Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, March 24, 1993 TAG: 9303240015
SECTION: NATIONAL/INTERNATIONAL PAGE: A-4 EDITION: METRO
SOURCE: Associated Press
DATELINE: WASHINGTON LENGTH: Medium
HEALTH AID NOT REACHING SENIORS
Nearly half of the nation's poorest senior citizens are not taking advantage of a government program that pays their out-of-pocket medical expenses, a health advocacy group said.A study concluded that complicated application forms - such as Michigan's 27-page version - discourage seniors and disabled Americans from seeking benefits.
Families USA found that 4.25 million seniors and disabled Americans living below the poverty level are eligible for government help to pay out-of-pocket medical bills.
But its study to be released today found that 42 percent, nearly 1.8 million people, have not received benefits, although they have been eligible for assistance for two years or more.
Another 1 million Americans with incomes just above the poverty line became eligible for lesser benefits in January. Families USA said many of them also may not be getting assistance.
"The Medicare buy-in is an unfilled promise," said Ron Pollack, executive director of Families USA. "Now, a million more older Americans are eligible for protection. But we fear that many of them will fall between the cracks rather than actually getting the protection."
Sen. Donald Riegle, D-Mich., chairman of a Senate health subcommittee, said the government has not done enough to publicize the program, created by Congress to help the poorest seniors pay for some medical costs not covered by Medicare.
But Health and Human Services Secretary Donna Shalala told Riegle in a recent letter that her department is "working aggressively to notify and enroll elderly Americans who are eligible."
Riegle said he is concerned that some low-income seniors may delay medical treatment because they cannot afford the out-of-pocket expenses. A hospital stay and a year's worth of co-payments can quickly add up to $1,700, or one-fourth of the income of the poorest seniors.
Medicare requires several out-of-pocket payments, including a $36.60 monthly premium for outpatient and physician coverage that is deducted from a recipient's monthly Social Security check.
Other costs include an annual $100 deductible for physician's fees; a $676 deductible for hospital stays; and co-payments for doctor's fees, hospitalizations over 60 days or nursing home stays longer than 21 days.
The Qualified Medicare Beneficiary program, for which the 4.25 million people are eligible, will pay those costs for seniors and disabled Americans with monthly incomes below $601 for an individual and $806 for a couple. The cost is paid by Medicaid, the joint federal-state insurance program for the poor.
The Specified Low-income Medicare Beneficiary program is aimed at another 1 million seniors just above the poverty line - those with monthly incomes of $601 to $659 for individuals and $806 to $884 for couples.
That program covers the $36.60 monthly premium.
Seniors must apply for the benefits at their local welfare office.
Families USA said the process for seniors may be as daunting as it is in Michigan.
Bernice Weston, a 67-year-old farmer in Westford, Vt., said she "had a devil of a time" applying for assistance and that an advocate for the elderly had to help her.
"I wouldn't have known which route to take," she said.