enabling them to make informed decisions about benefits To assist in resolving problems in paying for health care
4 Why SHIPs were Created (cont.) To provide free, confidential, unbiased information and guidance To provide feedback on state and local problems to the Centers for Medicare & Medicaid Services (CMS) Congress created the SHIP network in 1990 as part of the Medigap reform package
5 Funding Missouri Department of Insurance Financial Institutions & Professional Registration (DIFP) received first federal grant in 1993 Primaris has been awarded the contract through the DIFP since 1993 Primaris is a health care consulting company and Missouri s Medicare Quality Improvement Organization
6 Scope of Services Medicare Education MO Healthnet Medicare Advantage Medigap policies Supplemental policies Medicare Prescription Drug Program Billing Issues Appeals and grievances Long-term care Distribute Medicare materials Outreach Missouri Rx Program Fraud and Abuse
7 Examples of Consumer Phone Calls A 70-year-old widow A 45-year-old disabled person A daughter taking care of her mom and dad A social worker helping a very sick client A 64-year-old retiring in 3 months Someone who recently lost her benefits A professional or caregiver who needs information A person needing assistance to enroll in Part D A man needing a general question answered
8 How are Clients Needs Met? Volunteers are trained Solid understanding of local needs and circumstances Respond to each individual s needs Volunteers can relate to the questions and needs of those they assist Volunteers have access to staff support, CMS and other professionals Currently close to 300 volunteers statewide
9 Community Partners CLAIM collaborates with local community partners Provide volunteers with a counseling location and connect beneficiaries with the local community Hospitals, area agencies on aging, civic centers, public housing, faith based programs, health care organizations and associations, libraries, RSVP programs Currently over 50 community partners Community partners and volunteers are a vital link between the consumer and Medicare
10 Special Projects and Outreach Efforts Medicare Improvement for Patients and Providers Act (MIPPA Project) (helping people pay for their Medicare costs) Low Income Subsidy (LIS) Medicare Savings Programs (MSP) People with Disabilities Part D Enrollment Events during AEP (10/15 to 12/7) Medicare Preventative services education
11 Reaching out to New Medicare Beneficiaries Working with employer s and employer organizations Holding workshops throughout the state and inviting persons about to turn 65. Welcome to Medicare events Aligning the program more closely with organizations that assist the disabled
12 Our Common Goal is to serve Missourians
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