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Health Resources for Seniors

How to get the care you need when money is tight

The rising cost of health care, coupled with a troubled economy, means that times are tough for the many older adults who live on a fixed income. Treating a chronic condition, adding a new prescription to your daily regimen or having surgery can lead to financial distress—the last thing you need when you’re trying to stay well.

Here at the Wisconsin Medical Society, the state’s largest association of medical doctors, we care for you and your family in more ways than one. That’s why we’ve assembled this list of resources to help you get the health care you need when you’re on a very tight budget.

Tips for Seniors with Limited Financial Resources

There are many programs designed specifically for seniors, especially seniors in financial distress. Whether you’re looking for a health insurance plan, low-cost prescriptions or simply wondering how to make sense of Medicare, read these tips on getting the care you need without spending a lot of money.

1. Find out which federal and state health care programs you qualify for:
  • Medicare, a federal health insurance program for all Americans who are 65 or older and some people with disabilities.
  • Wisconsin Medicaid, a federal-state partnership that pays for medical services for seniors with limited incomes and/or disabilities.
  • SeniorCare, a prescription drug program for Wisconsin residents who are 65 or older.
  • The Wisconsin Chronic Disease Program, a program that provides assistance to Wisconsin residents with chronic renal disease, hemophilia or adult cystic fibrosis.
  • Family Care, a state program that provides services such as nursing, personal care and housekeeping in your home or residential-care facility.
To find out if you are eligible for these programs, visit ACCESS, the Wisconsin Department of Health Services’ online screening tool, or call 800.362.3002.

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2. Learn how to navigate Medicare Part D, the federal government’s prescription drug program for seniors.

Though it’s designed to help seniors pay for prescription medications, Medicare Part D doesn’t cover everybody who’s age 65 or older. At the moment, the program covers each Medicare patient’s drug expenses up to a certain amount ($2,250 per year in 2006), then stops covering them until the number reaches a level the program considers “catastrophic” ($5,100 per year in 2006).

This coverage gap, known as a "donut hole," means that many seniors must pay for 100 percent of their prescription drug costs. Many seniors are covered for a while, then lose this coverage once they need an additional prescription or are diagnosed with a chronic disease. Plus, once this drug coverage is lost, many of these patients stop filling their prescriptions, often resulting in more visits to the doctor and the hospital.

Some health insurance plans offer coverage that fills this hole, but their premiums are typically double those of standard basic plans that offer no donut-hole coverage or only cover generic versions of prescription drugs. A recent article in U.S. News & World Report describes this issue in greater detail.

Moreover, the donut hole issue is just plain confusing for a lot of people. Many ideas are being proposed to fix the problem, so it’s important to stay up-to-date on this issue.

In particular, stay tuned for information about a change in Medicare Part D that will take place January 1, 2010. This change may mean lower drug costs for seniors since they will no longer be paying for the administrative costs of the organizations that sponsor drug plans under Part D.

For more information on Medicare Part D, visit the federal government’s Medicare website and browse its Frequently Asked Questions page, or call 800.MEDICARE (800.633.4227).

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3. Take advantage of other low-cost prescription programs.

In addition to SeniorCare and Medicare Part D, seniors may also be able to participate in discounted or reduced-cost prescription programs offered by pharmacies and pharmaceutical companies.

Many pharmacies operated by large retailers (e.g., Costco, Jewel-Osco, K-Mart Shopko, Sam’s Club, Target, Wal-Mart, Walgreens) offer discounted generic medications or prescription savings programs. Local independently owned pharmacies may also offer similar programs or price matching.

The majority of pharmaceutical companies (e.g., Abbott, AstraZeneca, Eli Lilly, Merck, Novartis, Pfizer, Roche, Wyeth) also offer “prescription assistance programs,” discounts and coupons to help patients. You mayobtain information on such programs by contacting the pharmaceutical companies directly or visiting their websites.

A number of civic organizations, including Lions Club International, also offer programs to help seniors with limited incomes purchase other prescription items such as hearing aids and eyeglasses.

In addition, the Partnership for Prescription Assistance (PPA), RxAssist, NeedyMeds and BenefitsCheckUp all provide free online resources to assist patients in finding a prescription assistance program that will provide them the medications they need for free or at a low-cost. PPA also offers assistance via a toll free phone number (888.477.2669). The call center accepts calls in English, Spanish and about 150 other languages. Patients may call PPA and speak with trained representative that will assist them in determining their eligibility and guide them through the application process.

Note: Many companies provide patients with information on, and assistance with, “prescription assistance programs” for free. E-mails, ads and websites for companies that guarantee free or low-cost prescription drugs for a hefty fee upfront are scams. Information on, and applications for, these programs are available for free. Information on this issue is available from the Federal Trade Commission (FTC).

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4. Find out if you are eligible to receive medical care at a free or reduced-fee health clinic.

Search the Internet for listings of free, reduced-fee and sliding-scale health clinics, then contact clinics in your area for more information.

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5. Stay healthy with good nutrition.

Eating the right amount of nutritious food is an essential part of staying healthy as well. A number of programs to help defray the cost of food are available to seniors. These include: To find out if you are eligible for these programs, visit ACCESS, the Wisconsin Department of Health Services’ online screening tool, or call 800.362.3002.

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6. Ask your doctor’s office or your county’s department on aging for recommendations.

Your doctor’s office may also have helpful tips on how to lower the cost of your prescriptions or lower your medical bills. The Department on Aging located in your county of residence or tribal area may also have suggestions about how to obtain medical care, food and other necessities for a low cost—or for free.

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7. Keep up-to-date on health care resources.

The Wisconsin Department of Health Services has assembled a Health Care Resource Guide for Seniors, as well as a helpful Consumer Guide to Health Care that outlines how to find low-cost medical and dental care, prescriptions and hospitals. It also has tips on dealing with chronic illnesses and specific conditions such as Alzheimer’s disease, diabetes and arthritis.

The nonprofit BenefitsCheckUp program can help you determine which federal and state assistance programs you qualify for, how to obtain low-cost food and prescription medicine, how to make sense of Medicare Part D and more. BenefitsCheckUp was developed by the National Council on Aging and is maintained by this organization as well.

Tips on obtaining health care, medicine and food for people of all ages—especially those who’ve recently lost a job—may be found in the Wisconsin Medical Society’s forthcoming Recession Survival Guide.

Social workers are also available at almost every local hospital and can help you and your family navigate the health care system, make sense of forms you need to fill out, apply for financial assistance and health insurance, access other community health resources and work through difficult emotional issues that may arise during times of physical or financial distress. To locate a social worker at a hospital, ask a doctor, nurse or the hospital’s information desk for assistance.

In addition, stay tuned to this Wisconsin Medical Society web page for more tips and resources on health care for seniors.

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The information provided in this document is provided for informational purposes only. The Wisconsin Medical Society (Society) does not specifically endorse any of the programs, services, companies, organizations or facilities referenced in this document or in the links included in this document. The Society does not testify to, sponsor or endorse the accuracy of the information provided on externally linked pages. The absence of program, service, company, organization or facility from this document does not indicate that such program, service, company, organization or facility is not qualified to provide assistance.