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The Health Insurance Counseling & Advocacy Program (HICAP)

By Jenna MacRae The US Census estimates that 6.4 million seniors live in poverty throughout the United States. It can be difficult to make ends meet. The Health Insurance Counseling & Advocacy Program (HICAP) is a program of Elder Law & Advocacy that provides free, unbiased Medicare counseling to beneficiaries and their representatives. HICAP is increasing its efforts to assist low-income beneficiaries who struggle to afford their Medicare Part D costs and Medicare premiums. Social Security’s Extra Help low-income subsidy (LIS) helps to reduce the Part D prescription drug plan costs by reducing the monthly premium, lowering co-payments and eliminating the “donut hole.” CMS estimates that 2 million people qualify for Social Security’s Extra Help Program and are not yet enrolled. Medicare Savings Programs help pay for the monthly Medicare Part A or Part B premiums and automatically qualify an individual for LIS. Our goal is to inform Medicare beneficiaries of these programs and assist those who may qualify to apply.  HICAP is scheduling individual appointments for beneficiaries. To...

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News Affecting Seniors

Do Medicare/Medi-Cal “Dual Eligibles” Have to Pay Co-pays? By Jenna MacRae Many low-income individuals have both Medicare and Medi-Cal (sometimes referred to as Dual Eligibles). Dual Eligibiles should never be charged co-pays or deductibles for their Medicare Part A (hospital) and Part B (medical) benefits. In fact, it is illegal for a doctor, hospital or other Medicare health-care provider to “balance bill” and charge dual eligibles Medicare co-pays.1 Despite both federal and state law1 , EL&A’s HICAP Program has heard dual eligibles report that they frequently pay these co-pays. Surprisingly, many health-care providers do not know or are confused by these laws. Some dual eligibles have been told, “we don’t accept Medi-Cal, but you can see the doctor if you pay 20%.” Others simply receive a bill in the mail. Either way, these charges are illegal. Whether the dual eligible uses Original Medicare or is enrolled in a Medicare Advantage Plan, such as a Medicare HMO,2 they should not be charged co-pays for Medicare Part A or Part B...

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