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Benefits And Rights For Individuals With Dementia And Their Families

BENEFITS AND RIGHTS FOR INDIVIDUALS WITH DEMENTIA AND THEIR FAMILIES:


Pennsylvania Department of Aging

 

Consumer Protection and Information

 

Health Care

 

Health Insurance

 

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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:

  • home delivery meals

  • transportation

  • legal assistance

  • housing options                                                                                

  • recreational and social activities
    adult day care
    senior center programs

  • home health services

  • elder abuse prevention                                                                    

  • nursing home Obudmsan

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.

FOR MORE INFORMATION:
www.eldercare.gov

 

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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:

  • advocacy

  • court accompaniment

  • crisis intervention

  • supportive counseling

  • assistance in filing a claim with the Victims Compensation Program

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:

  1. 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.

  2. 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.

  3. 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.

  4. 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:

  1. inpatient hospital care     

  2. psychiatric hospital care 

  3. medically necessary skilled nursing facility care after a hospital stay           

  4. home health care

  5. hospice care                                                                    

Medicare B (Medical Insurance) is a voluntary program with a requirement to pay a monthly premium.  It helps pay for:

  1. doctor’s services

  2. outpatient hospital services

  3. 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:

  • birth or baptismal certificate recorded before your fifth birthday

  • Other proof of age documents may be substituted ONLY if these are not available

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
 

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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:

  1. The Healthy Horizons Categorically Needy Program: pays medical benefits including prescriptions, doctor or clinic visits, dental and eye coinsurance.

  2. The Healthy Horizons Medicare Cost-Sharing Program: pays only Medicare premiums and Part A and B  deductibles and coinsurance (QMB).

  3. 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:

  1. Group Health Insurance Continuation- conversion or continuation of an employer-provided policy.

  2. Long-Term Care Insurance – pays cash amounts for care received in a nursing facility or in your home.

  3. Hospital Indemnity Policies - pays cash amounts for each day of inpatient hospital services.

  4. 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:
  1. 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.

  2. 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.

  3. Assessment of need for and provision of services and care management to persons over the age of 18 considering nursing facility care.

  4. 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.

  5. The nursing facility assessment also includes screening for mental illness, mental retardation and other related conditions, and the assessment of need for specialized services.

  6. 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. 
 
Contact: Your local Area Agency on Aging.

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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.
  1. 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.

  2. Determined financially eligible for Medicaid nursing facility payments but chooses community services.

  3. 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:
  1. Helps mentally and/or physically challenged adults to maintain or improve their level of functioning in order to remain in the community.

  2. 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.

  3. 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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All rights reserved.  This page was last updated August 06, 2004.
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