Medicare Rights Center's Frederic Riccardi trains Lisa Okamoto to help Medicare recipients who call the Center's hotline.

"From an economic and public health perspective it makes sense to have as many people receiving health care as possible."  - Jenny Rejeske, health advocacy coordinator, New York Immigration Coalitio

August 2010

Navigating the Medicare and Medicaid Maze

You shouldn’t have to be a brain surgeon to be able to figure out if you’re covered for brain surgery. Yet millions of elderly and immigrant New Yorkers are unable to understand the complexities of Medicare and Medicaid eligibility, fees, subsidies, premiums, and drug plans. Because of the recent changes in our national health care system, even the agencies these people turn to for help are struggling to best help their clients.

Saving Seniors Money

While Medicare covers a lot, filling pill boxes and paying premiums, deductibles, and coinsurance can mean foregoing dinner or paying rent for many poor and fixed-income seniors in the City. Subsidies and reimbursement programs are available but with a dizzying array of Medicare options, many seniors don’t know about them or need help enrolling. In fact, less than one-half of those eligible have even applied for help. “These programs can save seniors upwards of $5,000 per year, which means a lot, especially when you live on a fixed income,” says Rachel Bennett, program development director at Medicare Rights Center.

Even before federal health reform, few elders understood all of their choices and confusion led to gaps in coverage and increased costs. Last year, The Trust helped the Center streamline its enrollment and counseling services to help more seniors through the financial crisis, many of whom saw their retirement savings plummet. A new grant of $75,000 will help Medicare Rights train staff of elder-serving agencies, including the Isabella Geriatric Center and the Hamilton-Madison House, to help at least 1,000 seniors apply for low-income Medicare programs and appeal when claims are denied. “Medicare Rights’ staff members helped my sister re-enroll in a Medicare Savings Program,” says the family of one client. “The whole process was very daunting, and without their involvement and care, she would have easily lost her benefits.”

Figuring Out Who is Covered and for What

“Will I get deported if I bring my child to the hospital?” “What am I eligible for, and what are my kids eligible for?” “What are my options if I don’t have insurance and I’m undocumented?” “If I’m sponsoring my mother, am I liable for her medical bills?” “Has health care reform changed any of this?”

The staff of immigrant-serving agencies hear these questions all the time—and answering them has never been simple—but with new changes brought about with health care reform, help is needed to make sure staff is giving out the most up-to-date information.

Sorting out what programs are available, and for whom, is no small task. For instance, undocumented immigrants are still not eligible for full-coverage Medicaid, nor are they allowed to buy insurance. However, all immigrant youth under the age of 19, pregnant women, adolescents, and those with medical emergencies can get subsidized medical care.

And while 85 percent of immigrants are legal residents, many of them do not take advantage of the subsidized health care options available. “Many eligible immigrants don’t use available health programs because it’s complicated and confusing, especially for those who don’t speak the language,” says Jenny Rejeske, health advocacy coordinator at the New York Immigration Coalition. “As a result, immigrants in general use the health system at much lower rates than native residents.”

A $140,000 grant will help the Immigration Coalition coordinate efforts to help more eligible immigrants get health care. It will develop materials explaining who is eligible for what types of government insurance. It will also work with nine of the partners, such as Filipino American Human Services and Haitian-Americans United for Progress, to organize fifty community information forums and work with health care providers to ensure that they continue to provide the full range of health services required by State law.

Rejeske continues: “From an economic and public health perspective it makes sense to have as many people receiving health care as possible. Preventive care will save everyone money in the long run, and of course you always want those you work, learn, and commute with to be as healthy as possible.”