BENEFITS
AND RIGHTS FOR INDIVIDUALS WITH DEMENTIA AND THEIR FAMILIES:
Pennsylvania Department of Aging
Consumer Protection and Information
Health
Care
Health Insurance
Home and Community-Based
Services
Transportation
DEPARTMENT OF AGING
Through a statewide network of 52 Area
Agencies on Aging, the Department provides many benefits and services to
Pennsylvania’s 2.4 million people over the age of 60.
Millions of dollars are spent each year to
provide a wide array of services to older Pennsylvanians from abuse
protection to personal care to transportation services. These services are
delivered through the Area Agencies on Aging.
In the ensuing years, the Department will
continue to develop new programs for older Pennsylvanians as well as improve
those already in place. These efforts will ensure that communities,
families and the elderly will continue to all have an enhanced quality of
life.
For more info on the Department of Aging:
Pennsylvania
Department of Aging
555 Walnut Street, 5th Floor
Harrisburg, Pa
17101-1919
(717)-783-1550
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AREA AGENCIES ON AGING SERVICES
Pennsylvania has 52 Area Agencies on Aging
(AAAs) that span 67 counties. They are the local representatives for the
Pennsylvania Department of Aging. As such, their main function is to
implement programs and services offered by the Department to the older
population.
These agencies on aging services offer
assistance, supportive service and advice. Assistance can be found with
providing care, investigating abuse and neglect reports, recommending
recreational, social or educational opportunities. They are staffed with
skilled workers in various fields such as geriatrics, social work, and
community resources.
Like the Department that they represent, the
Area Agencies on Aging have a mission of acting as advocates for the aging
and to keep that population active and independent in their own
communities.
Phone Numbers and Addresses can be found
here (listed by region and county):
Central PA |
Adams
Adams Co. Office for
Aging, Inc.
318 Middle St.
Gettysburg,
PA
17325
(717) 334-9296 |
Cumberland
Cumberland Co. Office
of Aging
Health Services Bldg.
16 W. High St.
Carlisle,
PA
17103-2922
(717) 240-6110 |
Dauphin
Dauphin Co. AAA
Administration Bldg, 3rd
Flr.
2 S. 2nd St.
Harrisburg,
PA
17101-2025
(717) 780-6130 |
Franklin
Franklin Co. AAA
218 N. 2nd St.
Chambersburg,
PA
17201-3098
(717) 263-2153
|
Huntngdon, Bedford, Fulton
Hunt./Bedford/Fulton
Agency on Aging
240 Wood St., P.O. Box 46
Bedford,
PA
15522
(814) 623-8148
|
Lancaster
Lancaster Co. Office of
Aging
150 N. Queen St., Ste. 301
Lancaster,
PA
17603
(717) 299-7979
Toll Free:
1-800-801-3070
|
Lebanon
Lebanon Co. AAA
710 Maple St.
Rm. 209 – Senior
Centers
Lebanon,
PA
17046
(717) 273-9262 |
Mifflin, Juniata
Mifflin/Juniata AAA,
Inc.
1 Buena Vista Circle
P.O. Box 750
Lewistown,
PA
17044-0750
(717) 242-0315
|
Perry
Perry Co. AAA
Center Square
P.O. Box 725
New Bloomfield, PA
17068
(717) 582-2131
|
Union, Snyder
Union/Snyder Co. AAA
116 N. 2nd St.
Lewisburg, PA 17837
(570) 524-2100 |
York
York Co. AAA
141 W. Market St.
York, PA 17401
(717) 771-9610
Toll Free:
1-800-632-9073 |
|
Northeastern PA |
Carbon
Carbon Co. AAA
401 Delaware Ave., 3rd
Flr.
Palmerton, PA 18071
(610) 824-7830
Toll Free:
1-800-441-1315 |
Columbia, Montour
Columbia/Montour AAA
702 Sawmill Rd., Ste.
201
Bloomsburg, PA
17815-7727
(570) 784-9272
Toll Free:
1-800-598-5001 |
Lackawanna
Lackawanna Co. AAA
Lackawanna Co. Office
Bldg.
200 Adams Ave.
Scranton, PA 18503
|
Luzerne, Wyoming
Luzerne/Wyoming
Counties
Bureau of Aging
111 N. Pennsylvania
Blvd.
Wilkes-Barre, PA 18701
(570) 822-1158 |
Lycoming, Clinton
Lycoming/ Clinton
Bi-County Office of Aging
2138 Lincoln St., P.O.
Box 3156
Williamsport, PA 17701
(570) 323-3096
Toll Free:
1-800-332-8555 |
Monroe
Monroe Co. AAA
724 B Phillips St.
East Stroudsburg, PA
18360
(570) 420-3735
|
Northumberland
Northumberland Co. AAA
2154 Trevorton Rd.
Coal Township, PA 17866
(570) 644-4545
Toll Free:
1-800-479-2626 |
Pike
Pike Co. AAA
150 Pike Co. Blvd.
Hawley, PA 18428
(570) 775-5550
|
Schuylkill
Schuylkill Co. Office
of Senior Services
110 E.
Laurel Blvd.
Pottsville,
PA 17901
(570) 622-3103
|
Tioga, Bradford, Sullivan, Susquehanna
AAA for Tioga,
Bradford, Sullivan and Susquehanna Counties
220 Main St., Unit 2
Towanda, PA 18848
(570) 265-6121 |
Wayne
Wayne Co. AAA
323 Tenth St.
Honesdale, PA 18431
(570) 253-4262
|
|
Northwestern PA |
Cameron, Elk, McKean
Office of Human
Services, Inc
P.O. Box A
Ridgway, PA 15853
(814) 776-2191
Toll-Free:
1-800-672-7145 |
Centre
Centre Co. office of
Aging
Willowbank Office Bldg.
420 Holmes St.
Bellefonte, PA
16823-1488
(814) 355-6716 |
Clarion
Clarion Co. AAA
12 Grant St.
Clarion, PA 16214
(814) 226-4640
|
Clearfield
Clearfield Co. AAA
103 N. Front St., P.O.
Box 550
Clearfield, PA 16830
(814) 336-1792 |
Erie
Greater Erie Community
Action Committee (GECAC)
18 W. 9th
St.
Erie, PA 16501
(814) 459-4581 |
Jefferson
Jefferson Co. AAA
186 Main St.
Brookville, PA 15825
(814) 849-3096 |
Mercer
Mercer Co. AAA, Inc.
133 N. Pitt St.
Mercer, PA 16137-1206
(724) 662-6222
Toll Free:
1-800-570-6222 |
Potter
Potter Co. AAA
P.O. Box 241, North St.
Roulette,
PA 16746-0241
(814)
544-7315 |
Venango
Venango Co.
AAA
1283 Liberty St., P.O.
Box 1130
Franklin, PA 16323
(814) 432-9711
Toll Free:
1-866-452-4464 |
Warren, Forest
Experience Inc. – AAA
Warren/Forest Counties
905 4th
Ave., P.O. Box 886
Warren, PA 16365
(814) 726-1700
Toll Free:
1-800-281-6545 |
|
|
Southeastern PA |
Berks
Berks Co. AAA
County Services Center
633 Court St.
Reading, PA 19601-4303
(610) 478-6500 |
Bucks
Bucks Co. AAA
30 E. Oakland Ave
Doylestown, PA 18901
(215) 348-0515 |
Chester
Dept. of Aging Svcs.
601 Westtown Rd. Ste.
320
P.O. Box 2747
West Chester, PA
19380-0990
(610) 344-6350 |
Delaware
Delaware County Office
of Services of Aging
206 Eddystone Ave., 2nd
Fl.
Eddystone, PA
19022-1594
(610) 490-1300
Toll Free:
1-800-416-4504 |
Lehigh
Lehigh Co. AAA
17 S. 7th
St., Rm 230
Allentown, PA
18101-2400
(610) 782-3034 |
Montgomery
Montgomery Co. Office
on Aging & Adult Services
1430 Dekalb St., P.O.
Box 311
Norristown, PA
19404-0311
(610) 278-3601 |
Northampton
Northampton Co. AAA
Governor Wolf Bldg.
45 N. Second St.
Easton, PA 18042-3637
(610) 559-3245
Toll Free:
1-800-322-9269 |
Philadelphia
Philadelphia Corp. for
Aging
642 N. Broad St.
Philedelphia, PA
19130-3409
(215) 765-9000 |
|
Southwestern PA |
Allegheny
Alleghany Co. AAA
441 Smithfield St. Bldg
2nd Flr
Pittsburgh, PA
15222-2219
(412) 350-4234 |
Armstrong
Armstrong Co. AAA
125 Queen St.
Kittanning, PA 16201
(724) 548-3290
Toll Free:
1-800-368-1066 |
Beaver
Beaver Co. Office on
Aging
1020 8th
Ave.
Beaver Falls, PA 15010
(724)-847-2262 |
Blair
Blair Senior Services,
Inc.
1320 12th
Ave
Altoona, PA 16601-3308
(814) 946-1235
Toll Free:
1-800-245-3282 |
Butler
Butler Co. AAA
111 Sunnyview Circle,
Ste 101
Bulter, PA 16001-3547
(724) 282-3008
Toll Free:
1-888-367-2434 |
Cambria
Cambria Co. AAA
Central Park Complex
110 Franklin St. Ste.
400
Johnstown, PA
15901-1831
(814) 539-5595
Toll Free:
1-800-992-4464 |
Fayette, Greene,
Washington
Southwestern PA AAA,
Inc.
Fayette, Greene,
Washington Counties
Eastgate 8
Monessen, PA 15062
(724) 684-9000
Toll Free:
1-800-342-8980 |
Indiana
Aging Services, Inc.
1005 Oak St., P.O. Box
519
Indiana, PA 15701-0519
(724) 349-4500
|
Lawrence
Lawrence Co. AAA
Shenley Square
2706 Mercer Rd.
New Castle, PA
16105-1422
(724) 658-3729
|
Somerset
AAA of Somerset Co.
1338 S. Edgewood Ave.
Somerset, PA 15501
(814) 443-2681 |
Westmoreland
Westmoreland Co. AAA
200 S. Main St.
Greensburg, PA 15601
(724) 830-4444
|
|
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BUREAU OF CONSUMER
PROTECTION
An agency of the Office of Attorney
General. They investigate consumer complaints and will contact (with
subpoena if necessary) the agency in question in order to mediate between
the consumer and the agency to solve the problem. An example would be
you, as a consumer, are unhappy with a purchase from a particular company,
but that company refuses to consider the complaint you bring before them;
you should then contact the bureau.
EVERYONE is eligible for this service.
When you go to an office, take with you any materials you think would be
sufficient evidence for the problem.
Contact your local bureau headquarters:
Harrisburg
Strawberry Square, 14th Flr.
Harrisburg, PA 17120
(717) 787-9707
Kline Plaza
Harrisburg, PA 17104
(717) 787-7109
Allentown
801 Hamilton Mall, 4th Flr.
Allentown, PA 18101
(610) 821-690
Philadelphia
21 S. 12th St., 2nd
Flr.
Philadelphia, PA 19107
(215) 560-2414
Erie
1001 State St. Ste. 1009
Erie, PA 16501
(814) 871-4371
Pittsburgh
Manor Complex, 6th Flr
564 Forbes Ave.
Pittsburgh, PA 15219
(412) 565-5135
Scranton
214 Samter Building
101 Penn Ave.
Scranton, PA 18503
(570) 963-4913
Ebensburg
171 Lovell Ave., Ste. 202
Ebensburg, PA 15931
(814) 471-1831
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OMBUDSMAN
PRGRAM
The Department of Aging administers the
Ombudsman Program statewide for consumers 60 years of age or older through
contracts with each of the 52 Area Agencies on Aging (AAA) in
Pennsylvania.
Ombudsmen respond to
complaints from the older consumers of any long-term care service provided
in an institution, a community setting, or the private home.
The
Ombudsman Program is unlike any other long-term care service, for its sole
purpose is to support and empower consumers. An advocacy role takes two
forms: 1) to receive and help resolve individual complaints and issues by
or on behalf of consumers of long-term care services, and 2) to improve
and enhance the long-term care system, its laws, regulations, policies,
and administration through public education and empowerment. As such it
must:
-
Follow-up on all
received complaints
-
Obtain consent from
the consumer/complainant before proceeding with the investigation
-
Provide Tier Two
training to each local Ombudsman prior to allowing the Ombudsman to
investigate a complaint
-
Refer to the
appropriate agency all complaints that allege abuse, neglect, or
financial exploitation
-
May enter a
facility at any time as necessary to advocate on behalf of a resident
-
Ensure
confidentiality of information and records
-
Not release the
identity of the older person and the complainant without consent or
court order
-
Work with all
parties such as facility staff, family members, and regulatory agencies
in seeking a resolution to verified complaints
-
Work with licensing
agencies for effective enforcement, as ombudsmen do not have authority
to require action by a facility or other providers of long-term care.
The Office of the State Long-Term Care
Ombudsman can be reached at:
Pennsylvania Department of Aging
Office of the State Long-Term Care Ombudsman
555 Walnut Street, 5th floor
Harrisburg, Pa. 17101-1919
(717) 783-7247
Email -
[email protected]
Local Ombudsman Listing
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OLDER ADULTS PROTECTIVE
SERVICES
Protects Pennsylvanians 60 years of age and older against neglect and
physical, mental or financial abuse. Those who report said negligence or
abuse are shielded from retaliation and protected from criminal or civil
liability. Neglect and/or abuse should be reported to your local Area
Agency on Aging, which is open to receive these reports 24 hours a day.
They are required by law to begin an investigation no later than 72 hours
after the report is made. There are two types of reporting: voluntary and
mandatory.
Voluntary
Reporting
- Any person who believes that an older adult is being abused,
neglected, exploited or abandoned may file a report 24 hours a day with
any
Area Agency on Aging
or call the statewide elder abuse hotline at
1-800-490-8505.
- Abuse reports can be made on behalf of an older adult whether the
person lives in the community or in a care facility such as a nursing
home, personal care home, hospital, etc.
- Reporters may remain anonymous.
- Reporters have legal protection from retaliation, discrimination and
civil or criminal prosecution.
Mandatory
Reporting
- Employees and administrators of nursing homes, personal care homes,
domiciliary care homes, adult day care centers and home health care
are mandated by Act 13 of 1997 to immediately report any suspected
abuse of a recipient of care to the Area Agency on Aging. If the abuse
involves serious injury, sexual abuse or suspicious death, reporters
must also call
police and the Pennsylvania Department of Aging at (717) 783-6207. In
addition, the reporter may also call the Pennsylvania Department of
Health Nursing Home Complaint Line at 1-800-254-5164.
- Failure to report as required by Act 13-1997 can result in
administrative or criminal penalties.
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COMMONWEALTH INFORMATION CENTER
This center is open to all Pennsylvania residents and provides information
regarding any government related problems you might have. It will
investigate complaints as well as refer you to the appropriate service
agency that may best assist you with your needs.
CONTACT:
Toll Free: 1-800-932-0784 or
Call: (717) 787-2121
Hours: Monday – Friday 8:00 a.m. to 5:00 p.m.
ELDERCARE LOCATOR
This
service is administered by the National Association Area Agencies on
Aging. Eligibility is open to any person regardless of age and is
conducted nation-wide to help families/friends, etc find information
about community services for older people through a network of
organizations that serve this population at state and local levels.
Information on the following services may be available:
Call the National Toll Free Number
1-800-677-1116 between the hours of 9:00 a.m. and 8:00 p.m. Eastern
Time for assistance. The Following Information is Needed when you
call:
1.
the county,
city or zip code of the older person you are assisting (helps with
identification of the nearest information and assistance sources)
2.
a brief and
general description of the problem or type of assistance you are seeking
The Eldercare Locator will provide you with
the telephone numbers of the appropriate state or local agency.
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VICTIM’S SERVICES
Developed to help
crime victims deal with the physical, emotional, and financial
consequences that crime imposes upon them. This service is eligible for
all older Pennsylvanians. Call the providers in your area to determine
which agencies are best suited to provide you with adequate help. Some
examples of these services include:
Contact: Area Agency
on Aging or visit
PCCD. Some Toll free numbers include: Victim Compensation Assistance
Program 1-800-233-2339 and for information on publications and other
materials regarding compensation call 1-800-692-7292, extension 3227.
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DEPARTMENT OF HEALTH/
COMPLAINT HOTLINE
The Department
of Health assists those with complaints about the quality of nursing home
care. The process includes:
-
You should first
talk to your Nursing Home Administrator and/or Director of Nursing.
That person is licensed and responsible for the operation of the
facility. The facility should have a system to address your concerns
and develop a plan with which to obtain a reasonable and acceptable
solution.
-
Call your local
Area Agency on Aging. This phone number should be located in the
blue pages of the telephone book. A trained professional will help
you resolve the issue or contact the proper authority.
-
Call the toll free
hotline Monday through Friday from 8:00 a.m. – 4:30 p.m. or upon
emergency someone will be there to answer your call. The phone number
is 1-800-254-5164.
-
After a
complaint or report is filed, a division staff will conduct an
investigation, the results of which will be shared with the person who
filed the complaint.
CONTACT:
Toll free hotline (1-800-254-5164): located at the central office in
Harrisburg. Also contact one of the field offices listed below through
telephone, mail, fax or email. They also receive referrals of complaints
from other agencies associated with nursing homes.
Harrisburg Field Office
100 North Cameron St.
Second Floor
Harrisburg, PA 17101-2424
(717) 783-3790
(717) 772-3641 (fax)
Jackson Center Field Office
19 McQuiston Dr
Jackson Center, PA
16133
(724) 662-6050
(724) 662-6067 (fax)
Lehigh Valley Field Office
4520 Bath Pike
Bethlehem, PA 18107
(610) 861-2117
(610) 861-2123 (fax)
Pittsburgh Field Office
300 Liberty Avenue
Pittsburgh State Office Building
Room 505
Pittsburgh, PA 15222
(412) 565-2836
(412) 565-2893 (fax)
Norristown Field Office
1937 New Hope Sreet
Norristwon PA 19401
(610) 270-3475
(610) 270-1152 (fax)
Scranton Field Office
100 Lackawanna Avenue
Scranton State Office Bldg.
Room 111
Scranton PA 18503
(570) 563-4331
(570) 963-3415 (fax)
Ebensburg Field Office
650 Industrial Park Road
Ebensburg, PA 15931-4108
(814) 472-7275
(814) 472-7901 (fax)
Lionville Field Office
P.O. Box 500
110 Pickering Way
Exton, PA 19341-0500
(610) 594-8041
(610) 594-9267 (fax)
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Prime Time Health
The Pennsylvania
Department of Aging’s PrimeTime Health Program focuses on health promotion
and disease prevention activities for older Pennsylvanians. Through the
52 Agencies on Aging, the PrimeTime Health program helps persons learn and
maintain good health habits. The program focuses on the following
priority areas: exercise; nutrition; chronic conditions; incontinence;
mental health; injury prevention; medication management; and alcohol. Two
components of PrimeTime Health are: PEPPI (Peer Exercise Program Promotes
Independence), which helps older adults maintain their independence and
fitness through weight resistance training and walking; and FRIENDS (Fall
Risk Initiative-Establishing New Directions for Safety), a screening
program developed to help identify people with a high risk of falling and
to help raise awareness of ways to reduce their risks. Is eligible for
anyone.
Contact: local
Area Agency on Aging.
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PACE
(Pharmaceutical Assistance Contract for the Elderly)
PACE is a program
which assists eligible Pennsylvania residents with payment of their
prescription medicines. PACE pays the difference between your $6
co-pay and the cost for your prescription. This co-payment is
written into the PACE law and pharmacies must collect the co-pay.
Those Eligible:
Persons age 65 and older whose income last year (2003) was less than
$14,000 for single persons and $17,200 for married couples. Persons must
be Pennsylvania residents for at least 90 days prior to the application.
Persons enrolled in PACE as of December 31, 2000, will remain eligible for
benefits if their total income exceeds the limit solely because of a
cost-of-living adjustment in their Social Security income.
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PACENET
Another tier of
eligibility under the PACE Program extends eligibility income limits
another $3,000 – for single persons between $14,000 and $17,000 and for
married couples between $17,200 and $20,200 – making them eligible for
modified PACE benefits. Pennsylvanians who are eligible for PACENET must
first be enrolled and then have their prescription expenses credited
toward a $500 per person deductable, after which PACENET will reimburse
prescriptions for a co-pay of $8 for generic drugs and $15 for brand name
drugs.
Income includes, but
is not limited to, gross Social Security and pensions, taxable IRAs and
annuities, interest, dividends, capital gains, wages, rental and business
income, worker’s compensation, unemployment compensation, gifts exceeding
$300 and life insurance benefit payments exceeding $5,000. Assets are not
considered as income.
Contact:
Applications for PACE are available at Area Agencies on Aging, pharmacies,
legislators’ offices and on the department’s
website. In addition to
proof of age and residency, photocopies verifying income must also be
submitted. Upon approval, applicants will receive a card, in most cases,
good for one year. This card must be presented with each prescription.
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OTHER PHARMACEUTICAL PROGRAMS
Medial Assistance covers the cost of
prescription drugs. Many local pharmacies offer reduced rates for
prescription drugs and other pharmaceutical items. Check with the drug
stores in your area to determine which offer such discounts. You should
ask your doctor or pharmacist about multisource or generic drugs.
Multisource drugs are less expensive but just as effective as brand name
drugs in most cases.
Members of the
American Association of Retired Persons, National Retired Teachers
Association, the National Council of Senior Citizens and other groups
receive reduced prescription rates through direct prescription drug buying
services. Click here for a listing. Retired
members of some unions may also be eligible or reduced rates at local drug
stores.
Many pharmaceutical
manufacturers sponsor programs that provide certain prescription
medications free of charge to physicians whose patients are needy and may
not otherwise have access to necessary medications. Your physician can
obtain up to date information by calling Toll Free 1-800-PMA-INFO.
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MEDICARE
Medicare A
(Hospital Insurance) helps pay for five kinds of care:
-
inpatient hospital
care
-
psychiatric
hospital care
-
medically
necessary skilled nursing facility care after a hospital stay
-
home health care
-
hospice
care
Medicare B
(Medical Insurance) is a voluntary program with a requirement to pay a
monthly premium. It helps pay for:
-
doctor’s services
-
outpatient
hospital services
-
various medical
services and supplies
Those eligible to
receive these services include most of those over 65 years of age and some
of those under 65 years of age having disabilities.
If you are now
receiving Social Security or Railroad Retirement benefits or are eligible
for these benefits, your Medicare Card will be automatically sent to you.
However, if you are nearing 65, still employed and do not receive monthly
checks, you must apply for the program at your local Social Security
Administration office. To ensure full coverage, be sure to file your
application at least three months before your 65th birthday.
If you are employed or covered under a large group employer health
insurance contract, contact the local Social Security Office about
coordinating your insurance.
CONTACT: The
Social Security Administration Office nearest you for specific information
about the benefits and their funding.
Click here for a list of offices in Pennsylvania.
Be sure to take with you when you go:
BE
SURE TO FILE APPLICATION AT LEAST 3 MONTHS BEFORE 65th BIRTHDAY TO ENSURE
FULL COVERAGE
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MEDICARE PRESCRIPTION
DISCOUNT CARDS
In June of 2004, most Medicare
beneficiaries enrolled in Medicare-approved prescription discount cards.
Enrolling in a discount card may save you money on the cost of your
prescription drugs.
Visit here for more information regarding Medicare Prescription
Discount Cards.
Contact the PA
Department of Aging
555 Walnut Street, 5th Floor
Harrisburg, Pa
17101-1919
(717)-783-1550
MEDICARE MANAGED CARE
More and more Medicare
beneficiaries are joining managed care plans. Many find that managed care
plans are a good way to get more health care for their dollar.
Benefits: these are prepaid plans most of which are health maintenance
organizations (HMOs) that contract with Medicare and provide or arrange
for all Medicare-covered services. Many offer additional benefits not
covered by Medicare, such as dental care, prescription drugs and hearing
aids, for little or no additional cost.
Contact: HMOs in your area that have a contract with Medicare. Contact
the APPRISE program for a listing of Medicare HMOs at 1-800-783-7067.
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MEDICARE SUPPLEMENT INSURANCE
Medicare does not offer complete health care insurance protection.
Medigap insurance is regulated by federal and state law and must be
clearly defined as Medicare supplemental insurance. It is designed
specifically to complement Medicare’s benefits by filling in some of the
gaps in Medicare coverage.
Benefits: Regulations limit Medigap policies to 10 standard benefit plans
(Plans A through J). Each of the plans includes a core benefit package,
plus a different combination of benefits.
Eligibility: Persons
eligible for Medicare Parts A and B through attainment of age 65 or
through Social Security Disability.
Contact: Private
insurance companies or local insurance agents licensed to do business in
Pennsylvania. Shop carefully before you buy, as policies differ as to
coverage, limitations and cost.
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MEDICARE FREE CONTROL ACT
Reduces the amount of out-of-pocket expenses of Medicare beneficiaries by
limiting the amount which can be charged by providers of health care
services to the ‘reasonable charge’ for service as determined by the
Medicare program. After the annual deductible is met, the Medicare
beneficiary’s liability will generally remain 20 percent of the reasonable
charge with the Medicare program picking up the remaining 80 percent.
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MEDICAID (MEDICAL ASSISTANCE)
Benefits: Medicaid pays, without cost or bills to you, many medical
expenses including physician’s services, psychiatric care, nursing
facility care, laboratory, clinic and x-ray services and hospitalization,
among others. Coverage varies according to your particular situation and
you should check with Medicaid to find out what you are eligible for. If
you need emergency ambulance transportation for medical care, Medicaid
will pay the cost. Nonemergency medical transportation may also be
covered under other programs. In most cases, your Medicare part B
premiums are also paid by Medicaid.
Contact:
Centers for Medicare and Medicaid services.
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HEALTHY HORIZONS
Benefits: To ensure
adequate health care for elderly and disabled persons with low incomes and
to allow more spendable income by paying their Medicare premiums.
The three levels of
benefits are:
-
The Healthy
Horizons Categorically Needy Program: pays medical benefits including
prescriptions, doctor or clinic visits, dental and eye coinsurance.
-
The Healthy
Horizons Medicare Cost-Sharing Program: pays only Medicare premiums and
Part A and B deductibles and coinsurance (QMB).
-
Healthy Horizons
Specified Low Income Medicare Beneficiary Program (SLMB): pays only the
Medicare Part B monthly premium.
Eligibility:
For the first two programs: your income may not be greater than 100
percent of the Federal Poverty Income Guidelines. For the SLMB Program,
your income must be between 100 percent and 120 percent of the Federal
Poverty Guidelines. For the Healthy Horizons Categorically Needy Program
resources may not exceed the SSI resource standards. For the Healthy
Horizons Medicare Cost-Sharing Program and the SLMB Program, resources may
not exceed twice the SSI resource standards.
Contact: For
more information of the program contact your local
Department of Public Welfare County Assistance Office or call toll
free 1-800-842-2020 from 9:00 a.m. to 4:30 p.m. Monday through Friday, or
contact your local Area Agency
on Aging.
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OTHER HEALTH
INSURANCE OPTIONS
Benefits: A variety of other options are available to help pay off
medical expenses, services and supplies that Medicare covers only partly
or not at all. These include:
-
Group Health
Insurance Continuation- conversion or continuation of an
employer-provided policy.
-
Long-Term Care
Insurance – pays cash amounts for care received in a nursing facility or
in your home.
-
Hospital Indemnity
Policies - pays cash amounts for each day of inpatient hospital
services.
-
Specified Disease
Insurance - provides benefits for the treatment of a specific disease
such as cancer.
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APPRISE – HEALTH INSURANCE COUNSELING AND ASSISTANCE PROGRAM
Benefits: Trained volunteer counselors provide free one-on-one or
telephone assistance with understanding Medicare and Medicaid eligibility
and benefits; comparison and selection of Medicare Supplemental Insurance
Plans, Medicare Managed Care Programs, long-term care insurance plans, and
other health insurance and public benefit programs. Claims filing and
other paperwork assistance, advocacy, and referral to other appropriate
federal and state agencies are also available.
Eligible: People over
age 60, their families, or their caregivers needing assistance and people
entitled to Medicare because of disability.
Contact: The APPRISE
Program toll free 1-800-783-7067 from 9:00 a.m. to 4:00 p.m. or your local Area Agency on
Aging.
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QUALITY INSIGHTS OF
PENNSYLVANIA
Benefits: Quality Insights of Pennsylvania is a quality improvement
organization (QIO) which protects the rights of Medicare beneficiaries
receiving care in Pennsylvania. Call Quality Insights if you are denied
admission to a hospital, and asked to leave a hospital before you feel
well enough, or are dissatisfied with the quality of medical care you
received from a medical provider. Quality insights performs these
services free of charge to Medicare beneficiaries, including those
enrolled in HMOs.
Eligibility: All
Medicare beneficiaries who receive medical care in the Commonwealth of
Pennsylvania.
Contact:
Quality Insights of
Pennsylvania
2801 Market Place Street, Ste. 320
Harrisburg, PA
17110
Toll Free: 1-800- MEDICARE (633-4227)
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FAMILY
CAREGIVER SUPPORT PROGRAM
Benefits: The package of benefits begins with an assessment to determine
what benefits best meet the needs of the caregivers and the older person
receiving care. Benefits could also include counseling, education and
financial information. The family caregiver support program takes a
reimbursement approach. Income-eligible families may receive up to $500
per month service reimbursement for caregiving expenses and a $2000 ‘life
time grant’ for home modifications and assistive devices. Such
adaptations might include installing a stair climb or modifying a
bathroom. Family caregiver reimbursement is based on the care receiver’s
total household income on a sliding scale.
Assessment, care
management, caregiving counseling and training, access to support groups
and other caregiving assistance are provided to all enrolled in the
program regardless of income.
Contact: Information
on the Family Caregiver Support Program can be obtained from your local
Area Agency on Aging or by
contacting:
Division of
Quality Assurance and Managed Care
Pennsylvania
Department of Aging
555 Walnuts St., 5th
Flr.
Harrisburg, Pa
17101-1919
(717) 783-6213
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OPTIONS PROGRAM
OPTIONS provides assessment, care management and in-home services for
aging and disabled consumers. OPTIONS includes:
-
Assessment of need
for and provision of services and care management to persons over age 60
with complex, ill-defined problems, problems remaining at home, or
requiring personal advocacy.
-
Assessment of need
for and provision of services and care management to persons over age 60
requesting the following Area Agency on Aging (AAA) services: day care,
counseling, personal assistance services, home health, personal care,
protective services, home delivered meals, transportation services,
respite care, home support services and any other AAA community or
in-home service.
-
Assessment of need
for and provision of services and care management to persons over the
age of 18 considering nursing facility care.
-
Mandatory
assessment for persons applying for medical assistance (Medicaid) for
nursing facility care or for placement in a domiciliary or personal care
home who are eligible for the State Supplement to SSI; an assessment is
also available for any individual who is thinking about nursing facility
care.
-
The nursing
facility assessment also includes screening for mental illness, mental
retardation and other related conditions, and the assessment of need for
specialized services.
-
Consumers found
appropriate and eligible for nursing facility placement can be served at
home with the same AAA services as listed above and, if needed, more
intensive community and in-home services; this depends on availability
of needed services to ensure adequate care and safety; development and
implementation of care plan which meets required standards for quality
and safety, and often on availability of informal supports.
Contact: To apply for
OPTIONS services, contact you local
Area Agency on Aging.
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OPTIONS COST SHARING
The new mandatory Cost Sharing program
applies only to OPTIONS services and not to the Medicaid-funded PDA
Waiver Program, Home Delivered Meals, assessment, care management, and the
Family Caregiver Support Program. This program was instituted in order to
serve more consumers, provide additional services and reduce waiting lists
for home and community based services. A sliding payment scale based on
home is used to determine the percentage to be paid based on services
received. Those consumers whose income is below 125 % of the Federal
Poverty Level (FPL) Guideline will not have to pay a cost share. The
scale rises to 300% FPL at which point the consumer would be responsible
for 100% of the cost of OPTIONS services, excluding those listed above.
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BRIDGE PROGRAM
The new BRIDGE
program, funded from Tobacco Settlement Funds, expands in-home care
options and enables a seamless transition into the Medicaid PDA Waiver.
Consumers with assets not exceeding $40,000 will spend down these assets
through a 50/50 cost share plan to purchase services to be received in
their income over the course of 12 months or until they qualify for the
Medicaid Waiver. Though direct services are subject to cost share
assessments, counseling, care management and protective services are
available at no cost.
Contact: Your local
Area Agency on Aging or
call the SeniorLine at
(412) 350-5460.
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PENNSYLVANIA DEPARTMENT
OF AGING WAIVER
The PDA Waiver Program provides in-home
services to consumers, age 60 and over, who have medical needs, but would
like to be cared for at home.
-
Assessment of need
for provision of services and care management to persons 60 years of age
or older who are clinically eligible to be admitted to a nursing
facility but choose to receive services at home.
-
Determined
financially eligible for Medicaid nursing facility payments but chooses
community services.
-
Person can be
served at home with the same, and if needed, more intensive community
and in-home services described under the OPTIONS program; this depends
on availability of services to ensure adequate care and safety.
For more information
on the PDA Waiver, go
here.
Contact: Local
Area
Agency on Aging or call the Department of Public Welfare
toll-free at 1-800-692-7462.
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OLDER ADULT DAILY LIVING
CENTERS
Benefits: Older
Adult Daily Living Centers (also known as Older Adult Day Service Centers)
provide a program of social, recreational and health services in a group
setting that:
-
Helps mentally
and/or physically challenged adults to maintain or improve their level
of functioning in order to remain in the community.
-
Offers participants
the opportunity to socialize, enjoy peer support, and receive health and
social services in a stimulating and supportive environment that
promotes better physical and mental heath.
-
Provides assistance
to families and other caregivers who have responsibility for adults who
cannot be left alone and needs supportive services to improve or
maintain their level of independence.
Adult day services
offer an individual plan of care to meet the needs of each participant.
Participants attend on a scheduled basis, and services may include the
following: care and supervision, group and individual activities, meals
and snacks, recreation, exercise, personal care, nursing care, education,
health monitoring, counseling, information and referral, care management,
assistance with activities of daily living, and therapies.
Contact: Funding to
attend adult day care may be available through your local
Area Agency on Aging.
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SENIOR COMMUNITY CENTERS
Over 650 full
and part-time senior community centers throughout the state offer people
age 60 and older, and their spouses, a place to go for nutritious meals,
social activities and a range of programs such as health screenings,
health and consumer education, creative arts, exercise, and special events
unique to individual centers. Senior community centers often work with a
variety of local organizations, and provide access to other community
services as well. Centers also offer volunteer opportunities where older
people can contribute their experience and skills in meaningful and
satisfying ways. Additionally, there are another 100 centers known as
‘satellite’ centers where people age 60 and over, and their spouses, can
get together, socialize, and enjoy group dining.
Contact: For more
information, contact your local
Area Agency on Aging.
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PENNSYLVANIA’S FREE TRANSIT
PROGRAM
Benefits: This program provides free transit services on established bus
routes, trolley and rapid-transit lines during the midday and evening
hours on weekdays and all day on Saturday, Sunday and certain holidays.
Free rides are not permitted on weekdays from
7:00 a.m. to 8:00 a.m. or from 4:30 p.m. to 5:30 p.m.
Eligibility: Persons
65 years of age or older. You will need a senior citizen transit
identification card to ride free. The identification card is available
free of charge from participating local transit operators. An acceptable
proof of age document must be shown to the transit operator to obtain the
identification card.
Contact: Your local
transit operator or:
Free
Transit Program for Senior Citizens
Commonwealth
Keystone Building
P.O. Box 3151
Harrisburg, PA
17105-3151
(717) 783-8025
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SHARED-RIDE PROGRAM
Benefits: This program provides
reduced fare transportation services to eligible older persons utilizing
shared-ride transportation services. The cost to the rider under this
program is 15 percent of existing shared-ride fare; the Lottery fund pays
the remaining portion of the fare. In some cases the 15 percent charge or
reduced fare may be paid by a third party sponsor such as the local Area
Agency on Aging, thus resulting in a free fare program.
Eligibility: Persons
age 65 and over. Proof of age is required when enrolling in the program.
Contact: Your local Area
Agency on Aging or your local shared-ride transportation provider or:
The Shared Ride
Program
Commonwealth
Keystone Building
P.O Box 3151
Harrisburg, PA
17105-3151
(717) 783-8025
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TRANSPORTATION FOR THE ELDERLY
NOTE: Local Area Agencies on Aging
may also provide transportation for older people who have special needs or
where regular mass transit services are not available. This service
provides rides to senior centers, medical appointments and to social
services agencies.
Contact: Your local Area Agency on Aging.
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IDENTIFICATION CARDS
Benefits: Because most
establishments require a driver’s license for identification, an
identification card – similar in appearance to a driver’s license – can be
obtained by non-drivers and is accepted as a bona fide ID.
Eligibility: Any
Pennsylvania driver who voluntarily surrendered his/her license for
medical reasons can obtain the special ID free of charge. For all others,
including those who never received a license, there is a $10 fee.
Contact: Any PennDOT
Driver License
Center. Bring along proof of ID: a birth certificate, or your old drivers’
license, and a Social Security Card.
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