大巴尔的摩华人医生协会大巴尔的摩华人医生协会 THE CHINESE AMERICAN DOCTORS ASSOCIATION OF THE CHINESE AMERICAN DOCTORS ASSOCIATION OF

BALTIMOREBALTIMORE

内容 内容 ContentContent

• 大巴尔的摩华人医生协会大巴尔的摩华人医生协会简介 简介 张斗 张斗 MD PhDMD PhD

• 简介美国的政府医疗 简介美国的政府医疗 (Medicare and Medicaid)(Medicare and Medicaid) 计计划及划及 Howard County Howard County 最新福利医疗计划 最新福利医疗计划 郑雷 郑雷 MD MD

PhDPhD • 简介美国政府医疗宣传资料 简介美国政府医疗宣传资料 唐梅 唐梅 MDMD

• 回答问题回答问题

大巴尔的摩华人医生协会宗旨大巴尔的摩华人医生协会宗旨

• 1) CADAB intends to unite Chinese American 1) CADAB intends to unite Chinese American doctors for a common purpose of promoting doctors for a common purpose of promoting social and professional image of Chinese social and professional image of Chinese American doctors.American doctors.

• 2) CADAB aims to facilitate friendship and 2) CADAB aims to facilitate friendship and exchange of new medical knowledge among exchange of new medical knowledge among its members its members through its activities.through its activities.

• 3) CADAB shall try to assist 3) CADAB shall try to assist member and member and non-membernon-member Chinese American doctors in Chinese American doctors in need.need.

• 4) CADAB shall help to promote the health 4) CADAB shall help to promote the health care awareness in Chinese communities.care awareness in Chinese communities.

大巴尔的摩华人医生协会 大巴尔的摩华人医生协会 (CADAB)(CADAB)April 6, 2008April 6, 2008

简介美国的政府医疗 简介美国的政府医疗 (Medicare and Medicaid)(Medicare and Medicaid) 计划计划

及及 Howard County Howard County 最新福利医疗计划最新福利医疗计划

What Types of Insurance You What Types of Insurance You May Have?May Have?

• Private Insurance (including visitors’ Private Insurance (including visitors’ insurance): e.g. Bluecross/Blueshieldinsurance): e.g. Bluecross/Blueshield

• MedicareMedicare

• MedicaidMedicaid

• Healthy Howard Access Plan Healthy Howard Access Plan (available after July 1, 2008)(available after July 1, 2008)

What is Medicare?What is Medicare?

• Medicare is health insurance for people Medicare is health insurance for people age 65 or older, under age 65 with certain age 65 or older, under age 65 with certain disabilities, and any age with permanent disabilities, and any age with permanent kidney failure (called “End-Stage kidney failure (called “End-Stage RenalDisease”).RenalDisease”).

• Medicare hasMedicare has– Part A (Hospital),Part A (Hospital),– Part B (Medical),Part B (Medical),– Part C (Medicare Advantage Plans, like HMOs Part C (Medicare Advantage Plans, like HMOs

and PPOs)and PPOs)– Part D (Medicare prescription drug coverage).Part D (Medicare prescription drug coverage).

Medicare Part AMedicare Part A

• Cover: inpatient care in hospitals, skilled Cover: inpatient care in hospitals, skilled nursing facilities, hospice care, qualified nursing facilities, hospice care, qualified home health care.home health care.

• Do not cover: custodial or long-term care. Do not cover: custodial or long-term care.

• Cost: No monthly payment for people who Cost: No monthly payment for people who or whose spouse paid Medicare taxes while or whose spouse paid Medicare taxes while working. If you are 65 or over and have not working. If you are 65 or over and have not worked long enough to receive free worked long enough to receive free Medicare Part A, you may be able to buy it.Medicare Part A, you may be able to buy it.

Medicare Part B Medicare Part B • Cover: medical services like doctors’ services, Cover: medical services like doctors’ services,

outpatient care, some preventive services, and outpatient care, some preventive services, and other medical services that Part A doesn’t cover. other medical services that Part A doesn’t cover.

• Do not cover: cosmetic surgery, health care you get Do not cover: cosmetic surgery, health care you get while traveling outside of the United States (except while traveling outside of the United States (except inlimited cases), hearing aids, most hearing exams, inlimited cases), hearing aids, most hearing exams, long-term care (like care in a nursing home), most long-term care (like care in a nursing home), most eyeglasses, and more. eyeglasses, and more.

• Cost: Part B is optional. Cost: Part B is optional. Most people pay the standard Part B premium ($93.50 in Most people pay the standard Part B premium ($93.50 in

2007). 2007). You are usually charged a fee for each health care service You are usually charged a fee for each health care service

or supply you get. For some services, you will pay an or supply you get. For some services, you will pay an amount called a deductible before Medicare pays its part. amount called a deductible before Medicare pays its part.

Then, when you get a Medicare-covered medical supply or Then, when you get a Medicare-covered medical supply or service, Medicare pays its share, and you pay your share, service, Medicare pays its share, and you pay your share, called the coinsurance or a copayment. called the coinsurance or a copayment.

Part C: Medicare Advantage Part C: Medicare Advantage Plans = private insurance-like Plans = private insurance-like Medicare Medicare • Cover: All Part A and Part B Cover: All Part A and Part B

coverage, Part D drug coverage, and coverage, Part D drug coverage, and extra benefits like those you get from extra benefits like those you get from private insurance.private insurance.

• Cost: Monthly premium generally Cost: Monthly premium generally higher than Part B. Costs vary by higher than Part B. Costs vary by plan and the services you use. plan and the services you use.

Medicare Part D: Prescription Medicare Part D: Prescription Drug Coverage Drug Coverage • Cover: help lower prescription drug costsCover: help lower prescription drug costs• Cost: Part D is optional. Cost: Part D is optional.

Monthly premium varies by plans. Monthly premium varies by plans. Deductibles also vary by plan. No Medicare drug plan may Deductibles also vary by plan. No Medicare drug plan may

have a deductible more than $265 in 2007. have a deductible more than $265 in 2007. After you have paid the deductible, you pay the same After you have paid the deductible, you pay the same

copayment (a set amount) or coinsurance (a percentage copayment (a set amount) or coinsurance (a percentage of the cost) for any prescription. of the cost) for any prescription.

Some Medicare drug plans have a coverage gap. You Some Medicare drug plans have a coverage gap. You reach the coverage gap when you and your Medicare reach the coverage gap when you and your Medicare drug plan have spent a certain amount of money for drug plan have spent a certain amount of money for covered drugs. While you are in the coverage gap, you covered drugs. While you are in the coverage gap, you have to pay all costs for your drugs. For plans with a have to pay all costs for your drugs. For plans with a coverage gap, the most you will ever have to pay out-of-coverage gap, the most you will ever have to pay out-of-pocket before you are out of the coverage gap is $3,850 pocket before you are out of the coverage gap is $3,850 (in 2007). (in 2007).

Where can I get more Where can I get more information?information?

• www.medicare.gov www.medicare.gov

• 1-800-MEDICARE (1-800-633-4227) 1-800-MEDICARE (1-800-633-4227)

What is Medicaid? What is Medicaid?

• Medicaid (also called Medical Assistance) is a Medicaid (also called Medical Assistance) is a program that pays the medical bills of people who program that pays the medical bills of people who have low income and cannot afford medical care. have low income and cannot afford medical care.

• Cover:Cover:– Health insuranceHealth insurance– Long-term care for older (nursing home)Long-term care for older (nursing home)– Supplemental coverage for low-income Medicare Supplemental coverage for low-income Medicare

beneficiaries (e.g., payment of Medicare premiums, beneficiaries (e.g., payment of Medicare premiums, deductibles, and cost sharing). deductibles, and cost sharing).

• Medicaid is a joint federal and state program. Each Medicaid is a joint federal and state program. Each state establishes its own eligibility standards, state establishes its own eligibility standards, benefits package, provider requirements, payment benefits package, provider requirements, payment rates, and program administration under broad rates, and program administration under broad federal guidelines. federal guidelines.

You must be…… to get You must be…… to get Medicaid Medicaid • A resident of MarylandA resident of Maryland• And a U.S. citizen or green carder holder And a U.S. citizen or green carder holder • And have lived in the United States as a qualified And have lived in the United States as a qualified

alien for at least 5 yearsalien for at least 5 years• And one of the followings: And one of the followings:

At least 65 years oldAt least 65 years old DisabledDisabled BlindBlind Under 21 years oldUnder 21 years old Caring for a related child in your homeCaring for a related child in your home PregnantPregnant The parents of an unmarried child under 21. The parents of an unmarried child under 21.

• And have low incomeAnd have low income

How much money can I How much money can I have and be eligible for have and be eligible for Medicaid?Medicaid? Family SizeFamily Size Countable Monthly IncomeCountable Monthly Income Countable Countable

AssetsAssets

11 $ 350$ 350 $ 2,500$ 2,500

22 $ 392$ 392 $ 3,000$ 3,000

33 $ 434$ 434 $ 3,100$ 3,100

44 $ 475$ 475 $ 3,200$ 3,200

55 $ 521$ 521 $ 3,300$ 3,300

66 $ 573$ 573 $ 3,400$ 3,400

(This is sample information. For updated information, please call (This is sample information. For updated information, please call Maryland State Department of Health or visit its website.)Maryland State Department of Health or visit its website.)

Can I have both Medicaid and Can I have both Medicaid and Medicare at the same time?Medicare at the same time?

• Yes if you are qualified for both.  Yes if you are qualified for both.  • Medicaid program will pay your monthly Medicaid program will pay your monthly

Medicare Part B premiums for you.Medicare Part B premiums for you.• Medicaid will also pay your Medicare co-Medicaid will also pay your Medicare co-

payments and deductibles.  payments and deductibles.  • If you are 65 or over and have not worked If you are 65 or over and have not worked

long enough to receive free Medicare Part long enough to receive free Medicare Part A, the Medicaid program will also pay the A, the Medicaid program will also pay the Medicare Part A premium.  Medicare Part A premium. 

What will I need to do when I What will I need to do when I apply?apply?

• you must go to the you must go to the Local Department Local Department of Social Servicesof Social Services in the city or county in the city or county where you live. where you live.

• You will be interviewed by an eligibility You will be interviewed by an eligibility worker who will ask for information worker who will ask for information about your income, assets, and private about your income, assets, and private health insurance coverage.  You will be health insurance coverage.  You will be asked to prove what you say is true. asked to prove what you say is true. 

Where can I find information Where can I find information for Maryland State Madicaid?for Maryland State Madicaid?

• For more information about For more information about Medicaid and other Medical Care Medicaid and other Medical Care Programs:Programs:

(410) 767-5800(410) 767-5800

(410) 767-5503(410) 767-5503

1 (800) 492-52311 (800) 492-5231

1 (800) 445-11591 (800) 445-1159

www.dhmh.state.md.uswww.dhmh.state.md.us

What will soon be available to you What will soon be available to you if you are not qualified for if you are not qualified for

Medicare and you have been legal Medicare and you have been legal US resident for less than 5 years US resident for less than 5 years

(so, not qualified for Medicaid), but (so, not qualified for Medicaid), but have been a resident of Howard have been a resident of Howard

County for at least one year on by County for at least one year on by July 1, 2008?July 1, 2008?

Healthy Howard Access Healthy Howard Access PlanPlan

To qualify you mustTo qualify you must

• be a legal United States resident be a legal United States resident

• a resident of Howard County for at a resident of Howard County for at least one year least one year

• make 300 percent of poverty level or make 300 percent of poverty level or below below

• have been without insurance for one have been without insurance for one year year

Major Coverage and CostMajor Coverage and Cost

• Primary Care Visits: 6 visits to primary care physician Primary Care Visits: 6 visits to primary care physician at Chase Brexton. Pay $ 50-85 monthly fee.at Chase Brexton. Pay $ 50-85 monthly fee.

• Diagnostic Lab & X-ray: 100% provided with referral Diagnostic Lab & X-ray: 100% provided with referral if performed at HCGH, Quest or by arrangement if performed at HCGH, Quest or by arrangement through Chase Brexton.through Chase Brexton.

• Outpatient Prescription Drugs: 100% provided when Outpatient Prescription Drugs: 100% provided when prescriptions are filled at Chase Brexton. $10 fee per prescriptions are filled at Chase Brexton. $10 fee per prescription, not to exceed $20 per month for all Rx. prescription, not to exceed $20 per month for all Rx. $30 fee for three-month supply of maintenance $30 fee for three-month supply of maintenance drugs.drugs.

• Inpatient care, Anesthesia and Inpatient Surgery: Inpatient care, Anesthesia and Inpatient Surgery: 100% provided for ≤ 300% FPL. Only at HCGH; not 100% provided for ≤ 300% FPL. Only at HCGH; not provided at other facilities.provided at other facilities.

Important InformationImportant Information

• Enrollment starts on July 1, 2008. The Enrollment starts on July 1, 2008. The first year will enroll 2,000 people.first year will enroll 2,000 people.

• Health care will be available October 1, Health care will be available October 1, 2008.2008.

• For more information call the information For more information call the information hotline at hotline at 410-313-HELP410-313-HELP (4357) (4357)

• http://www.howardcountymd.gov/http://www.howardcountymd.gov/Health/HealthMain/Health/HealthMain/Health_HHAccessPlan.htm Health_HHAccessPlan.htm

Help with prescriptionsHelp with prescriptions

• Wal-Mart $4 PrescriptionsWal-Mart $4 Prescriptionshttp://http://www.walmart.comwww.walmart.com/pharmacy/pharmacy

• The Bristol-Myers Squibb Patient Assistance The Bristol-Myers Squibb Patient Assistance FoundationFoundation

http://http://www.bmspaf.orgwww.bmspaf.org//• Rx Outreach Patient Assistance ProgramRx Outreach Patient Assistance Program

http://www.rxoutreach.com/rxoutr/Default2.aspxhttp://www.rxoutreach.com/rxoutr/Default2.aspx• Partnership for Prescription AssistancePartnership for Prescription Assistance

https://www.pparx.org/Intro.phphttps://www.pparx.org/Intro.php

If you are not qualified for any of these If you are not qualified for any of these health plans and you don’t afford health plans and you don’t afford private insurance, ……private insurance, ……

• Go to emergency rooms if you have Go to emergency rooms if you have urgent illness. You will be treated urgent illness. You will be treated equally as those who have insurance. equally as those who have insurance.

• Ask help from patient financial Ask help from patient financial assistants and social workers in the assistants and social workers in the hospital. hospital.

Questions?Questions?

• Please visit or call your health Please visit or call your health department offices or visit their department offices or visit their official websites for updated official websites for updated information. information.