Dialysis and Financial Resales - A Social Worker's Guide

Transcription

1 7 CHAPTER 7 A Summar y o f H e l p f u l P r o g r a m s and Financial Resour ces T his chapter brings together information on key support programs and financial resources available to people with chronic kidney disease (CKD). We ve listed the organization or program, what assistance it can provide, how people can qualify for help, and contact information. There also are page numbers you can turn to in this booklet to read about these programs in more detail. 56 Your social worker a guide thr ough the maze Every dialysis and transplant center has a social worker on staff who will be an important part of your health-care team. These professionals are highly skilled and knowledgeable about the medical, social, psychological, and financial needs of people with CKD and their families. Your dialysis or transplant social worker will get to know you and support you as you adjust to life with CKD. Talk with your social worker about your financial concerns and ask for his or her help in finding ways to pay your medical costs. Almost every person facing the high costs of kidney disease needs some help and your social worker may be able to help you get it. If your center has a financial coordinator, he or she will work with you on money issues.

2 Program or Resource Type of Assistance Who Can Qualify Who to Contact Personal Financial Resources Your health insurance Depends on your plan You and family Your health insurance plan members covered contact at your work or at See page 12 by your plan the company you bought your plan from Life insurance Depending on the People who own life Your insurance agent or value and type of insurance policies insurance company See page 43 policy, you may borrow funds to pay for medical costs U.S. Government Financial Resources Medicare The Medicare ESRD Anyone with kidney Your social worker, or program pays part of failure who is a U.S. Part A the treatment costs citizen or permanent To apply: Hospital Insurance for dialysis and legal resident with transplants, including a work history Your local Social Security office Part B some drugs (has earned enough Medical Insurance work credits); also spouses or Part D Prescription dependent children or Drug Coverage of workers who (new in 2006) have kidney failure For what Medicare covers: A Summar y of Helpful Programs and Financial Resources See page MEDICARE ( ) (continued on page 58) 57

3 7 (continued from page 57) Program or Resource Type of Assistance Who Can Qualify Who to Contact U.S. Government Financial Resources Medigap Costs for services People with Your social worker, or (Medicare Supplement Medicare covers but Medicare Part A Insurance) doesn t fully pay and Part B; other MEDICARE qualifications vary ( ) See page 31 by state, including age and how soon you must apply after getting Medicare & You Handbook, Medicare Publication No. CMS-10050, or Your State Health Insurance Assistance Program (SHIP) or State Insurance Department (Look under State Government in the Government Pages of your phone book and then Insurance) click NAIC States & Jurisdictions, then your state for Insurance Department contacts click Find Helpful Phone Numbers and Web Sites, then Organization, and then SHIP from the drop down menu of Organizations 58

4 Program or Resource Type of Assistance Who Can Qualify Who to Contact U.S. Government Financial Resources Medicaid Helps pay Medicare People with Your social worker, or premiums, deductibles, low income and See page 32 and coinsurance, little savings Your local Medicaid or welfare plus drugs and some department (Department of costs Medicare Social Services) office (look doesn t cover such under State Government in the as non-emergency Government Pages of your phone transportation book and then Medicaid), or (Centers for Medicare & Medicaid Services site) Medicare Different programs People eligible for Your social worker, or Savings Programs may pay all or Medicare Part A part of Medicare and B who don t MEDICARE Qualified Medicare premiums, deductibles, qualify for Medicaid ( ) Beneficiary (QMB) and coinsurance and have limited income and savings Your state Medicaid office Specified Low-Income or Medical Assistance Office Medicare Beneficiary (SLMB) A Summar y of Helpful Programs and Financial Resources Qualified Individual 1 (QI) Qualified Disabled and Working Individual (QDWI) See page 33 (continued on page 60) 59

5 7 (continued from page 59) Program or Resource Type of Assistance Who Can Qualify Who to Contact Social Security Disability Monthly income People with enough Insurance (SSDI) work history under Social Security or See page 36 Railroad Retirement Supplemental Security Monthly income People with limited Income (SSI) income and savings; little or no work See page 37 history is required TRICARE for Life Health insurance For active duty Your local Veterans Affairs military retirees, office, or See page 42 their spouses and unmarried DOD-CARE children, surviving ( ) spouses, or former spouses in limited situations State Children s Health Health insurance for Uninsured children; MEDICARE Insurance Program children up to age 19 eligibility varies ( ) (SCHIP) by state (Centers for See page 42 Medicare & Medicaid Services site) American Indian Health-care services Enrolled members of Your local Indian Health Health Services federally recognized Services office, or tribes who live on Title VI Native American or near reservations Aging Programs (Indian Health Services site) See page 42 60

6 Program or Resource Type of Assistance Who Can Qualify Who to Contact Area Agencies on Aging Health insurance Age 60 and older (AAA) counseling, transportation, meals, home health care, (National Association of Area other essential services Agencies on Aging site) State Financial Resources State kidney programs Health-care costs, People who meet for information varies by state state guidelines, about programs in your state, See page 41 which vary by state, if any people may have other coverage and still get this help State high-risk Health insurance for Depends on the State Insurance Department insurance pools people who can t get program offered in it anywhere else your state, if any click NAIC States See page 16 & Jurisdictions, then your state for Insurance Department contacts, or A Summar y of Helpful Programs and Financial Resources National Association of Insurance Commissioners (Help Desk) Job/Employment Related Programs Consolidated Omnibus Allows you to Workers and their Your employer, or Budget Reconciliation Act temporarily keep families who lose (COBRA) your health insurance health insurance if you work for a from an employer See page 14 company with 20 due to job layoff, or more employees illness, reduced Search for COBRA hours, or death (continued on page 62) 61

7 7 (continued from page 61) Program or Resource Type of Assistance Who Can Qualify Who to Contact State Continuation Some states have Workers and their State Insurance Department for Small Firms programs that allow families who lose you to buy, change, health insurance See page 15 or continue health from an employer insurance if you due to job layoff, do not qualify for illness, reduced click Managed Care & Health COBRA coverage hours, or death Insurance, then State COBRA Expansions Temporary Continuation Allows you to Federal government Your personnel office, or of Coverage temporarily keep workers who lose your health insurance health insurance See page 15 from their government employer Health Insurance Protects people from Newly hired workers Your employer, or Portability and being denied health in companies with Accountability Act insurance from a at least two current (HIPAA) new employer just employees enrolled because they have in its group health See page 13 kidney disease plan, or Search for HIPAA Helps those who lose a job get other insurance People losing group health insurance, including Medicare or Medicaid, who want to buy individual coverage 62

8 Program or Resource Type of Assistance Who Can Qualify Who to Contact Americans with Protects people with People with physical Your social worker, or Disabilities Act (ADA) disabilities, including or mental disabilities, kidney disease, from including those on See page 15 discrimination in dialysis or who have getting or keeping had a transplant jobs, promotions, who are working in (Americans with raises, job training, or applying for jobs Disabilities Act site) and more in a company with at least 15 current employees Family and Medical Permits eligible People in companies Your employer, or Leave Act (FMLA) workers to take with at least 50 up to 12 weeks full- or part-time See page 15 unpaid leave in a employees who have 12-month period a work history in that company and Search for FMLA need time off to care for their own or a close family member s health needs A Summar y of Helpful Programs and Financial Resources Vocational Job evaluation and People with physical Rehabilitation agencies training, education, or mental disabilities, job placement and including people See page 50 retention services who receive Social Security Disability at (Job Insurance (SSDI) Accommodation Network site), or Supplemental click The Small Business and Security Income (SSI) Self-Employment Service and want to return (SBSES), then Resources for Small Business and Self- Employment, then State Vocational Rehabilitation Offices to a job or retrain for a new one (continued on page 64) 63

9 7 (continued from page 63) Program or Resource Type of Assistance Who Can Qualify Who to Contact Work incentive Helps people ease People who receive The work incentive specialists at programs back into work with- Social Security your local Social Security office out losing benefits Disability Insurance See page 51 at first; helps them (SSDI) or Supple- keep health insurance mental Security Income (SSI) and want to return to work Workers Compensation Cash settlement People who have Your employer developed kidney See page 45 disease as a result Your state Workers of their job Compensation office State Disability Pays a portion of Workers in states Your employer s Human Insurance wages lost because that offer these Resources office worker is disabled programs and See page 41 and can t work who qualify Kidney Organizations National Kidney Financial help People who meet Your social worker, or Foundation and its and services including guidelines for local affiliates nutritional support, specific programs Your local National Kidney medication assistance, Foundation affiliate, or See page 45 transportation assistance, scholarships, disaster relief, vocational rehabilitation and more 64

10 Program or Resource Type of Assistance Who Can Qualify Who to Contact American Kidney Fund Various financial People with Your social worker, or help and services low income or See page 46 large expenses Help With Specific Costs People who meet guidelines for specific programs Drug Assistance Free or People who meet Your social worker, or Programs discounted drugs low income limits and have no Partnership for See page 45 insurance that Prescription Assistance covers drugs PPA-NOW ( ) A Summar y of Helpful Programs and Financial Resources Also, (continued on page 66) 65

11 7 (continued from page 65) Program or Resource Type of Assistance Who Can Qualify Who to Contact Transportation to Transportation source Must be elderly or Your social worker, or dialysis and medical disabled and meet appointments requirements of National Kidney Foundation the transportation See page 46 agency systems American Kidney Fund Area Agencies on Aging (if 60 or older) Accessible transportation Nationwide listing of For people for travelers accessible tours and with disabilities tour companies, (Easter Seals National Accessible See page 54 airport and other Travelers Database) private shuttles, taxi companies, public transit 66