Federal Programs For Older Persons

Federal Programs For Older Persons
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FEDERAL PROGRAMS FOR OLDER PERSONS
The purpose of this guide is to provide an overview of the various federal programs
and services available to older persons. It is not an exhaustive list, but rather is meant to
provide information on the more significant current programs. In addition to these programs,
there are others, which, although not limited to the elderly, provide them with important
benefits.
New laws amending old programs or laws creating new ones may affect the accuracy
of the information contained in this publication once it is released. Also, telephone numbers
and addresses are subject to change. Please keep this in mind as you read this guide.
We urge you to contact your local Area Agency on Aging/Aging & Disability Resource
Connection (ADRC) at 1-877-222-3737 for additional information and assistance. For your
convenience, a list of Area Agencies on Aging/ADRCs is included with this guide.
We hope this information proves helpful.
i
FEDERAL PROGRAMS FOR OLDER PERSONS
- TABLE OF CONTENTS INTRODUCTION
OLDER AMERICANS ACT........................................................................
FEDERAL CITIZEN INFORMATION CENTER.....................................……...
1
1-2
EMPLOYMENT
Senior Community Service Employment Program (SCSEP)................……...
2
Employment and Training (One-Stop Career System)...............…...............
3
HEALTH AND INSURANCE PROGRAMS
MEDICARE..........................................................................................
3
Original Medicare.........................................................……...................
4
Medicare Options.................................................................……...
4
The Center for Medicare and Medicaid Innovation...........................……...
4
Medicare Health Plans Demonstrations/Pilot Programs...................……...
Medigap Insurance...............................................................……...
4-5
5
Medicare Enrollment Periods
Medicare Enrollment Period Options...........................................……...
6
New 5-Star Special Enrollment Period.........................................……...
6
Annual Enrollment Period (AEP) (Medicare Fall Open Enrollment)..................
7
Initial Coverage Enrollment Period (ICEP).....................................……...
7
Initial Enrollment Period for Part D (IEP for Part D)...........................……...
7
Medicare Advantage Disenrollment Period (MADP).........................……...
8
Special Enrollment Period (SEP)...............................................……...
8
Medicare Hospital Insurance Program (Part A)
Medicare Part A...................................................................……...
8
HEALTH AND INSURANCE PROGRAMS, cont.
Hospital Premium.................................................................……...
9
Part A Late Enrollment...........................................................……...
9
Benefit Periods....................................................................……...
9
Inpatient Hospital Deductible/Co-Payments..................….............…...
9-10
Skilled Nursing Facility Care...................................................……...
Home Health Care...........................................................……...
10-11
Hospice Care.....................................................................……...
Patients' Rights, HQSI, Quality of Care Complaints....................……...
10
11
11-12
Hospital Discharge..............................................................……...
12
Information, Complaints.........................................................……...
12
Medicare Medical Insurance Program (Part B) ............................................
12
Deductible/Limiting Charge.....................................................……...
13
Medicare Mental Health Services.............................................……...
13
Transplant Services.............................................................……...
13
Medicare Prescription Drug Coverage (Part D)..............................……...
14-15
Medicare Prescription Drug Coverage (Part D) Gap........................……...
15-16
Medicare Prescription Drug Catastrophic Coverage...........................……...
16
Medicare’s Low-performing Prescription Drug Plans..........................……...
17
Medicare Rules for the Special 5-Star Plans.....................................……...
17
Medicare Extended Coverage For Additional Medical Treatments and Devices
Airway Pressure Device.......................……....................................
18
Ambulatory Blood Pressure Monitoring.......................................……...
18
Chiropractic Coverage......................…....................................…...
18
ii
HEALTH AND INSURANCE PROGRAMS, cont.
Eyeglasses......................….................................................…...
18
Foot Care.........................................................................……...
18
Therapeutic Footwear...........................................................……...
18
Medicare Preventive Services.................................................................
19
Medicare-Covered Preventive Services (NO Coinsurance or Deductible)
Abdominal Aortic Aneurysm (AAA/ADRC) Screening......................……...
19
Alcohol Misuse Counseling............................….........................…...
19
Annual Wellness Visit.......................................................……...
19-20
Bone Mass Measurements.....................................................……...
20
Breast Cancer Screenings...................…...................................…...
20
Cardiovascular Disease Screening & Counseling..........................……...
20
Colorectal Cancer Screening...................................................……...
20
Depression Screening..........................................................……...
21
Diabetes Education..............................................................……...
21
Diabetes Glucose Monitoring..................................................……...
21
Electrocardiogram Screening (EKG)..........................................……...
21
Hepatitis B Shots.................…...............................................…...
21
HIV Screening...................……....................................................
21
Influenza Virus Vaccine...........…..............................................…...
21
Medical Nutrition Therapy..................................................……...
21-22
Obesity Screening and Counseling...........................................……...
22
Pap Test and Pelvic Exam (Cervical and Vaginal Cancer Screening)...….…...
22
Pneumococcal Vaccine.........................................................……...
22
iii
HEALTH AND INSURANCE PROGRAMS, cont.
Preventive Physical Exam (“Welcome to Medicare”)................….......…...
22
Prostate Cancer Screening.....................................................……...
23
Shingles Vaccine................................................................……...
23
Smoking Cessation (Counseling to quit smoking)..................……............
23
STI Screening and Counseling........…..........…..............……............
23
Medicare-Covered Preventive Services WITH Coinsurances or Deductibles
Colorectal Cancer Screening - Barium Enema.................….............…...
23
Glaucoma Screening...............................................................…...
24
Hepatitis B Vaccine..............................................................……...
24
Prostate Cancer Screening.....................................................……...
24
Tetanus Vaccine.................................................................……...
24
Durable Medical Equipment/Supplies (DME) Competitive Bidding................. 24-25
Medicare Part A and Part B Carriers..........................................……...
25
Electronic Handbook (eHandbook)........................................................ 25
Non-Covered Services Medicare Part A and Part B Services.............……...
25-26
Advance Beneficiary Notice (ABN)............................................……...
26
Accountable Care Organizations (ACOs).................................……...
26-27
Medicare Advantage Plans (Part C).......................................................
27-28
Medicare Advantage Health Maintenance Organization (HMO)..............…...
28
Medicare Advantage Preferred-Provider Organization (PPO)...............……... 28
Point of Service (POS) Plans..................................................……...
29
Medicare Advantage Special Needs Plan (SNP)..............…..............…...
29
Medicare Advantage Dual Eligible Special Needs Plan (D-SNP)...............
29-30
iv
HEALTH AND INSURANCE PROGRAMS, cont.
Medicare as Secondary Payer (MSP)........................................……...
30
Original Medicare Appeals.....................................................……...
30
Medicare Fraud and Abuse....................................................……...
31
Medicare Marketing Fraud..................................................……...
31-32
Fighting Medicare Fraud Can Pay............................................……...
33
Senior Medicare Patrol Project (SMP of NJ).................................……...
33
Identity Theft........…….............................................................
33-34
Planning Ahead
Long-Term Care Insurance................................................……...
34-35
Advance Directives..............................................................……...
MyMedicare.gov.............................................................……...
35
35-36
Quality Care finder Tools.......................................................……...
36
Health Records - Electronic and Personal
Electronic Health Records (EHRs)........................................……...
36-37
Personal Health Records (PHRs).............................................……...
37
Electronic Prescribing...............…............................................…...
37
Medicare Savings Programs...............…..........................................…...
37
Specified Low-Income Medicare Beneficiary (SLMB).......................……...
38
Qualified Medicare Beneficiary (QMB)........................................……...
38
Qualifying Individual (QI-1).....................................................……...
38
NJ FamilyCare...............................................................……...
38-39
GROUP HEALTH INSURANCE
Continuing Coverage After Leaving Employment (COBRA)...............……...
39
v
HEALTH AND INSURANCE PROGRAMS, cont.
NJ Protect (Pre-existing Condition Insurance)...........................……...
39-40
Health Coverage Tax Credit................................................……...
40-41
Federally Qualified Health Centers - Medicare (FQHCs)...............……...
41-42
HOUSING
FEDERALLY ASSISTED HOUSING PROGRAMS...........................................
Section 8...........…...........................................................…...
42-43
Section 202...............…........................................................…...
Section 202 Conversion....................................................……...
43
43-44
Reverse Mortgage...............................................................……...
Homeless/Homeless Prevention..........................................……...
42
44
44-45
OTHER FEDERAL HOUSING ASSISTANCE.................................................
45
Public Housing..............….....................................................…...
45
Program Availability, Assistance..............................................……...
45
Housing Lists.....................................................................……...
46
Pet Ownership...................................................................……...
46
ENERGY ASSISTANCE PROGRAMS
Low Income Home Energy Assistance Program (LIHEAP)............……...
46-47
Weatherization Assistance Program..........................................……...
48
INCOME MAINTENANCE
SOCIAL SECURITY..............................................................................
49
Coverage.........................................................................……...
49
Benefit Eligibility.................................................................……...
49
Social Security Protection Act of 2004 (Public Law 108-203)..............……...
49
vi
INCOME MAINTENANCE, cont.
Retirement Age/Benefits....................................................……...
49-50
Delayed Retirement Credit.....................................................……...
50
Earnings Limitations.............................................................……...
50
Social Security Annual Earnings Statement..............................……...
50-51
Direct Deposit....................................................................……...
Social Security Benefit Statement/Taxes.................................……...
51
51-52
Social Security Toll-Free Service..............................................……...
52
Disability Insurance
Eligibility...........................................................................……...
53
Initial Determination of Impairment............................................……...
53
Compassionate Allowances................................................……...
52-53
Further Information..............................................................……...
53
SURVIVORS BENEFITS.........................................................................
53
Lump Sum Death Payment.....................................................……...
53
Information............……...............................................................
53
SUPPLEMENTAL SECURITY INCOME (SSI)................................................
54
Income Limitations...........…....................................................…...
54
Resource Limitations........................................................……...
54-55
Payments.........................................................................……...
55
Applications, Appeals, Information............................................……...
55
RAILROAD RETIREMENT PROGRAM........................................................
55
Annuities......................................................................……...
55-56
Current Connection..............................................................……...
56
vii
INCOME MAINTENANCE, cont.
Spouse Requirements..........................................................……...
Applications, Denials, Appeals.............................................……...
56
56-57
FEDERAL CIVIL SERVICE RETIREMENT.........................................……...
57
PRIVATE PENSIONS..............….....................................................…...
58
Interpretation..............….......................................................…...
58
Termination...............……...........................................................
58
Information, Complaints............….........................................…...
58-59
Age Related Complaints.......................................................……...
Private Welfare Plans...........................................................……...
Pension Counseling and Information Project............................……...
59
59
59-60
NUTRITION
PROGRAMS PROVIDING MEAL SERVICES..........................................…...
60
Congregate or Group Meals...............….....................................…...
60
Home-Delivered Meals......................................................……...
60-61
Privately Funded Programs....................................................……...
61
Additional Information...........................................................……...
61
NUTRITION ASSISTANCE PROGRAMS
Supplemental Nutrition Assistance Program (NJ SNAP).......................……...
61-62
SNAP Fraud.............................................................................……...
62
Senior Farmers’ Market Nutrition Program.....................................................
63
LEGAL
SERVICES AND PROGRAMS................................................................... 63
Legal Services Corporation Act.........……......................................
63-64
viii
LEGAL, cont.
Title XX............................................................................……...
64
The Age Discrimination in Employment Act (ADEA)............................…...
64
Penalties for Employer Violation...............................................……...
65
Filing a Charge...................................................................……...
65
Equal Employment Opportunity Commission (EEOC)................................
65
NJ Division on Civil Rights......................................................……...
65
RECREATION
PARKS AND RECREATION AREAS.........................................................
66
American the Beautiful - National Parks and Federal Recreational Lands
Annual Pass (for the general public)..........................................……...
Senior Pass (For persons age 62 and older).............................……...
66-67
Access Pass (For Blind and Permanently Disabled Persons).......................
Volunteer Pass – Free...............….......................................…...
66
67
67-68
Federal Duck Stamp..............…..............................................…...
68
Golden Eagle Sticker.............…..............................................…...
68
National Parks Located In New Jersey...................................……...
68-69
NJ Senior Citizen Park Pass...................................................……...
69
TAX BENEFITS
Federal Income Tax Benefits..................................................……...
69
Sale of Principal Place of Residence.........................................……...
70
Taxpayer Advocate Service....................................................……...
70
IRS Tax Counseling/Assistance...............................................……...
70
ix
VETERANS' BENEFITS...............................................................……...
71
VA Welcoming Vets Home.....................................................……...
71
Veterans' Pensions..............................................................……...
71
Disability Compensation........................................................……...
71
Medical Care..............….......................................................…...
72
Prescription Drug Coverage...................................................……...
72
Home Loans.........................................................................…...
72
Homelessness...............................................................……...
72-73
Death Benefits...................................................................……...
73
Denial of Benefits................................................................……...
73
Other Services, Benefits........................................................……...
73
Uniformed Services Beneficiaries..........................................……...
73-74
TRICARE For Life........................................................................... 74
Veterans’ Information...........................................................……...
Additional VA Assistance.......…............................................…...
74
74-75
VOLUNTEER OPPORTUNITIES
THE CORPORATION FOR NATIONAL AND COMMUNITY SERVICE (CNCS)........
The National Senior Service Corps - or SENIOR CORPS.............……...
75
75-76
Foster Grandparent Program (FGP)..........................................……...
76
Retired and Senior Volunteer Program (RSVP).............................……...
76
Senior Companion Program (SCP).......................................……...
76-77
Program Availability.............................................................……...
PEACE CORPS..........…...........................................................…...
77
77-78
x
VOLUNT
TEER OPP
PORTUNITIIES, cont.
SCORE PROGRAM
MS......................................……................……...
AMERIC
CORPS...................................................……
…..............……...
78-79
79
VOLUNT
TEERS IN SERVICE TO
T AMERICA (VISTA
A)............................……...
79-80
Appendiix -Area Ag
gencies on Aging/ADR
A
RCs......................................……...
81-82
SUMMA
ARY OF TO
OLL-FREE TELEPHON
T
NE NUMBE
ERS.........................……...
83-86
xi
NEW JERSEY DEPARTMENT OF HUMAN SERVICES
DIVISION OF AGING SERVICES
Who we are
What we do
Whom we serve
The Department of Human Services (DHS) is dedicated to providing quality services
that consistently meet expectations with the goal to protect, assist and empower
economically disadvantaged individuals and families, seniors and people with disabilities to
achieve their maximum potential. We strive to ensure a seamless array of services through
partnerships and collaborations with communities statewide. We seek to promote
accountability, transparency and quality in all that we do.
The New Jersey Division of Aging (DoAS) within DHS administers programs
designed to make it easier for seniors to get the help they need to support their well-being
and maintain themselves in the community for as long as possible with independence,
dignity and choice.
OLDER AMERICANS ACT
The federal Older Americans Act of 1965, as amended sets out policy goals aimed at
improving the lives of individuals 60 and over. It also provides the legislative basis for the
creation of the U.S. Administration on Aging (AoA) within the U.S. Department of Health and
Human Services
The Act establishes authority for grants to State Agencies on Aging. In NJ, the funds
available under the Act are awarded to the Division of Aging Services within the NJ
Department of Human Services. The Division allocates the funds under the Act to the 21
County Area Agencies on Aging/ADRC. Each AAA/ADRC develops and administers an Area
Plan on Aging, which outlines how the funds will be used to provide a comprehensive and
coordinated system of community-based programs to try to assist the needs of the county's
elderly population. Preference is given to those elderly with the greatest economic and social
needs.
Information on local programs funded by the Older Americans Act may be obtained by
contacting your Area Agency on Aging/ADRC at 1-877-222-3737. (For the addresses of the
Area Agencies on Aging/ADRC in NJ, please see pages 81 and 82).
FEDERAL CITIZEN INFORMATION CENTER
The Federal Citizen Information Center (FCIC) operates a variety of information
channels that provide government information and services to citizens. A direct telephone
line has answers to most of the important questions you may have. For access to the federal
government, they can point you in the right direction and get you on your way with details
about where you need to go and what you need to do depending on your state.
1
Federal Citizen Information Center, cont.
For more information call 1 (800) FED-INFO (1-800-333-4636) or visit the website at
www.usa.gov. Government information is available in Spanish at the Spanish portal to the
U.S. government GobiernoUSA.gov.
EMPLOYMENT
Senior Community Service Employment Program (SCSEP)
The Senior Community Service Employment Program (SCSEP) is authorized under
Title V of the federal Older Americans Act, and administered by the U.S. Department of
Labor. In New Jersey, the Department of Labor and Workforce Development, Division of One
Stop Programs and Services administers the SCSEP statewide program known as
WorkForce 55. The main objective of the WorkForce 55+ is to bring together the talents of
older workers and the unmet needs of communities by:

providing income and gainful part-time subsidized work activities for low income older
persons 55 years or older;

demonstrating how low income older workers can help respond to the delivery of their
community's service needs by working in community service jobs; and

transitioning job-ready older persons into quality jobs in private, public and non-profit
sectors through training and job finding assistance.
The focus of WorkForce 55+ is training and transitioning program enrollees into
unsubsidized jobs with private sector and/or public sector employers.
For information on this program contact the Division of One Stop Programs and
Services, NJ Department of Labor and Workforce Development, PO Box 055, Trenton, NJ
08625-0055, telephone 609-943-5107.
2
EMPLOYMENT
Employment and Training (One-Stop Career System)
The One-Stop Career service delivery system promotes universal access to services
and information on services needed to get jobs. The system serves as the single point of
contact for job seekers and employers seeking information about workforce development
activities and access to all local employment and training services. The system allows older
workers outside of the Senior Community Service Employment Program (SCSEP) to gain full
access to all services provided through the local workforce development network.
There are local One-Stop Career Centers in every county in NJ. In addition an on line
job search engine, Jobs4Jersey’s on Ramp has been added to help guide job-seekers to
some of New Jersey’s online tools for finding work, finding skilled employees and connecting
to the many programs established to aid businesses and workers alike.
On line assistance is available at Jobs4Jersey.com. For more information contact the
Division of One Stop Programs and Services, NJ Department of Labor and Workforce
Development, PO Box 055, Trenton, NJ 08625-0055, telephone 609-292-5005 or call ADRC
toll-free at 1-877-222-3737.
HEALTH AND INSURANCE PROGRAMS
MEDICARE
Medicare insurance is generally available to the following: Individuals 65 or older, if
they are eligible for, or are receiving, Social Security or Railroad Retirement benefits;
individuals (any age) who have received Social Security disability benefits for at least 24
months; individuals (any age) who have permanent kidney failure; and certain government
employees whose work has been covered for Medicare purposes. Contact should be made
with Social Security (1-800-772-1213, www.ssa.gov) to obtain further information regarding
eligibility and enrollment.
3
HEALTH AND INSURANCE PROGRAMS
Original Medicare - Under Original Medicare beneficiaries receive health benefits
under Part A (hospital insurance) and Part B (medical insurance). They generally can go to
any doctor, specialist or any hospital that accepts Medicare patients. You must pay a
monthly Part B premium which is usually taken out of your monthly retirement payment. You
are also responsible for a Part A deductible, and a Part B deductible before Medicare
begins to pay. After Medicare pays 80% of the allowed amount for covered medical services,
you will also be responsible for a 20% coinsurance and any remaining Medicare Part B
deductible.
Medicare Options - When you are eligible for Medicare, you will be in Original
Medicare unless you choose one of the other Medicare options. In New Jersey you have
options on how you receive your Medicare coverage: Original Medicare, Medicare Advantage
Health Maintenance Organization, Medicare Advantage Preferred Provider Organization PPO (Point of Service - POS) or a Medicare Advantage Special Needs.
No matter which option you choose, you have Medicare.
The Center for Medicare and Medicaid Innovation - The Innovation Center is a new
initiative to introduce and encourage the adoption of practices that provide better health care,
better health and reduce the national cost of healthcare and lower out-of-pocket expenses
through continuous improvement. These projects validate research and demonstration
findings and help monitor program effectiveness. New models of care and payment that
improve the heath care system are encouraged and adopted for achieving a reformed health
care delivery system.
Medicare Health Plans Demonstrations/Pilot Programs – Demonstrations/pilot
programs (“research studies”) usually operate for a limited time for a specific group of people
and/or are offered only in specific areas. These special projects test improvements in
4
HEALTH AND INSURANCE PROGRAMS
Medicare Health Plans Demonstrations/Pilot Programs, cont.
Medicare coverage, payment and quality of care. Check with the demonstration or pilot
program about how it works availability and additional information.
For more information about Medicare demonstrations and pilot programs, call
1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048.
Medigap Insurance– Medigap is private insurance that is designed to help pay
deductibles and coinsurance amounts for Original Medicare - Parts A and B. These policies
are also called supplement policies and only work with Original Medicare. You will have to
pay a premium for your Medigap policy and you must continue to pay the monthly Part B
premium. The standard Medigap policies offer different combinations of benefits that fill
different gaps in Original Medicare. The benefits for each plan are the same no matter which
company offers them, but Insurance companies may charge different premiums for the same
exact policy. For a period of six months from the date you are first enrolled in Medicare Part
B and are age 65 or older, you have a right to buy the Medigap policy of your choice. Once
this Medigap "open enrollment" period ends, your option to buy a Medigap policy may be
limited and it may cost more. You will have special rights to buy a Medigap policy if you
return to Original Medicare within 12 months of joining. Medigap supplement policies are
“guaranteed renewable”. The policy cannot be cancelled or non-renewed for any reason
except non-payment of premium. Federal law does not require insurance companies to sell
Medigap policies to people under 65 but the state of New Jersey does require Medigap
insurance companies to sell certain Medigap policies to you, even if you are under age 65.
5
HEALTH AND INSURANCE PROGRAMS
Medicare Enrollment Periods
The Medicare enrollment periods have been changed. The open enrollment period
begins and ends earlier and a new special enrollment period has been added. During the Fall
Open Enrollment you can change how you receive your health coverage and add change or
drop drug coverage. You can make as many changes as you want. The last change that is
made is the one that will take effect. Changes made during the Fall Open Enrollment take
effect January 1. During the special enrollment you can switch to a Medicare Advantage Plan
(like an HMO or PPO) or Medicare Prescription Drug Plan that has a 5-star rating at any time
during the year.
No one should call you or come to your home uninvited to sell Medicare products. If
you believe you have been given incorrect information call 1-800-MEDICARE (1-800-6334227), TTY users should call 1-877-486-2048.
Medicare Enrollment Period Options
The enrollment periods during which individuals may make enrollment requests are:
New 5-Star Special Enrollment Period – A new Special Enrollment Period (SEP)
was created in 2012 that you can use at any point in the year to enroll in a Medicare
Advantage plan or stand-alone part D plan with a five-star rating. Medicare health and
prescription drug plans get an overall rating reviewed annually that summarizes all categories
and measures into a single “star” rating. A plan can get ratings between one and five stars
with a 5-star rating considered excellent, 5  Excellent, 4  Above Average, 3
, Average, 2  Below Average, 1  Poor. A five star plan rating does not mean it is
the best option for you. Think about how the plan will affect your prescriptions and other
health benefits if you have a Medicare Advantage plan or retiree coverage.
6
HEALTH AND INSURANCE PROGRAMS
Medicare Enrollment Periods, cont.
Annual Enrollment Period (AEP) (Medicare Fall Open Enrollment) – The Medicare
AEP is from October 15 through December 7. Eligible individuals can enroll in or disenroll
from a Medicare Advantage (MA) plan. The open enrollment dates have changed to give you
more time if you want to choose and join a Medicare Advantage plan. Your coverage will
begin on January 1, as long as the plan gets your request by December 7.
This may be the one chance you have each year to make a change to your health and
prescription drug coverage.
Initial Coverage Enrollment Period (ICEP) – ICEP is the period an individual newly
eligible for MA may make an initial enrollment request to enroll in an MA plan. This period
begins three months before the individual’s first entitlement to both Medicare Part A and Part
B and ends on the last day of the month preceding entitlement to both Part A and Part B, or
the last day of the individual’s Part B initial enrollment period, whichever is later. The initial
enrollment period for Part B is the seven (7) month period that begins three months before
the month an individual meets the eligibility requirements for Part B, and ends three months
after the month of eligibility. If you enroll in Part A and/or Part B the month you turn 65 or
during the last 3 months of your initial Enrollment Period, your start date will be
delayed.
Initial Enrollment Period for Part D (IEP for Part D) – IEP for Part D is the period
during which an individual is first eligible to enroll in a Part D plan. An individual is eligible to
enroll in a Part D plan when he or she is entitled to Part A or is enrolled in Part B, and
permanently resides in the service area of a Part D plan. During the IEP for Part D,
individuals may make one Part D enrollment choice, including enrollment in an MA-PD plan.
7
HEALTH AND INSURANCE PROGRAMS
Medicare Enrollment Periods, cont.
Medicare Advantage Disenrollment Period (MADP) – MADP is the period people
may disenroll from a Medicare private health plan, also known as a Medicare Advantage plan
and return to Original Medicare. If you switch to Original Medicare during this period, you will
have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage.
Your coverage will begin the first day of the month after the plan gets your enrollment form.
During this new enrollment period January 1 to February 14 you cannot do the
following:

Switch from Original Medicare to a Medicare Advantage Plan.

Switch from one Medicare Advantage Plan to another.

Switch from one Medicare Prescription Drug Plan to another.

Join, switch, or drop a Medicare Medical Savings Account Plan.
Special Enrollment Period (SEP) – SEP is a period outside of the usual IEP, AEP or
MADP when an individual may elect a plan or change his or her current plan election. There
are various types of SEPs, including SEPs for dual eligibles, for individuals whose current
plan terminates, who change residence and who meet “exceptional conditions”. An individual
must also meet all applicable MA eligibility criteria.
Medicare Hospital Insurance Program (Part A)
Medicare Part A - the premium free Hospital Insurance Program, helps pay for four
kinds of medically necessary care: (1) inpatient hospital care; (2) some inpatient care in a
skilled nursing facility following a hospital stay; (3) home health care; and (4) hospice care.
Part A is free for most people.
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Medicare Hospital Insurance Program (Part A), cont.
Hospital Premium - Premium-free Medicare Hospital Insurance (Part A) is generally
available to individuals who are eligible for Medicare. Individuals age 65 and older who are
U.S. citizens and residents and who have not worked long enough to qualify for premium-free
Part A may buy Medicare coverage. There is a monthly premium and possibly a
surcharge for late enrollment. Aliens 65 or over who are U.S. residents and who have
been lawfully admitted for permanent residence and have resided in the U.S. for at least five
years at the time of filing may also be eligible to purchase both Part A and Part B, or just Part
B. If you are not sure you qualify for premium-free Part A, you should contact your local
Social Security Office, or call Social Security at 1-800-772-1213 or visit the Medicare website
at www.medicare.gov regarding your eligibility to enroll and the amount of the monthly
premium for Part A coverage that you would be required to pay.
Part A Late Enrollment - If you are eligible for premium-free Part A and do not enroll
when you are first eligible, your monthly premium may go up 10%. You will have to pay the
higher premium for twice the number of years you could have had Part A, but did not sign-up.
Benefit Periods - When you are admitted to a hospital or skilled nursing facility,
Medicare Part A pays benefits based on benefit periods. A benefit period begins the first day
you receive a Medicare covered service in a hospital or skilled nursing facility (SNF) and ends
when you have been out of a hospital or SNF for 60 consecutive days. If you enter a hospital
or SNF again after 60 days, a new benefit period begins. All Part A benefits, except for any
lifetime reserve days used, are renewed.
Inpatient Hospital Deductible/Co-Payments - Part A pays for all covered services for
the first 60 days of inpatient hospital care in a benefit period, except for the Part A deductible.
For the 61st-90th day, Part A pays for all covered services except for the per day
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Inpatient Hospital Deductible/Co-Payments, cont.
coinsurance. You pay all costs for each day after day 100 in a benefit period.
Every person enrolled in Part A also has a lifetime reserve of 60 days for inpatient
hospital care. These days may be used whenever more than 90 days of inpatient hospital
care are needed in a benefit period. While reserve days are being used, Part A pays for all
covered services except for a per day coinsurance for each "reserve day". Once used,
reserve days are not renewable. Deductibles/coinsurance amounts change annually.
Skilled Nursing Facility Care - Medicare Part A can help pay for medically
necessary inpatient care in a Medicare-participating skilled nursing facility following a
minimum three-day hospital stay. If your stay in a skilled nursing facility is covered by
Medicare, Part A helps pay for a maximum of 100 days in each benefit period, but only if
you need daily skilled nursing care or rehabilitation services for that long. Very specific
conditions must be met for you to qualify for skilled nursing facility care. Any service that
could be safely performed by an average non-medical person (or one’s self) without the direct
supervision of a licensed health care professional is not covered. In each benefit period, Part
A pays for all covered services for the first 20 days you are in a skilled nursing facility. Part A
pays for all covered services except for the per day coinsurance for days 21 through 100
which is the responsibility of the beneficiary.
If you have questions about what specific conditions must be met for you to qualify for
skilled care, please contact Medicare toll-free at 1-800-MEDICARE (1-800-633-4227).
Home Health Care - Part A pays the approved cost of medically necessary home
health visits for homebound beneficiaries who are ill or injured and require intermittent (parttime) skilled nursing services or skilled therapy. The beneficiary must be homebound and
receive home health services from a Medicare approved home health agency.
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Home Health Care, cont.
If you have questions about home health care and conditions of coverage, or to order a
pamphlet on this topic, call Medicare at 1-800-Medicare (1-800-633-4227).
Hospice Care - Medicare beneficiaries certified as terminally ill may elect to receive
hospice care under Part A instead of regular Medicare. Part A can pay for medical and
support services from a Medicare-approved hospice, drugs for symptom control and pain
relief, short-term respite care, care in a hospice facility, hospital, or nursing home when
necessary, home care and other services not otherwise covered by Medicare. You must
meet certain conditions to qualify for this service.

You pay nothing for hospice care.

You pay a copayment for outpatient prescription drugs

You pay a percentage of the Medicare-approved amount for inpatient respite care.
If you have questions about this service, or to order a pamphlet on this topic, call
Medicare at 1-800-MEDICARE (1-800-633-4227).
Patients' Rights, HQSI, Quality of Care Complaints - Medicare requires that
hospitals supply a statement of patients' rights to Medicare beneficiaries the day they enter
the hospital. In addition, Medicare contracts with Healthcare Quality Strategies, Inc.
(HQSI), an independent physician group, to ensure that beneficiaries receive the best medical
care possible. HQSI offers review of appeals of non-coverage during the hospital stay, and
responds to written complaints concerning quality of care received. Quality of care
complaints must be from Medicare beneficiaries treated in a facility certified by Medicare,
and the services received must be services that normally would be covered by Medicare.
NOTE: Complaints about quality of care include treatment as an inpatient/outpatient in
a hospital, or provision of services of a skilled nursing facility, home health agency,
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Patients' Rights, HQSI, Quality of Care Complaints, cont.
or ambulatory surgical center.
Hospital Discharge - You have the right to get all of the hospital care that you need,
and any follow-up care after you leave the hospital. Before discharge from the hospital,
Medicare patients should request a Discharge Plan from their doctor or hospital social
worker. This plan will specify the proper post-hospital care and treatment. Medicare patients
who feel that the Discharge Plan is unsatisfactory may request to have their case reviewed by
Healthcare Quality Strategies Inc. (HQSI).
Information, Complaints - For more information concerning rights of beneficiaries
under Medicare Part A, contact HQSI during business hours at 1-800-624-4557 or 732-2385570, www.hqsi.org. To file a complaint concerning quality of care, write Healthcare Quality
Strategies, Inc., 557 Cranbury Road, Suite 21, East Brunswick, NJ 08816-4026.
Medicare Medical Insurance Program (Part B)
Medicare Part B medical insurance helps pay for (1) doctor's services; (2) in/outpatient
medical and surgical services and supplies; (3) physical, occupational and speech therapy;
(4) diagnostic tests; (5) durable medical equipment; (6) ambulance services; (7) clinical
laboratory services (blood tests, urinalysis); (8) home health care when Part A does not pay,
and; (9) other health services and supplies which are not covered by Medicare Hospital
Insurance. A monthly premium is charged. A small proportion of people with Medicare
pay extra for their Part B coverage because their annual incomes exceed the established
income guidelines.
Under certain conditions, if you do not enroll for Part B when you are first eligible, you
will not be able to enroll until a general enrollment period and you may have to pay a higher
monthly premium for delaying enrollment.
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HEALTH AND INSURANCE PROGRAMS
Deductible/Limiting Charge - Medicare pays for some of your health care, but not all
of it. When you receive health care services, you will have to pay deductibles and
coinsurance or copayments. You must pay a deductible before Medicare will pay its share. If
a doctor or supplier does not accept the amount Medicare pays for most covered services,
there are limits on the amount that can be charged. The most the doctor or supplier can
charge you is 15% more than the Medicare-approved amount. The limiting charge applies to
certain services and does not apply to some supplies and durable medical equipment.
Medicare Mental Health Services - Medicare’s outpatient mental health service
coinsurance rate of 50% is being gradually reduced to 20%, the same rate that applies to
other types of Medicare outpatient medical care. In 2012 Medicare will pay 60% of its
approved amount for mental health services and you will be responsible for the remaining
40%. Limitation will be reduced incrementally until the limitation percentage of 100% is
reached effective January 1, 2014 when Medicare will pay 80% and the patient will pay 20%.
Transplant Services - Medicare covers doctor services for transplants under certain
conditions and only in a Medicare-certified facility. Medicare benefits may cover
immunosuppressive drugs and help pay for certain oral drugs and treatments. You pay 20%
of the Medicare-approved amount, and the Part B deductible applies.
If you’re thinking about joining a Medicare Advantage Plan check the plan’s coverage
rules for prior authorization before you join and make sure your doctors, other health care
providers and hospitals are in the plan’s network.
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HEALTH AND INSURANCE PROGRAMS
Medicare Prescription Drug Coverage (Part D)
The Medicare prescription drug coverage for Medicare beneficiaries is provided by
private companies whose plans are approved by Medicare. Brand-name and generic
prescription drugs are covered through participating pharmacies.
In the past, many people could not get Medicare coverage for certain anticancer
chemotherapeutic drug regimens because of limitations on what were considered acceptable
uses. Medicare now accepts drugs taken for an off-label use, if they have been included in
approved “compendia” (dictionaries of drugs and their officially recognized uses) and other
peer review medical literature.
Your decision about Medicare prescription drug coverage depends on the kind
of health care coverage you have now.

You must be enrolled in Medicare Part B.

You must sign up when you are first eligible or you may pay a penalty.

To get Medicare prescription drug coverage you can join a Medicare prescription drug
plan, you can join a Medicare Advantage Plan or other Medicare Health Plans that
offer drug coverage.

There are no restrictions due to income and resources, health status, or current
prescription expenses.

If you join, you will pay a monthly premium.

You may be required to pay a yearly deductible, a part of the cost of your prescriptions,
a co payment or coinsurance.

If you have limited income and resources you may qualify for support services from the
New Jersey Department of Human Services.
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Medicare Prescription Drug Coverage (Part D), cont.
Even if you don't use a lot of prescription drugs now, you should still consider enrolling
in a Medicare prescription drug plan. For most people, joining now means protecting yourself
from unexpected prescription drug bills in the future.
Medicare Prescription Drug Coverage (Part D) Gap
Most Medicare prescription drug plans (Part D) have an initial coverage level. You pay
co-payments or coinsurance until your drug costs reach the level limit on what they will cover.
Once you reach your plan’s coverage gap, known as the “doughnut hole,” you get a 50%
discount on covered brand name drugs. In addition to the 50% discount on covered brandname prescription drugs, there will be increasing savings for you in the coverage gap each
year until the gap closes in 2020. You will receive larger discounts on your generic
prescriptions – 14% in 2012, compared to 7% in 2011. If you get Extra Help, you will not
have some of these costs.
Not everyone will enter the coverage gap.
The following items all count toward you getting out of the coverage gap:

Your yearly deductible, coinsurance, and copayments

The discount you get on brand-name drugs in the coverage gap

What you pay in the coverage gap
The drug plan premium and what you pay for drugs that are not covered do not count
toward getting you out of the coverage gap. There are plans that offer additional coverage
during the gap, like for generic drugs. These plans with additional gap coverage may include
additional charges.
Here are some ways you can avoid or delay entering the gap, and continue to save
money on drug costs while in the gap:
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Medicare Prescription Drug Coverage (Part D) Gap, cont.

Consider switching to generic, over-the-counter (OTC), or other lower-cost drugs that
can save you hundreds or thousands of dollars a year.

Use mail-order pharmacies, generic or less-expensive brand-name drugs.

Always use your drug plan card - even in the gap. This ensures that you’ll get the drug
plan’s discounted rates and that the money you spend counts toward your catastrophic
coverage.

Rx4NJ offers comprehensive information on help for free or nearly-free prescriptions
through existing patient assistance programs. For more information on this program
call 1-888-793-6765 or go to www.rx4nj.org.

If you have limited income and resources, you may qualify for extra help paying for
your prescription drugs.
Medicare Prescription Drug Catastrophic Coverage
Most of the Medicare drug plans provide coverage if you have an unexpected illness or
injury (catastrophic) that results in extremely high drug costs. Catastrophic coverage assures
that you only pay a small coinsurance amount or copayment for covered drugs for the rest of
the year.
For more information or to see if you qualify for extra help, contact Social Security by
calling 1-800-772-1213. TTY users should call 1-800-325-0778 or visit
www.socialsecurity.gov or you can call the State Health Insurance Assistance Program
(SHIP) at 1-800-792-8820.
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HEALTH AND INSURANCE PROGRAMS
Medicare’s Low-performing Prescription Drug Plans - Medicare has raised the
standards for Medicare drug plans to improve performance. These new standards focus on
quality, clinical outcomes and process measures. A star rating system is used, with five stars
indicating the highest quality and one star the lowest. Low-performing prescription plans that
score below three stars for three consecutive years will not to be allowed to provide Medicare
Part D prescription drug plans. Medicare uses information from member satisfaction surveys,
plans, and health care providers to give overall performance star ratings to plans. A 5-star
rating is considered excellent. These ratings help you compare plans based on quality and
performance.
Medicare rules for the special 5-Star Plans:

You can only join a 5-star Medicare Advantage Plan if one is available in your area.

You can only use this special enrollment period to switch to a 5-star plan one time
each year.

You may lose your prescription drug coverage if you move from a Medicare Advantage
Plan that has drug coverage to a Medicare Advantage Plan that does not.

If your Medicare Advantage Plan includes prescription drug coverage and you join a
Medicare Prescription Drug Plan, you will be disenrolled from your Medicare
Advantage Pan and returned to Original Medicare.
If you are disenrolled from your Medicare Prescription Drug Plan, you will have to wait
until the next open enrollment period to get drug coverage, and you will have to pay a late
enrollment penalty.
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HEALTH AND INSURANCE PROGRAMS
Medicare Extended Coverage For Additional Medical Treatments and Devices
Airway Pressure Device – Medicare Medical Insurance will routinely cover
continuous positive airway pressure devices (nose masks) used to help control sleep apnea,
a condition that causes some people to stop breathing for brief periods during sleep.
Ambulatory Blood Pressure Monitoring – Medicare will cover this system of blood
pressure monitoring which involves wearing a cuff that automatically records blood pressure
over a 24-hour period. Targeted specifically are those patients with “white coat
hypertension”, a term meaning that just going into a doctor’s office is enough to raise their
blood pressure. Medicare does not cover the purchase of this item for private use.
Chiropractic Coverage - Medicare will cover manual chiropractic manipulation of the
spine and/or physiological function of the spine to correct a subluxation (when one or more of
the bones of your spine move out of position). You pay 20% of the Medicare-approved
amount. You pay all costs for any services or tests ordered by a chiropractor.
Eyeglasses - Medicare doesn’t cover eye exams, eyeglasses or contact lenses.
However, following cataract surgery Medicare can help pay for your first pair of eyeglasses.
Medicare can also cover some types of tints and coatings if your doctor prescribes them. The
suppler will submit the claim to Medicare.
Foot Care - Medicare Part B covers medically-necessary treatment of injuries or
diseases of the foot (such as hammer toe, bunion deformities, and heel spurs), but it doesn’t
cover routine foot care.
Therapeutic Footwear - Medicare Medical Insurance helps pay for fitting and for the
cost of one therapeutic pair of shoes and shoe inserts in a calendar year for beneficiaries who
have severe diabetic disease. The doctor treating the beneficiary under a comprehensive
diabetic care plan must certify the need for the shoes or inserts.
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HEALTH AND INSURANCE PROGRAMS
Medicare Preventive Services
If you have Original Medicare (Parts A & B) you will be able to get an annual wellness
exam and most preventive services for free. The preventive services will include screenings
and counseling for people at risk for chronic diseases. If the doctor or other health care
provider accepts assignment, you will no longer have to pay coinsurance or deductibles, they
have been eliminated. You pay nothing for the preventive visit. If your doctor or other
health care provider performs additional tests or services during the same visit that are not
covered under these preventive benefits, you may have to pay coinsurance, and the Part B
deductible may apply. Medicare will also cover two types of exams—a physical exam when
you are new to Medicare and a wellness visit each year after that.
Medicare-Covered Preventive Services (NO Coinsurance or Deductible)
Abdominal Aortic Aneurysm (AAA/ADRC) Screening - Medicare covers this onetime screening ultrasound if you get a referral for it as a result of your "Welcome to Medicare"
physical exam. You must receive the physical exam and the screening ultrasound referral
(not the ultrasound exam itself) within the first twelve months you have Medicare Part B.
Alcohol Misuse Counseling - Medicare now covers screening and counseling for
alcohol misuse. Medicare will cover one alcohol misuse screening per year for adults with
Medicare who misuse alcohol, but aren’t alcohol dependant and are competent and alert
during counseling. People who screen positive can get up to 4 brief face-to-face counseling
sessions per year. A qualified primary care doctor or other primary care provider must
provide the counseling in a primary care setting.
Annual Wellness Visit - If you have had Part B for longer than 12 months, you can
get an annual wellness visit to develop or update a personalized prevention plan based on
your current health and risk factors. This exam is covered once every 12 months.
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Medicare-Covered Preventive Services (NO Coinsurance or Deductible), cont.
You do not need to get the “Welcome to Medicare” physical exam before getting an
annual wellness visit but your first annual wellness visit cannot take place within
12 months of your “Welcome to Medicare” physical exam.
Bone Mass Measurements - Medicare will provide one bone mass measurement
every two years for beneficiaries at risk for osteoporosis and other bone abnormalities.
These tests which help to identify bone mass, detect bone loss, or determine bone quality will
be provided more frequently if medically necessary.
Breast Cancer Screenings - Medicare Part B Insurance pays for annual breast
cancer screenings/examinations, x-ray screenings and new digital technologies for
mammogram screenings and genetic counseling every 12 months for eligible beneficiaries
age 40 and older and certain women with a family history of breast cancer. Medicare also
pays for diagnostic mammograms as needed when symptoms are present.
Cardiovascular Disease Screening & Counseling - Medicare will cover blood tests
every five years to screen for cholesterol, lipid and triglyceride levels. These tests help detect
conditions that may lead to a heart attack or stroke. Additional cardiovascular disease
preventive services include one-face-to-face visit each year to allow patients and their
providers to determine the best way to help prevent cardiovascular disease. Providers may
screen for hypertension and discuss dietary improvements at these visits.
Colorectal Cancer Screening - Medicare Part B covers an annual screening fecal
occult blood test; a flexible sigmoidoscopy once every 4 years, and a colonoscopy every 10
years for people not at high risk for colorectal cancer and every 2 years if you are at high risk
for colorectal cancer.
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HEALTH AND INSURANCE PROGRAMS
Medicare-Covered Preventive Services (NO Coinsurance or Deductible)
Depression Screening - Medicare covers one depression screening per year for all
people with Medicare. The screening must be done in a primary care setting that can provide
follow-up treatment and referrals. These screenings will not be covered if you are screened
in an emergency room, skilled nursing facility or as a hospital inpatient.
Diabetes Education - Medicare Part B covers a wide range of education and training
to teach diabetics to control their blood glucose levels.
Diabetes Glucose Monitoring - All Medicare beneficiaries with diabetes have
coverage for blood glucose monitors, lancets and testing strips. Every 12 months Medicare
will cover the laboratory tests to screen high-risk individuals for diabetes. The tests will be
provided twice a year if you have been diagnosed with pre-diabetes.
Electrocardiogram Screening (EKG) - Medicare covers a one-time screening EKG if
you get a referral for it as a result of your one-time "Welcome to Medicare" physical exam.
An EKG may also be covered as a diagnostic test.
Hepatitis B Shots - Medicare covers these shots for people at high or medium risk for
Hepatitis B or certain conditions that increase your risk for infection. Other factors may
increase your risk for Hepatitis B, so check with your doctor or other health care provider.
HIV Screening - Medicare covers HIV screening for people with Medicare who are at
increased risk for the infection, pregnant and anyone who asks for the test.
Influenza Virus Vaccine - Medicare Part B will cover an influenza virus vaccine and
its administration. Generally, only one influenza virus vaccination is medically necessary per
year.
Medical Nutrition Therapy - When referred by a doctor, Medicare Part B will cover
medical nutrition therapy to help you learn to eat well so you can better manage your illness.
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HEALTH AND INSURANCE PROGRAMS
Medicare-Covered Preventive Services (NO Coinsurance or Deductible), cont.
Medical nutrition services include nutritional assessment and counseling; an initial visit
for an assessment; and follow-up visit for interventions and reassessments to assure
compliance with the dietary plan. The services must be provided by registered dieticians or
other qualified nutrition professionals.
Obesity Screening and Counseling - Medicare now includes preventive services to
reduce obesity for eligible beneficiaries. Coverage includes screening, counseling,
management and prevention services for beneficiaries who screen positive for obesity based
on their body mass index. These covered services include weekly face-to-face counseling
visits for the first month biweekly visits for an additional five months and monthly visits for an
additional six months for eligible beneficiaries.
Pap Test and Pelvic Exam (Cervical and Vaginal Cancer Screening) - Medicare
Part B pays for "pap smear" screenings and related medically necessary physician services
(including a physician's interpretation of the results of the tests) for female Medicare
beneficiaries. Medicare pays for one screening every two years, or more frequently for
women at high risk for uterine or vaginal cancers.
Pneumococcal Vaccine - Medicare Part B pays the full-approved charges for
pneumococcal vaccine and its administration. Most people need only one shot in their
lifetime. A Medicare certified physician must administer the vaccine.
Preventive Physical Exam (“Welcome to Medicare”) – This is a one-time review of
your health. This doctor visit may include education and counseling about preventive
services, and referrals for other care if needed. Medicare will cover this exam if you get it
within the first 12 months you have Part B. When you make your appointment, let the
doctor’s office know that you would like to schedule a “Welcome to Medicare” physical exam.
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HEALTH AND INSURANCE PROGRAMS
Prostate Cancer Screening - Medicare Part B will cover annual preventive
screenings for prostate cancer for Medicare eligible men aged 50 and older. You pay nothing
for the PSA test, you pay 20% of the Medicare-approved amount, and the Part B deductible
applies for the digital rectal exam.
Shingles Vaccine – Shingles, also called herpes zoster or zoster, is a painful skin
rash caused by the varicella zoster virus. This illness is vaccine-preventable. This vaccine
reduces the risk of shingles in people ages 60 and older. The vaccine will be reimbursed
through the Medicare Part D (Prescription Drug) program. Contact your Part D plan for more
information.
Smoking Cessation (Counseling to quit smoking) - This benefit is designed to help
the patient without smoking-related illnesses quit smoking. This includes tobacco counseling
treatments and other services that can aid in smoking cessation. Smoking cessation drugs
are not covered under this benefit.
STI Screening and Counseling - An annual testing for sexually transmitted infections
for those at increased risk for an STI or those who are pregnant. Medicare also covers up to
two individual counseling sessions with your doctor per year for those meeting certain criteria
Medicare-Covered Preventive Services WITH Coinsurances or Deductibles
Colorectal Cancer Screening - Barium Enema - Once every 48 months if 50 or older
(high risk every 24 months) when used instead of a sigmoidoscopy or colonoscopy. You pay
20% of the Medicare approved amount for the doctor’s services. In a hospital outpatient
setting, you also pay the hospital copayment. You pay 20% before you pay your Part B
deductible.
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HEALTH AND INSURANCE PROGRAMS
Medicare-Covered Preventive Services WITH Coinsurances or Deductibles, cont.
Glaucoma Screening - Medicare Part B covers an annual dilated eye examination for
all people with Medicare at high risk for glaucoma. This includes people with diabetes or a
family history of glaucoma. A licensed eye doctor must provide the screening. You pay 20%
after you pay your Part B deductible.
Hepatitis B Vaccine - Medicare Part B helps pay for Hepatitis B vaccine administered
to beneficiaries considered to be at high or intermediate risk of contracting the disease. A
Medicare certified provider must administer the vaccine. This coverage is subject to regular
Medicare Part B deductible and coinsurance provisions.
Prostate Cancer Screening - Medicare Part B will cover an annual digital rectal
exam. You pay nothing for the PSA test. You pay 20% of the Medicare-approved amount,
and the Part B deductible applies for the digital rectal exam.
Tetanus Vaccine - It is recommended that as a preventive treatment, the vaccine be
given every 10 years for all persons of all ages. If this is a routine tetanus injection you will
have to pay for it, it will not be covered by Medicare. If you have been exposed to a disease
or condition, Medicare will pay for the injection. This coverage is subject to regular Medicare
Part B deductible and coinsurance.
Durable Medical Equipment/Supplies (DME) Competitive Bidding
Under specific guidelines, Medicare Part B helps pay for certain medically necessary
equipment that your doctor prescribes for use in your home, such as oxygen equipment,
wheelchairs and hospital beds. Certain medical supplies are also covered. To ensure that
you get quality equipment, supplies, and services; and help limit fraud and abuse, Medicare is
phasing in a program called “competitive bidding”. Your supplier must have a Medicare
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HEALTH AND INSURANCE PROGRAMS
Durable Medical Equipment/Supplies (DME) Competitive Bidding, cont.
approved number. You must get your equipment, supplies and replacement or repair
services from these specific Medicare-approved suppliers or Medicare will not pay for the
items and you will be responsible for the payment. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies.
Medicare Part A and Part B Carriers - Medicare replaced its private claims payment
contractors for Medicare Part A and Medicare Part B fiscal intermediaries with entities called
Medicare Administrative Contractors (MACs). Railroad Retirement beneficiaries entitled
to Medicare, services will continue to enroll with and bill the contractor designated by the
Railroad Retirement Board. For Medicare Part B carrier information the toll-free telephone
number is 1-800-Medicare (1-800-633-4227). The toll-free telephone for Railroad Retirement
Medicare information is 1-877-772-5772, TTY: 1-312-751-4701. More descriptions of
services covered under Part B can be found in the MEDICARE AND YOU handbook.
Electronic Handbook (eHandbook) - You can choose to receive the annual Medicare
& You handbook electronically (called the eHandbook). You will not receive a copy of the
handbook by mail if you select to receive it electronically. Save tax dollars by signing up to
access future handbooks electronically. Visit www.MyMedicare.gov or telephone toll-free
1-800-Medicare (1-800-633-4227) to request the eHandbook.
Non-Covered Services Medicare Part A and Part B Services
Medicare does not cover everything. In addition to your premiums, deductibles and
coinsurance, Medicare does not cover:

acupuncture

routine dental care and dentures

custodial care (help with bathing, dressing, toileting and eating)
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HEALTH AND INSURANCE PROGRAMS
Non-Covered Services Medicare Part A and Part B Services, cont.

long-term nursing home care for more than 100 days

cosmetic surgery, wigs, hearing aids and routine eye care

hearing aids and exams for fitting hearing aids

routine foot care and therapeutic shoes

most health care outside the United States and its territories
You are always free to get services not covered by Medicare if you choose to pay for a
service yourself.
To find out if Medicare covers a service you need, visit www.medicare.gov/coverage
or call 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.
Advance Beneficiary Notice (ABN) - Medical providers and suppliers are required to
give you an Advance Beneficiary Notice (ABN) with estimated cost when they offer you
service or items that they know or have reason to believe Medicare will not pay for. An ABN
is not an official denial of coverage by Medicare. You should always choose that your doctor
submit the claim to Medicare because Medicare may pay for the services, even if it seems
unlikely and you will also have the option to appeal.
Accountable Care Organizations (ACOs) – A lack of coordination between primary
care physicians, specialists and hospitals has sometimes led to unnecessary tests and
procedures. ACO’s encourage health care providers to communicate more and to work
together so that you get the right care, in the right place at the right time. These groups of
doctors, hospitals, and other health care providers come together voluntarily to give
coordinated high quality care to the Medicare patients they serve. Your doctor may choose to
join an Accountable Care Organization. If your doctor participates in one of these groups,
you will be notified. An ACO will not affect your costs, benefits or coverage. Your Medicare
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HEALTH AND INSURANCE PROGRAMS
Accountable Care Organizations (ACOs), cont.
benefits stay the same. You can still choose and see any doctor who accepts Medicare or,
you can choose to see a doctor who doesn’t participate in the ACO.
Medicare Advantage Plans (Part C)
The Medicare Advantage (MA) program allows beneficiaries to choose to receive their
Medicare benefits through a variety of other health delivery options: health maintenance
organizations (HMOs), with or without a point of service option, preferred provider
organizations (PPOs), provider sponsored organizations (PSOs) or special needs plans
(SNPs). Medicare Advantage plans must provide the same services and benefits (other than
hospice care) as are covered under Original Medicare.
For information about availability in your area, you may call toll-free 1-800-MEDICARE
(1-800-633-4227).
To be eligible for Medicare Advantage health plans:

You must have Part A (Hospital Insurance)

You must have Part B (Medical Insurance)

You must not have End-Stage Renal Disease (there are some exceptions). An
individual who develops ESRD while enrolled in an MA plan may continue to be
enrolled in the MA plan and some Medicare Advantage Special Needs Plans accept
people with ESRD.

You must live in the geographic and service area where the plan accepts enrollees

You must agree to provide the necessary information to the plan

You must agree to follow the plan’s rules, and

You must belong to only one Medicare Advantage plan at a time
27
HEALTH AND INSURANCE PROGRAMS
Medicare Advantage Plans (Part C), cont.
Your out-of-pocket costs may depend on:

Which Medicare health plan you choose

How often you need health care

What type of health care you need

Which extra benefits are covered by the plan
CAUTION: Changing the way you receive your health care is an important decision
and should be reviewed carefully before determining which new choices may be right for you.
Remember: you do not have to change from Original Medicare - doing so is your
choice.
Medicare Advantage Health Maintenance Organization (HMO) - An HMO involves
a group of doctors, hospitals, and other health care providers who have agreed to treat
members of the plan. The plans have lock-in requirements. This means you generally
receive all covered care through the plan's network of doctors and hospitals. Insurance plans
will no longer charge higher co-payments or coinsurance amounts for out-of-network
emergency services or impose other coverage limitations that would not apply to in-network
care. You are no longer required to seek approval from the health plan before getting
emergency care.
Medicare Advantage Preferred-Provider Organization (PPO) - A PPO is a type of
managed care plan that allows the beneficiaries to use any doctors or hospitals and other
providers who are reimbursed on a fee-for-service basis. The insurance plan decides how
much to reimburse for the services you receive. Providers may bill more than the plan pays
and you will be responsible for paying the difference. Fees charged will be less if use is
limited to approved providers.
28
HEALTH AND INSURANCE PROGRAMS
Medicare Advantage Plans (Part C), cont.
Point of Service (POS) Plans - Medicare pays a set amount of money every month to
the private insurance company to provide health care coverage on a fee-for-service
arrangement. You get care from any Medicare-approved provider who agrees to accept the
Medicare Private Fee-for-Service Plan’s terms and conditions. Before you get any services,
ask your doctor or hospital if they are willing to accept the plan’s payment terms.
Medicare Advantage Special Needs Plan (SNP) - A SNP is a special type of
Medicare Advantage Plan that provides more focused and specialized health care for specific
groups of people, such as those who have both Medicare and NJ FamilyCare, those who
reside in a nursing home, or those who have certain chronic medical conditions. New
guidelines identify 15 specific chronic conditions defined as severe or disabling that will
dictate eligibility for a Chronic Care Medicare Advantage Special Needs Plan. The conditions
include dementia, chronic heart failure, diabetes mellitus, and stroke.
Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) - a health plan that
covers all of your Medicare and Medicaid health and drug benefits by one network of doctors,
specialists, hospitals and dentists. When enrolled in a D-SNP you will be automatically
disenrolled from original Medicare, Medicare Part D plan and Medicaid HMO

There is no cost for joining a D-SNP

Before enrolling in a D-SNP you should check with your current Medicare providers to
find out if they participate in the D-SNP network

You will receive all Medicare and Medicaid health and drug benefits through the DSNP

The D-SNP will cover all of your Medicare cost sharing (co-insurance, deductibles and
co-payments), including Medicare Part D co-pays
29
HEALTH AND INSURANCE PROGRAMS
Medicare Advantage Dual Eligible Special Needs Plan (D-SNP), cont.

Within your D-SNP network, you should never receive a bill from a provider for
services or covered drugs
You can change from one D-SNP to another at any time.
Note: Dual eligibles can change Medicare enrollment options monthly.
Medicare as Secondary Payer (MSP) - Medicare has special rules that apply to
beneficiaries who have employer group health plan coverage through their employment or the
employment of a spouse or civil union partner. If you accept your employer's health plan, it
will pay first on your health claims; Medicare will become the secondary payer. If you reject
your employer's health plan, Medicare will remain the primary health insurance payer. If you
elect Medicare to be the primary payer, your employer plan cannot offer you coverage that
supplements Medicare. If an employer has fewer than 20 full and/or part-time employees, the
MSP rules do not apply unless the employer participates in a multiple employer group health
plan. Contact your former employer or union for information on your plan. If your employer
denies you coverage or pays benefits that are secondary to Medicare, call 1-800-MEDICARE
(1-800-633-4227).
Original Medicare Appeals - If you disagree with a decision on the amount Medicare
will pay on a claim or whether Medicare covers services you received, you have the right to
appeal the decision. The notice you receive from Medicare tells you the decision made on
the disputed claims and also tells you exactly what appeal steps you can take. If you need
more information about your right to appeal and how to request it, call Medicare or the State
Health Insurance Assistance Program (SHIP).
30
HEALTH AND INSURANCE PROGRAMS
Medicare Fraud and Abuse - The majority of physicians, providers, and suppliers
who serve people with Medicare provide high quality care to their patients and bill the
program only for the payments they have earned. There are a few individuals who may
attempt to defraud (cheat) Medicare. When Medicare is billed for services or supplies you
never received, this is fraud and costs Medicare a lot of money each year.
Remember these tips to help prevent billing fraud:

Ask questions! You have the right to know everything about your health care,
including the costs of the items and services billed to Medicare.

Educate yourself about Medicare. Know your rights and what a provider can and can
not bill to Medicare.

Review your Medicare Summary Notice and other statements, and, if necessary, ask
your health care provider about what items and services they have billed.

Be wary of providers who tell you that the item or service is not usually covered, but
they “know how to bill Medicare” so Medicare will pay.
If you believe a Medicare plan or provider has used false information to mislead you,
call 1-800-MEDICARE (1-800-633-4227).
Medicare Marketing Fraud - Medicare’s open enrollment period is the time when
people with Medicare can enroll in, disenroll from, or switch to another Medicare private
health plan or change to Original Medicare. You should be aware that your Medicare benefits
change each year and it is important to review your Medicare coverage to make sure that it
will still cover your health care needs at a cost you can afford. During this time period, the
insurance companies may attempt to enroll people with Medicare into their health plans. To
increase the probability of getting people interested in their plans a salesperson may
repeatedly make contact (phone or in person) or overstate the benefits of their product. This
31
HEALTH AND INSURANCE PROGRAMS
Medicare Marketing Fraud, cont.
increased enrollment activity can mean an increase in deceptive enrollment practices, called
marketing fraud.
There has been a decrease in marketing fraud but there are still oversight activities to
ensure that programs adhere to Medicare rules: The rules for all Medicare plans, agents, and
any contactors who work for these plans are:

Must be licensed by the state;

May not make unsolicited contact, including door-to-door sales, cold calls or
approaching you in a parking lot;

Must have an appointment in advance before coming to your home;

Must arrange with you in advance the type of products that will be discussed during a
scheduled sales appointment. They may not attempt to sell you other types of
insurance coverage other than the type agreed upon in advance;

May not try to sell you non-health care related products (like a life insurance policy or
an annuity) during a sales or marketing presentation of a Medicare Plan;

May not attempt to sell you a plan at an educational event;

May not offer you free meals at promotional or sales events and

May not offer you gifts or other promotional items with a value greater than $15.
If you were provided incorrect information unintentionally or based on incorrect or
misleading information, or were kept in or enrolled in a plan you did not want, call Medicare at
1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048.
32
HEALTH AND INSURANCE PROGRAMS
Fighting Medicare Fraud Can Pay
You may get a reward of up to $1,000 when you report suspected Medicare fraud if:

The suspected Medicare fraud you report is proven as potential fraud by the Medicare
contractors responsible for investigating potential fraud and abuse;

You did not participate in the fraud offense being reported;

You do not qualify for a reward under another government program;

The person or organization you’re reporting is not already under investigation;

Your report leads directly to the recovery of at least $100 of Medicare money.
Senior Medicare Patrol Project (SMP of NJ) - SMP of NJ is a program that identifies
and reports health care waste, fraud and abuse. Volunteers are trained to work in their
communities to help identify deceptive health care practices, such as overbilling,
overcharging, or providing unnecessary or inappropriate services. If you suspect other than
proper billing has been provided for services rendered to you, please contact your local SMP
Program 1-877-767-4359.
For more information, call 1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048. For more information on protecting yourself from Medicare fraud and tips
for spotting and reporting fraud, visit www.stopmedicarefraud.gov,
Identity Theft - Identity theft is a serious crime. Identity theft happens when someone
uses your personal information without your consent to commit fraud or other crimes.
Personal information includes things like your name and your Social Security, Medicare or
credit card numbers. Guard against identity theft by taking action to protect yourself.
Here are some tips to help you protect your identity:

Don't carry your Social Security card or number in your wallet and carry only needed
credit cards.
33
HEALTH AND INSURANCE PROGRAMS
Identity Theft, cont.

Shred all pre-approved credit offers, bank statements and utility bills before putting
them in the trash.

Never give out personal information or a Social Security number over the phone, instore or online unless you know the company.

Check bank and credit card accounts regularly and credit scores at least once a year.
Keep your personal Information safe. No one should call you or come to your home
uninvited selling Medicare products. You have control over what you provide and who you
allow to have your personal information.
Note: Medicare demonstrations or pilot programs are allowed to call you to ask if you
want to enroll. Call 1-800-MEDICARE (1-800-633-4227) to report any plans that ask for your
personal information over the telephone or that call to enroll you in a plan.
Planning Ahead
Long-Term Care Insurance - Medicare and most health insurance plans, including
Medigap (Medicare Supplement insurance) policies do not cover long-term care (“custodial
care”). Medicare only pays for medically necessary skilled nursing facility or home health
care if you meet certain conditions. For long-term care, you can use your personal resources,
pay through a trust or annuity, life insurance policies, or other private options. What option is
best for you depends on your age, your health status, your risk of needing long-term care,
and your personal financial situation.
Long-term care insurance is private insurance purchased to help pay for many types of
long-term care (skilled and non-skilled, in-home and in long-term care facilities). This
insurance provides a variety of services including medical and non-medical care for people
who have a chronic illness or disability. If you are considering buying a policy, look for one
34
HEALTH AND INSURANCE PROGRAMS
Planning Ahead, cont.
that covers a range of services including informal home care, medical equipment, adult day
health services (day care), assisted living and nursing home care.
Note: Long-term care insurance does not replace your Medicare coverage.
For information on Long Term Care Insurance, please contact the NJ Division of Aging
Services, telephone 1-800-792-8820 or 609-943-3437.
Advance Directives - Advance directives are legal documents that allow you to put in
writing what kind of health care you would want or name someone who can speak for you if
you are too ill to speak for yourself. Some advance directives include a health care proxy
(durable power of attorney), a living will and after-death wishes.
A health care proxy (sometimes called a “durable power of attorney for health care”)
is used to name the person you wish to make health care decisions for you if you are not able
to make them yourself. A living will states which medical treatment you would accept or
refuse if your life is threatened. You can choose to accept or refuse a breathing machine if
you can no longer breathe on your own, CPR (cardiopulmonary resuscitation) if your heart
and breathing stop, or tube feeding if you can no longer eat. Each state has its own laws for
creating advance directives.
Addition information on advance directives can be found on the NJ Department of
Health website at www.state.nj.us/health/advancedirective.
MyMedicare,gov – Medicare’s online service that allows you access to personalized
information regarding your Medicare benefits and services. In order to use this service you
must be a registered user. New Medicare enrollees will automatically be registered to use the
website but existing Medicare beneficiaries must register for use. Only registered users or
their designee will be able to access the site using a unique password. You will be able to
35
HEALTH AND INSURANCE PROGRAMS
MyMedicare.gov, cont.
download your personal health information to your own personal computer. Registering with
MYMedicare.gov provides you with access to your personalized information at any time.
Information on the registration process is available by calling 1-800-633-4227 or at
https://www.mymedicare.gov/registration.aspx.
Quality Care Finder Tools – It can be difficult to find hospitals, nursing homes, home
health agencies and other health care providers that meet your needs. Medicare collects
information about the quality of care and services given by Medicare health care providers, as
well as information about how satisfied people are with the care and service they get. With
Medicare’s Quality Care Finder, you will be able compare healthcare providers, facilities,
health and drug plans, equipment suppliers and more.
Find and compare High Quality Healthcare Options (Pub. #11580) and Find High
Quality Healthcare Options (Pub. #11581) are publications about the quality Care Finder that
may be downloaded at www.medicare.gov/default.aspx. The Quality Care Finder is
available at http://www.medicare.gov/quality-care-finder/index.html.
Health Records - Electronic and Personal
Through health information technology (health IT) you can manage your health
information on line, improve how you communicate with your health care providers, and
improve the quality and coordination of your health care instead of writing this information in a
paper chart. The tool helps manage your health information online while reducing paperwork
and errors. Two types of health records are stored electronically.
Electronic Health Records (EHRs) are records that your doctor, your doctor’s staff,
or a hospital keeps with information about your health and medical treatment (like lab
reports). EHRs let your providers share up-to-date information about your conditions,
36
HEALTH AND INSURANCE PROGRAMS
Health Records - Electronic and Personal, cont.
treatments, tests and prescriptions. EHRs help cut down on medical errors and prevent
getting duplicate tests.
Personal Health Records (PHRs) are records you keep or control to track information
like the date of your last physical, test results, illnesses, allergies and medications. Over
time, these electronic records will help providers have the same knowledge about your
condition, treatments, tests, and prescriptions, in order to lower the chances of medical errors
and to help improve your overall quality of care. Federal and state governments have strict
rules about protecting the privacy and security of this electronic information.
For information about EHRs and PHRs visit www.medicare.gov.
Electronic Prescribing lets prescribers write and send your prescriptions directly to
your pharmacy. Electronic prescribing can save you money, time, and help keep you safe:

You don't have to drop off and wait for your pharmacist to fill your prescription-it may
be ready when you arrive.

Prescribers can check which drugs your insurance covers and prescribe a drug that
costs you less.

Electronic prescriptions are easier for the pharmacist to read than handwritten
prescriptions, so there's less chance you'll get the wrong drug or dose.

Prescribers have secure access to your prescription history, so they can be alerted to
potential drug interactions, allergies and other warnings.
Medicare Savings Programs
The Medicare Savings Program (MSP) and its Low Income Subsidy Program (LIS)
helps low income individuals pay out-of-pocket Medicare costs. If you qualify, you may not
37
HEALTH AND INSURANCE PROGRAMS
Medicare Savings Programs, cont.
have to pay your Medicare Part A and B premiums, deductibles, and coinsurance premiums
or out of pocket expenses. The savings plans are:
Specified Low-Income Medicare Beneficiary (SLMB) - Certain individuals who have
Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) and who are
slightly above the national poverty level may qualify for State help in paying their Medicare
Part B premium. To qualify, a person's annual gross income and their financial resources
such as bank accounts, stocks, and bonds must be within established limits. The Medicare
Part B premium must be included in determining annual gross income.
Qualified Medicare Beneficiary (QMB) - The Qualified Medicare Beneficiary
(QMB) in NJ is a component of the New Jersey FamilyCare program. QMB also helps pay
for the Medicare Part B premium, deductibles and coinsurance. The QMB program has
slightly lower income guidelines but the same asset guidelines as the SLMB program.
Qualifying Individual (QI-1) - Persons not financially eligible for the Qualified
Medicare Beneficiary (QMB) program under New Jersey Medicaid may be eligible for
assistance as a Qualifying Individual (QI) to have monthly Medicare Part B premiums paid.
NJ FamilyCare
NJ FamilyCare is a joint federal-state medical assistance program that provides
affordable health coverage for certain individuals of with low income and limited resources. In
NJ, persons eligible for Supplemental Security Income (SSI) are also eligible for NJ
FamilyCare, and automatically receive it.
Persons 65+, or blind or disabled planning to live in a non-institutional type setting
should contact Social Security (1-800-772-1213) to determine if they are eligible for
Supplemental Security Income (SSI), since those eligible for SSI (see page 54-55)
38
HEALTH AND INSURANCE PROGRAMS
NJ FamilyCare, cont.
also receive NJ FamilyCare. Persons seeking NJ FamilyCare assistance for institutional care
should contact the Board of Social Services/Welfare Office in their county to determine if they
are eligible for Institutional NJ FamilyCare.
Please call your County Board of Social Services for information on NJ FamilyCare.
GROUP HEALTH INSURANCE
Continuing Coverage After Leaving Employment (COBRA) - Employees covered
by an employer-provided group health insurance policy covering more than 20 persons,
leaving the employ of their employer for any reason except gross misconduct, are entitled to a
minimum of 18 months continuation of their group health insurance policy at group rates for
themselves and their families provided that they are not covered by another group health
insurance policy, and provided that the employer's policy remains in effect.
For additional information contact the U.S. Department of Labor, Employee Benefits
Security Administration, Division of Technical Assistance and Inquiries, 200 Constitution
Avenue NW, Suite N-5619, Washington, DC 20210 telephone toll-free 1-866-444-EBSA
(3272) or 202-693-8664; TTY: 202-501-3911 or www.dol.gov/COBRA.
NJ Protect (Pre-existing Condition Insurance)
NJ Protect is a health insurance option for uninsured New Jerseyans with pre-existing
medical conditions. Coverage through NJ Protect will generally cost less than comparable
individual health insurance and offer superior benefits. Because the program is federally
subsidized, treatment for pre-existing medical conditions will be covered as of the day a policy
goes into effect, and preventive care will be covered at no out-of-pocket cost to the
policyholder.
39
HEALTH AND INSURANCE PROGRAMS
NJ Protect (Pre-existing Condition Insurance), cont.
You are eligible for NJ Protect if you meet the following requirements:

You must be a U.S. citizen or national or lawfully present in the United States;

You must be a New Jersey resident;

You must have been without any creditable coverage for at least 6 months;

You must have a pre-existing condition
NJ Protect will end when you become covered under Medicare or under a group plan.
NJ Protect is offered by two carriers: AmeriHealth of New Jersey and Horizon Blue
Cross and Blue Shield of NJ. Contact one of these companies about enrolling in NJ Protect.
Please be sure to explain you are asking about NJ Protect so the customer service
representative can quickly provide information for the NJ Protect options.
AmeriHealth of New Jersey, 8000 Midlantic Drive, Mount Laurel NJ 08054, telephone
1-866-681-7368 or Horizon Blue Cross Blue Shield of NJ, P.O. Box 1330 Newark, NJ 071011330, telephone 1-888-551-2130.
Health Coverage Tax Credit
The federal Health Coverage Tax Credit which was created to help certain displaced
workers, certain retirees and employers experiencing financial hardship afford health
insurance coverage has been extended until January 2014. In order to receive the HCTC,
you must be enrolled in a qualified health plan and meet certain requirements, such as:

Trade Adjustment Assistance (TAA), Alternative Trade Adjustment Assistance (ATAA),
or Reemployment Trade Adjustment Assistance (RTAA) recipient

Pension Benefit Guaranty Corporation (PBGC) benefits recipient.

This credit is not available to everyone.
40
HEALTH AND INSURANCE
Health Coverage Tax Credit, cont.
A worker receiving certain specified health coverage, such as Medicare, will be
ineligible to use the HCTC program.
For more information about this program and about what is considered qualified health
insurance, you may call the HCTC Program Customer Contact Center's toll-free telephone
number (1-866-626-4282) or 1-866-628-4282 (for TTY/TDD users, or visit the IRS website
www.irs.gov/individuals.
Federally Qualified Health Centers - Medicare (FQHCs) - Medicare benefits have
been expanded to include payment for certain preventive health-care services provided in
federally qualified health centers (FQHCs). In addition, FQHCs may waive the deductible
normally required under Medicare Part B and may limit the out-of-pocket costs by applying
the co-pay responsibility of the Medicare beneficiary to a sliding scale based upon the
beneficiary's ability to pay.
The FQHCs do not charge for any service for which Medicare beneficiaries are entitled
to have payment made by the Medicare program. In order to be covered under Medicare
Part B (Medical Insurance) the FQHCs must meet the U. S. Public Health Service criteria and
agree to meet Medicare requirements.
In New Jersey, FQHCs are located in Atlantic, Bergen, Burlington, Camden, Cape
May, Cumberland, Essex, Gloucester, Hudson, Mercer, Middlesex, Monmouth, Morris,
Ocean, Passaic, Salem, Sussex, Union, and Warren counties. Anyone living in these
counties should contact the Area Agency on Aging/ADRC for the location of the FQHC.
FQHCs are in most cities and many rural areas. The FQHC can provide eligibility guidelines
and information on services provided.
41
HEALTH AND INSURANCE
Federally Qualified Health Centers - Medicare (FQHCs), cont.
Information on these centers is available from the New Jersey Primary Care
Association (NJPCA), 609-689-9930 or www.njpca.org.
HOUSING
FEDERALLY ASSISTED HOUSING PROGRAMS
The U.S. Department of Housing & Urban Development (HUD) has a wide range of
programs of interest to the senior consumer. These programs deal primarily with rental
housing and rental assistance programs. To preserve housing specifically designed to meet
the needs of senior citizens, some of HUD's housing developments are exclusively for the
elderly and the handicapped while, in others, the elderly are eligible tenants along with other
groups. The actual sponsors/developers of the housing may be non-profit or for-profit
organizations, public agencies, or consumer cooperatives. To qualify, an individual's income
generally must be within certain limits. According to the federal Administration on Aging,
preference for federally funded housing is given to people who pay more than 50% of their
income in rent, are being displaced from their homes, or live in inadequate housing. Be sure
to notify the agency that you contact about federal housing if any of these situations apply to
you. Most federally assisted housing provided to the elderly is funded under two programs,
known popularly as "Section 8" and "Section 202."
Section 8 - The Section 8 Housing Choice Voucher program was created to help very
low-income persons of all ages secure decent, safe and sanitary housing in the private rental
market by helping to pay a portion of the monthly rent. The participant is free to choose any
housing that meets the requirements of the program and is not limited to units located in
subsidized housing projects. Income limits are determined by family size and geographic
area. Participants usually pay no more than 30% of their adjusted monthly income for rent.
42
HOUSING
Section 8, cont.
The program pays the balance of the rent to the landlord. The rent must be reasonable.
Persons age 60 and older should call the New Jersey toll-free number 1-877-222-3737
to obtain the address and telephone number of the county agency that administers the
Section 8 program. This program is funded by HUD and administered in NJ by the Division of
Housing and Community Resources, NJ Department of Community Affairs,
PO Box 051, Trenton, NJ 08625-0051 telephone 609-292-4080. For other HUD related
information please call HUD at 1-800-669-9777 or visit their website www.hud.gov.
Section 202 - The Section 202 reform creates and sustains more affordable units.
The program provides direct, low-interest loans to non-profit sponsors to finance the
construction or rehabilitation of residential projects and related facilities for those 62 or older
and individuals with disabilities. Very low-income elderly households, in particular those
experiencing frailty or at-risk of frailty, often have unique needs that are best served through
affordable housing that offers connections to supportive services. Housing with a legal
definition of senior housing for older persons can exclude families with children.
Section 202 Conversion is the conversion of public housing residents to Section 8. If
it costs less to give the residents a Section 8 voucher, rather than maintain the low rent public
housing building under Annual Contributions Contract (ACC), the building is shut down and
the residents are provided Section 8. Section 202 is now only applicable to those Housing
Authorities with approved conversion plans that are in the process of implementation.
Persons age 60 and older should call the New Jersey toll-free number 1-877-222-3737
to obtain the address and telephone number of the county agency that administers housing
program. These programs are funded by HUD and administered in NJ by the Division of
Housing and Community Resources, NJ Department of Community Affairs, PO Box 051,
43
HOUSING
Section 202 Conversion, cont.
Trenton, NJ 08625-0051 telephone 609-292-4080. For other HUD related information please
call HUD Resource Center 1-800-955-2232 or 1-800-669-9777, or visit their website
www.hud.gov.
Reverse Mortgage - A reverse mortgage is a special type of mortgage that allows
seniors to access the equity in their home. The homeowner can convert the equity in the
home into cash. Unlike a traditional home equity loan or second mortgage, no repayment is
required until the borrowers no longer use the home as their principal residence. To be
eligible for a HUD reverse mortgage: a homeowner must be 62 years of age or older; have a
very low outstanding mortgage balance or own your home free; and meet with a HUDapproved counseling agency--to make sure they understand what a HUD Reverse Mortgage
means. The Federal Housing Administration (HUD) insures this program.
For information, call 1-800-792-8820 or write the NJ Division of Aging Services, PO
Box 807, Trenton, NJ 08625-0807. Information is also available by calling toll-free the NJ
Housing and Mortgage Finance Agency at 1-800-NJ-HOUSE (1-800-654-6873) or call the
National Council on Aging (NCOA) Reverse Mortgage Counseling Services at 1-800- 5100301.
Homeless/Homeless Prevention - For meeting the housing needs of the homeless
and the potential homeless, HUD along with many other federal agencies fund programs to
help. Homeless assistance agencies provide a range of services including shelter, food,
counseling and job skills. Awards are granted to state and local agencies, which provide the
actual services.
44
HOUSING
Homeless/Homeless Prevention, cont.
To learn more about homeless and homeless prevention services contact the Division
of Housing, NJ Department of Community Affairs, PO Box 0806, Trenton, NJ 08625-0806,
telephone 1-866-889-6270 or 609-633-6204.
OTHER FEDERAL HOUSING ASSISTANCE
The United States Department of Agriculture Rural Development (USDA Rural
Development) operates a program of home renovation and repairs for persons living in
non-urban areas. It also provides loans to finance homes and building sites. For low-income
homeowners age 62 or older, the program offers grants for home improvement as well as
loans, or a combination of the two. Further information on assistance is available from any
designated county office.
For the address of the nearest office contact the State Office of Rural Economic and
Community Development, 5th Floor North, Suite 500, 8000 Midlantic Drive, Mt. Laurel, NJ
08054, telephone 856-787-7700, Fax 856-787-7783, or www.rurdev.usda.gov/nj.
Public Housing - Public housing is low-income housing that is operated by your local
housing authority. Local Public Housing programs receive federal aid for housing
lower-income families. Tenants pay rent according to the same formula used for Section 8
housing. Public housing includes the elderly.
Program Availability, Assistance - For information on the availability of any of the
housing programs in your area, please contact the designated agency or your Area Agency
on Aging/ADRC (AAA/ADRC) for direction to the appropriate contact point. The AAA/ADRC
will also be able to provide referrals for home improvement and weatherization programs.
45
HOUSING
Housing Lists - For lists of subsidized housing or other lists of housing options for
older persons telephone toll-free (within NJ), 1-800-792-8820 or 609-943-3437, or write to the
NJ Division of Aging Services, PO Box 807, Trenton, NJ 08625-0807, Attention: Senior
Housing, or visit website www.njhrc.gov.
Pet Ownership - Residents of federally assisted rental housing designed specifically
for the elderly are allowed to keep pets, subject to certain regulations, and may not be
discriminated against because of pet ownership. Residents who refuse to comply with the
rules and regulations and properly care for the animals may be denied these rights.
ENERGY ASSISTANCE PROGRAMS
Low Income Home Energy Assistance Program (LIHEAP)
There are three important energy assistance programs for eligible households, The
Low Income Home Energy Assistance Program (LIHEAP), The New Jersey Universal
Service Fund (USF) and The Weatherization Assistance Program. The low Income
Home Energy Assistance Program (LIHEAP) provides subsidies to help low-income families
and individuals meet home heating and medically necessary cooling costs. LIHEAP funds
can also be used for energy crisis intervention and low cost residential weatherization and
other energy related home repairs.
To be eligible for LIHEAP benefits, the applicant household must be responsible for
home heating or cooling costs, either directly or included in the rent; and must meet income
qualifiers. Persons who live in public housing and/or receive rental assistance are not
eligible unless they pay for their own heating/cooling costs directly to the fuel supplier. The
amount of the LIHEAP heating benefit is determined by income, household size, fuel type,
and heating region.
46
ENERGY ASSISTANCE PROGRAMS
Low Income Home Energy Assistance Program (LIHEAP), cont.
There are four types of LIHEAP payments:

An eligible household that heats with natural gas or electricity may have its benefits
directly forwarded to its utility company.

Households directly responsible to a fuel supplier for payment of home heating costs
receive a two-party check in the name of the applicant and the fuel supplier.

Households whose heating costs are included in their non-subsidized rent receive a
single party check made out to the eligible applicant.
A household receiving medically necessary cooling benefit will receive a credit to their
active electric account or a single party check when no account is present. Payments vary
according to an applicant's income, household size, fuel type, and heating region.
LIHEAP agencies may require that low-income households meet additional criteria to
be eligible to receive LIHEAP assistance. Examples of each criterion include the use of
assets test, type of living situation or receipt of a utility shut off notice.
LIHEAP is a federally funded program, administered in NJ by the NJ Department of
Community Affairs, Division of Housing and Community Resources, PO Box 806, Trenton, NJ
08625-0806, 1-800-510-3102. Funding is provided by the US Department of Health and
Human Services via the NJ Department of Human Services. The Food Stamp automatic
payment portion of the program is administered by the NJ Department of Human Services.
To locate the nearest application agency, obtain an application, or further information
on energy assistance call 1-800-510-3102. Information is also available at
www.energyassistance.nj.gov. Information on the New Jersey Universal Service Fund
(USF) program can be found in our companion publication “Statewide Benefits for Older
Persons.”
47
ENERGY ASSISTANCE PROGRAMS
WEATHERIZATION ASSISTANCE PROGRAM
The Weatherization Assistance Program is a federal/state grant program of the U.S.
Department of Energy designed to promote energy conservation work in low-income
households. A household income must fall below 130% of the federal poverty level to be
eligible for the program.
Funds may be used for the following energy conservation measures:

Caulking, weather-stripping, insulation of doors/windows

Devices for minimizing energy loss through heating system, chimney or venting
devices

Ceiling, attic, wall, floor, duct, and water heater insulation

Heat-absorbing/heat-reflective window/door materials

Furnace efficiency modifications
After improvements are made, you should notice the following:

An increase in comfort - no drafts and an even temperature throughout your home

Your heating and cooling bill should be reduced

You should need less energy to heat and cool your home
In NJ, the Division of Housing and Community Resources NJ Department of
Community Affairs (see LIHEAP) administer the Weatherization Program, which in turn
awards grants to local agencies. These local agencies accept applications and determine
eligibility. Persons wanting further information on eligibility requirements, limits of assistance,
and whether or not funds remain available please call toll-free 1-866-551-7165 or 609-2926140.
48
INCOME MAINTENANCE
SOCIAL SECURITY
The Social Security system is designed to provide insured workers and their
dependents or survivors with some protection against the loss of worker's income due to
retirement, disability, or death. Created in 1935, the system is administered by the U.S.
Social Security Administration and is divided into four parts: Old Age, Survivors, Disability,
and Health Insurance programs.
Coverage - Almost all workers are covered automatically by the Social Security
program. Workers in non-profit organizations and government entities should check with their
employers to verify membership in the Social Security program.
Benefit Eligibility - Eligibility is based on contributions to the system during the
working life of the individual. Benefits are financed by payroll taxes paid jointly by employers
and employees and by the self-employed. To receive benefits, persons must have a
sufficient number of credits, usually 40 (10 years of work).
Social Security Protection Act of 2004 (Public Law 108-203) - Under this law, which
covers retirements effective July 1, 2004, public employees are required to work in jobs
covered by Social Security for the last five years (60 months) of their careers in order to be
eligible for Social Security and Pension Benefits. Under the previous law, if a person worked
as little as the last day of their careers in jobs covered by Social Security they were eligible for
both benefits.
Retirement Age/Benefits - Workers covered by Social Security may retire with full
benefits at age 65 if they were born in 1937 or earlier. The normal retirement age for full
benefits is periodically increasing until it reaches age 67 for people who become 62 in 2022.
If your full retirement age is older than 65 (that is, you were born after 1937), you still will be
49
INCOME MAINTENANCE
Social Security, cont.
able to take your retirement benefits at age 62, but the reduction in your benefit amount will
be greater than it is for people retiring now.
Here's how it works. If your full retirement age is 67, the reduction for starting your
benefits at:

62 is about 30%

age 63 is about 25%

age 64 is about 20%

age 65 is about 13 and 1/3%; and

age 66 is about 6 and 2/3%
As a general rule, early retirement will give you about the same total Social Security
benefits as full retirement over your lifetime, but in smaller amounts to take into account the
longer period you will receive them.
Delayed Retirement Credit - The delayed retirement credit increases Social Security
benefits for every month a person of normal retirement age remains employed and delays
receiving benefits. The amount of the delayed retirement credit depends on the year you
reach retirement age and the number of months you are eligible for and do not receive
benefits.
Earnings Limitations - Social Security no longer places restrictions on earnings for
beneficiaries above the normal retirement age (NRA) if your earnings exceed a certain level.
The NRA is age 65 for those born before 1938, and is gradually increasing to age 67. For
clarification on how this change will affect your benefits, contact Social Security.
Social Security Annual Earnings Statement - The Social Security Administration
(SSA) has suspended the mailing of the Social Security Statements for everyone except
50
INCOME MAINTENANCE
Social Security, cont.
near-retirees 60 and older. The statement based on an individual’s career wage record
projected future benefit payments, allowed taxpayers to check for errors in annual income
and helped workers plan for retirement. The statements you once received in the mail, the
government is working to replace with an online version.
You may be able to estimate your retirement benefit using the online Retirement
Estimator at http://www.socialsecurity.gov/estimator/.
Further information is available by calling Social Security at 1-800-772-1213 or online
at www.socialsecurity.gov/mystatement.
Direct Deposit – If you apply for Social Security or Supplemental Security Income
benefits on or after May 1, 2011, you must receive your payments electronically. You must
switch to electronic payments by March 1, 2013. If you do not, the U.S. Department of the
Treasury may send your benefits via the Direct Express® card program to avoid an
interruption in payment. It's safe, quick and convenient. If you are already receiving benefits,
you can obtain a password and start or change Direct Deposit online.
To sign up for direct deposit call toll-free 1-800-333-1795, or sign up on-line at
www.godirect.org. It takes just a few minutes and can make a big difference in your
financial safety. You can also sign up at your bank, credit union or savings and loan or call
Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
Social Security Benefit Statement/Taxes - Some time in January of each year, the
Social Security Administration will send each beneficiary a Social Security Benefit Statement
(Form SSA-1099-SM). This statement tells you how much you received in Social Security
benefits during the previous year and provides a worksheet to determine if any of your
benefits are taxable. If the only income you received was your Social Security or equivalent
51
INCOME MAINTENANCE
Social Security, cont.
tier I Railroad Retirement benefits, your benefits will not be taxed unless your modified
adjusted gross income is more than the base amount for your filing status.
Social Security Toll-Free Service - To assist persons in knowing what their benefits
are, or will be, the Social Security Administration maintains a nationwide, 24-hour toll-free
service - 1-800-772-1213 between 7:00 AM and 7:00 PM. People who are deaf or hard of
hearing may call toll-free "TTY" 1-800-325-0778. All information is confidential and must be
requested by the recipient/prospective recipient personally.
Disability Insurance
Eligibility – Workers who become severely disabled while employed may be eligible
for monthly benefits before age 65. However, to be eligible for disability benefits, a worker
must be covered by Social Security and should apply for such benefits as soon as possible
after the onset of the disability.
Initial Determination of Impairment - In NJ, the NJ Department of Labor and
Workforce Development makes the initial determination of disability. Evidence of medical
impairment must be provided by the doctor, hospital, or clinic providing treatment for the
impairment, and that, as a result of the impairment, "substantial gainful" employment cannot
be performed for at least twelve months. In addition to medical impairments, vocational
capacities, including age, education, and work experience, is evaluated.
Compassionate Allowances - the Compassionate Allowances list rare diseases,
cancers, traumatic brain injury (TBI) and stroke, medical condition impairments so serious
that they obviously meet Social Security and Supplemental Security Income disability
guidelines. The Quick Disability Determinations (QDD) receive expedited processing to get
52
INCOME MAINTENANCE
Compassionate Allowances, cont.
disability benefits quickly to those with severe and life-threatening conditions. Social Security
is able to electronically target and make speedy decisions for these disabled individuals.
Further Information - Because Disability Insurance is one of the most complicated of
all Social Security programs, you should call or visit Social Security for more information.
SURVIVORS BENEFITS
Social Security Survivors Insurance provides monthly benefits to the spouse/divorced
spouse or unmarried child(ren) of a deceased worker based on the worker's earnings record.
If the beneficiary is employed, the amount of monthly benefits received will be affected by
his/her earnings and age. Survivor benefits can be paid if the deceased worker had credit for
a certain amount of work in employment/self-employment covered by Social Security. The
exact number of work credits needed depends on the age of the worker at time of death. If
the surviving spouse is disabled, the Survivor Benefit could be available as early as age 50,
with the same reduction as for a non-disabled surviving spouse at age 60, 28.5%.
Lump Sum Death Payment - The lump-sum death benefit is payable upon the death
of a person who has worked long enough to be insured under Social Security. You must file
the application for the lump-sum death payment within the two-year period ending with the
second anniversary of the insured person's death. This special one-time payment is in
addition to any monthly survivor insurance benefits.
This payment can be made only to certain family members.
Information - Information on any of the above entitlements is available from any
Social Security office, from their toll-free service, 1-800-772-1213, or their website,
www.ssa.gov.
53
INCOME MAINTENANCE
SUPPLEMENTAL SECURITY INCOME (SSI)
The Supplemental Security Income Program (SSI) is a federally administered program,
which provides income to eligible persons 65 or older, or blind, or disabled and adults who
have been disabled since childhood. People who get SSI usually qualify for Food Stamps
and NJ FamilyCare also. SSI differs from Social Security in that it is based on a person's
income and resources (assets), and is funded by the general revenues of the U.S. Treasury,
not by the Social Security Trust Funds.
Income Limitations - The amount of income you can have each month and still get
SSI depends partly on the State in which you reside and your living arrangement. Social
Security does not count all of your income in deciding if you can get SSI. For example they
do not count:

Certain monthly unearned income

Certain monthly income you earn from working and 1/2 of the amount over

Food Stamps

Food, clothing, or shelter you receive from non-profit organizations

Most home energy assistance
Resource Limitations - Resources are things you own, such as personal belongings,
bank accounts, cash, or stocks and bonds. A single person may be able to get SSI with
resources of up to $2,000; a couple may be able to get SSI with resources of up to $3,000.
Not counted as resources are:

The home you live in and the land it's on

Personal and household goods, depending on their value

Car, if used for essential transportation, or if worth $4,500 or less

Certain monies set aside for burial are not counted
54
INCOME MAINTENANCE
Income Limitations, cont.

If you are blind or have a disability, some items may not count if you plan to use them
to work or earn extra income
Payments - The SSI program is administered through the U.S. Social Security
Administration. Payments to SSI recipients are made monthly by the federal government,
which includes a supplement provided by the State of New Jersey. For the convenience of
SSI recipients, the State of New Jersey and the federal government have agreed to include
the amount in the federal payment. SSI recipients receive one U.S. government payment
with federal and state money included.
Applications, Appeals, Information - Persons who have been denied SSI, or had
their payments stopped or reduced, have certain appeals procedures available to them free of
charge. To apply for SSI, initiate an appeal, or request more information, please contact the
nearest Social Security office or call their toll-free service, 1-800-772-1213.
RAILROAD RETIREMENT PROGRAM
Under the Railroad Retirement and Railroad Unemployment Insurance Acts, the
federal Railroad Retirement Board administers retirement and survivor, unemployment and
sickness benefit programs for railroad workers and their families. In addition, the Railroad
Retirement Board has administrative responsibilities for certain benefit payments and/or
Medicare coverage for railroad workers.
Railroad Retirement beneficiaries should contact the Retirement Railroad Board
1-877-772-5772, TTY: 1-312-751-4701 for answers to Medicare questions.
Annuities - The Railroad Retirement Board pays retirement and disability annuities to
railroad workers with at least 10 years of service. Annuities are also payable to workers with
5 years of service if performed after 1995, an “insured status” under Social Security Act rules
55
INCOME MAINTENANCE
Railroad Retirement, cont.
(usually 40 quarters of coverage). Early retirement annuity reductions are applied to
annuities awarded before full retirement age, which ranges from age 65 for those born before
1938 to age 67 for those born in 1960 or later, the same as under social security. Reduced
annuities are still payable at age 62 but the maximum reduction will be 30% rather than 20%
by the year 2022. An annuity based on age cannot be paid until the employee stops railroad
employment, files an application and gives up any rights to return to work for a railroad
employer.
Current Connection – An employee who worked for a railroad in at least 12 months in
the 30 months immediately preceding the month a railroad retirement annuity begins will meet
the current connection requirement for a supplemental annuity, occupational disability annuity
or survivor benefit. If an employee does not qualify on this basis, but has 12 service months
in an earlier 30-month period, they may still meet the requirement.
Spouse Requirements – The age requirements for a spouse annuity depend on the
employee’s age and date of retirement and the employee’s years of service. Early retirement
reductions are applied to the spouse annuity if the spouse retires prior to full retirement age.
A spouse may receive an annuity at any age if caring for a child under age 18 or a child who
meets disability requirements. A divorced spouse age 62 who was legally married to the
railroad employee at least 10 years and is not currently married may receive an annuity.
Applications, Denials, Appeals - Applications for railroad retirement/survivor benefits
should be filed with the nearest Railroad Retirement Board. Prospective retirees should
contact the Board several months before their planned retirement date in order to obtain
annuity estimates and to verify eligibility dates. Persons who have been denied Railroad
56
INCOME MAINTENANCE
Railroad Retirement, cont.
Retirement benefits/annuities or had their payments stopped or reduced, have certain appeal
procedures available free of charge.
Contact the nearest Railroad Retirement Board to initiate an appeal. The Railroad
Retirement Board serving northern NJ is located in Newark, and for southern NJ in
Philadelphia.
Their addresses are as follows:
Railroad Retirement Board - 1-877-772-5520 - www.rrb.gov
Veteran's Administration
Building
NIX Federal Building
900 Market Street,
Suite 301
Philadelphia, PA 19105
Fax: 215-597-2674
Veteran’s Administration
Building
20 Washington Place,
Room 516
Newark, NJ 07102-3127
Fax: 973-645-3990
TTY: 312-751-4701
U.S. Railroad Retirement
Board
844 North Rush Street
Chicago IL, 60611-2092
Toll Free: 1-877-772-5772
TTY: 312-751-4701
Directory: 312-751-4300 or
http://www.rrb.gov/field/fi
eld.asp
You can call the RRB Help-Line toll free at 1-877-772-5772 to obtain automated
information about unemployment and sickness benefits, request a letter showing your current
monthly annuity rate, request a replacement Medicare card and more.
FEDERAL CIVIL SERVICE RETIREMENT
The federal Civil Service Retirement System provides retirement, survivors, disability,
and death benefits to most federal government employees.
For further information contact the Retirement Information Office, U.S. Office of
Personnel Management, 1900 E Street, N.W., Washington, DC 20415, toll-free:
1-888-767-6738 or 202-606-0500 (taped message) for directions to the appropriate office.
57
INCOME MAINTENANCE
PRIVATE PENSIONS
Many persons are covered by a pension plan in addition to Social Security. Generally,
all employers must continue pension benefit accruals for persons working beyond a plan’s
normal retirement age. Plan limitations on the amount of benefits, years of service, or years
of participation are permissible if imposed without regard to age.
Interpretation - The U.S. Internal Revenue Service (IRS) has responsibility for
interpreting minimum standards of the federal private pension laws and ensuring that
company and union pension plans are in compliance with those laws. The basic law covering
private pension plans is the Employee Retirement Income Security Act of 1974 (ERISA). This
law established the federal pension insurance program and provided for individual rights,
funding requirements, and investment rules.
Persons having a question about the interpretation of a specific provision of these laws
should contact the Employee Plans Technical & Actuarial Division of the IRS at 1111
Constitution Avenue N.W., Room 6525, Washington, DC 20224, telephone 1-877-829-5500
Monday through Thursday, 8:00 AM - 6:30 PM exclusive of holidays.
Termination - If a private defined pension plan is terminated, the federal Pension
Benefit Guaranty Corporation (PBGC) offers protection against the loss of certain benefits.
For information about protection under a terminated plan, please contact the PBGC at
1200 K Street, N.W., Washington, DC 20005-4026, telephone toll-free 1-800-400-7242 or
202-326-4000, www.pbgc.gov. Be sure to have the name of the pension plan and the
employer's "Employer's Identification Number" (EIN).
Information, Complaints - For more information on pension plan regulations in
general, or to file a complaint, contact: U.S. Department of Labor, Employee Benefits Security
58
INCOME MAINTENANCE
Private Pensions, cont.
Administration, Division of Technical Assistance & Inquiries, 200 Constitution Avenue N.W.,
Room N-5658, Washington, DC 20210, telephone 1-866-444-3272, www.us.dol.gov.
For additional retirement and health benefit plan questions, call toll-free
1-866-275-7922. English, Spanish and Mandarin language service available.
Additional information, referral or assistance for general inquiries is available by calling
202-326-4000 or 1-800-400-7242.
For inquiries about plan administration please call 1-800-736-2444; for general legal
inquiries, please call 202-326-4020; or information is available from the Pension Rights
Center, 918 16th St., N.W., Suite 704, Washington, DC 20006, telephone 202-296-3776 or
1-866-444-3272.
Age Related Complaints, however, should be filed with the U.S. Equal Employment
Opportunities Commission, 1 Newark Center, 21st Floor, Newark, NJ 07102, telephone
973-645-6383 or call toll-free 1-800-669-4000.
Private Welfare Plans - Private welfare plans are also subject to federal regulations.
Contact the Employee Benefits Security Administration, as listed above, for information on
requirements of private welfare plans or to file a complaint concerning their administration.
Pension Counseling and Information Project – The pension counseling project
provides services to older Americans and their families who are having a problem getting
information about their pension, profit sharing or retirement savings plans. The project is
involved in a variety of initiatives to protect and promote the retirement security of retirees,
safeguard savings, protect promised pensions when plans are changed or terminated and
ensure benefits are provided to seniors and their families. Legal assistance is available to
those experiencing a problem. By producing fact sheets and other publications, conducting
59
INCOME MAINTENANCE
Private Pensions, cont.
outreach, education and awareness efforts, the pension counseling project provides indirect
services to seniors and their families.
To learn more about the service contact New York Pension Rights Office (Serves NY
and NJ), toll-free 1-800-355-7714 or 718-237-5500. http://www.sbls.org/index.php?id=253.
NUTRITION
PROGRAMS PROVIDING MEAL SERVICES
All NJ counties have community programs that provide meals and related nutrition
services to persons age 60 and older in a variety of settings, such as senior/community
centers and adult day health/day care centers. These include congregate or group meals, as
well as meals for the homebound. Many of these programs are federally funded, with meals
being available for a "suggested contribution”. Other meal programs are funded primarily by
private sector volunteer organizations. For these meal programs, a fee, usually based on the
actual costs of the service is charged.
Congregate or Group Meals - This service, administered by the Area Agencies on
Aging/ADRC in each county, provides at least one hot nutritious meal per day, five or more
days per week. These meals, along with counseling, socialization, and other services, are
usually provided in locations such as senior centers, schools, or churches. The program is
available to all persons age 60 or over and their spouses, regardless of age. Participants are
provided with an opportunity to voluntarily contribute whatever they can afford toward the cost
of these meals. Reservations are required, in most instances, 24 hours in advance.
Home-Delivered Meals - The Area Agencies on Aging/ADRC, through grantees,
provide one (or sometimes more) hot meal a day at least five days per week to older persons
who are homebound due to illness, incapacitating disability, or isolation. This program is
60
NUTRITION
Programs Providing Meal Services, cont.
federally funded and serves only persons age 60 or older. A meal may be provided to the
spouse if it is in the best interest of the homebound older person being served. This federal
program has been supplemented with state legislation providing nutrition services on
weekends and holidays for frail eligible participants. A formal needs assessment is required
for participation in these nutrition programs; however, there are no strict income
requirements.
Privately Funded Programs - In addition to the home-delivered meal programs,
which are federally/state funded, there are privately funded programs sponsored by churches
and various civic organizations, which offer meals to the disabled, the isolated, the
temporarily ill shut-ins, and others in need.
Additional Information - Further information and referral to the designated meal
programs and services is available from the Area Agencies on Aging/ADRC. (See pages 81
and 82) or call ADRC toll-free at 1-877-222-3737.
NUTRITION ASSISTANCE PROGRAMS
Supplemental Nutrition Assistance Program (NJ SNAP)
Supplemental Nutritional Assistance Program (NJ SNAP) is the new name for the
federal Food Stamp Program in New Jersey. With a focus on nutrition and an increase in
benefits, this program funded by the U. S. Department of Agriculture and administered in New
Jersey by the NJ Department of Human Services, Division of Family Development is
designed to increase the food purchasing power of low-income households. Eligibility for
benefits is based on the number of people in a household, their income and resources.
People at least 60 years of age and those receiving Social Security Disability benefits may
apply as separate households independently of the other people they are living with.
61
NUTRITION
Supplemental Nutrition Assistance Program (NJ SNAP), cont.
Food Stamp benefits are administered to eligible recipients through use of the
“Families First” card.
Please note households in which all members are applicants for or recipients of
Supplemental Security Income (SSI) may apply for Food Stamps at the Social Security
District office at the same time they apply for SSI.
For more NJ SNAP information call toll-free 1-800-687-9512 or call your County Board
of Social Service or visit www.njsnap.org.
SNAP Fraud
The SNAP program is helping struggling families put food on the table. Any fraud
hurts the ability of SNAP to provide this service to those who need it the most. To fight SNAP
fraud and prevent any abuse of the program the following are inappropriate uses for SNAP.

When benefits are exchanged for cash

When someone lies on their application to get benefits or to get more benefits that they
are supposed to get

When a retailer has been disqualified from the program for past abuse and provides
false information on the application to get in the program again.
Report suspicious SNAP Activity 1-800-424-9121 or NJ SNAP Information Line
1-800-687-9512.
Program fraud complaints of any kind may be filed with the USDA Office of Inspector
General; contact information is found at: http://www.usda.gov/oig/hotline.htm.
Fraud may also be reported to the appropriate States. To report for NJ, please call
1-800 792 9773. Phone numbers to report fraud for other states are available at
http://www.fns.usda.gov/snap/contact_info/fraud.pdf.
62
NUTRITION
Senior Farmers’ Market Nutrition Program
The Senior Farmers’ Market Nutrition Program provides low-income older adults with
vouchers that can be used to purchase fresh fruits and vegetables from farmers markets,
roadside stands and community supported agriculture programs. For some seniors on fixed
incomes buying fresh fruits and vegetables is not a possibility. The farmer’s markets benefits
eligible seniors with the goal of improving their health and well-being with access to fresher,
better tasting produce with less travel.
The Senior Farmers Market Nutrition Program is administered by the Department of
Human Services, Division of Aging Services, with funds provided by the USDA Food and
Nutrition Service,
For more information on the Farmers Market Nutrition Program, visit
www.nj.gov/agriculture/divisions/md/prog/wic.html.
For complete information on locations, days and hours of community farmers markets
throughout New Jersey, visit www.state.nj.us/jerseyfresh/searches/urban.htm.
LEGAL
SERVICES AND PROGRAMS
Legal services for older persons are provided under a number of existing programs
funded under the Legal Services Corporation Act, the Older Americans Act, and Title XX of
the Social Security Act. All Area Agencies on Aging/ADRC fund legal assistance to protect
and secure the rights of older persons 60 years of age and older. Legal assistance is
provided in priority areas, such as public entitlements, planning/protecting autonomy, health
care/long term care, family/domestic, housing/utilities, individual rights and consumer issues.
Legal Services Corporation Act - The purpose of this Act is to make legal assistance
available to those who face an economic barrier to adequate counsel. Although programs
63
LEGAL
Services and Programs, cont.
funded under the Legal Services Corporation Act make services available to all low-income
people without focusing on any group, priority consideration is given to clients with special
access difficulties or special unmet legal needs. Older persons are being confronted with the
challenge of protecting themselves or their loved ones from the threats of elder abuse,
neglect, and exploitation. Legal assistance and elder rights programs work with other AoA
programs and services to provide important protections for older persons.
Title XX - Title XX of the Social Security Act allocates funds to state governments for
social services into a single grant. This increases the state's flexibility in using the grants to
furnish services to achieve or maintain economic self-support to prevent, reduce or eliminate
dependency. Individuals can obtain legal help in civil matters such as housing, child support,
guardianship, paternity, and legal separation. Services are also directed toward preventing or
reducing institutional care by providing for community-based care, home-based care or other
forms of less intensive care and services to individuals.
Persons desiring information concerning services available under this or any of these
programs should contact their Area Agency on Aging/ADRC.
The Age Discrimination in Employment Act (ADEA) protects most persons 40
years of age or older from arbitrary age discrimination in hiring, discharge, pay, promotions,
fringe benefits (including health insurance, pension plan), and other aspects of employment.
Generally, older persons are protected if they work for a private employer of 20 or more
persons, or for any federal, state or local governmental agency. The ADEA's broad ban
against age discrimination specifically prohibits an age limit except in the rare circumstances
where age has proven to be a bona fide occupational qualification.
64
LEGAL
Penalties for Employer Violation - Employers found guilty of discrimination are
subject to penalties, which include: payment of damages, interest, liquidated damages,
attorney's fees, and court costs.
Filing a Charge
Equal Employment Opportunity Commission (EEOC) - Charges of unlawful
discrimination due to age must be filed with the U.S. Equal Employment Opportunity
Commission (EEOC). Every effort should be made to act on a discriminatory action as soon
as possible, given the strict time limits under the ADEA. First, you must file a charge within
180 days of the discriminatory act. State laws may extend this 180-day filing deadline to 300
days. Second, you should also attempt to file a timely charge under applicable state law.
EEOC's NJ office is located at 1 Newark Center, 21st Floor, Newark, NJ 07102. For
information about federal laws on job discrimination, call EEOC's toll-free number,
1-800-669-4000, TTY 1-800-669-6820, [email protected] or visit website at www.eeoc.gov.
NJ Division on Civil Rights - Complaints of age discrimination may also be filed with
the Division on Civil Rights, NJ Department of Law & Public Safety, PO Box 090, Trenton, NJ
08625-0090, telephone toll-free 1-800-830-0647 or 609-292-4605.
RECREATION
PARKS AND RECREATION AREAS
The National Park Service protects a wealth of forests, seas, rivers, lakes, mountains,
deserts, and grasslands and has endeavored to protect these areas—and the plants and
animals that call them home. The National Park Service is a participant in the Interagency
Pass Program which includes the National Park Service, U. S. Department of Agriculture,
Forest Service, Fish and Wildlife Service, Bureau of Land Management and Bureau of
Reclamation. A series of passes covers the entrance and standard amenity fees charged for
65
RECREATION
Parks and Recreations Areas, cont.
using federal recreational lands – including national wildlife refuges. This pass series is
collectively known as the America the Beautiful – National Parks and Federal
Recreational Lands Pass. The passes are the Annual Pass, the Senior Pass, the Access
Pass and the Volunteer Pass. Of these passes, three are specific to target populations. A
brief explanation of each pass follows. During National Park Week visitors can enjoy the
beauty and wonder of 84 million acres of the world’s most spectacular scenery, historic
places and cultural treasures for FREE!
Download a copy of The National Parks Owner’s Guide, the one-stop resource to
discover all 397 national parks at www.nationalparks.org/explore/download-center/.
American the Beautiful - National Parks and Federal Recreational Lands Pass Annual Pass (for the general public) - This Annual Pass admits the permit holder and any
accompanying passengers in a single, private, non-commercial vehicle. Where entry is not
by private vehicle, the pass permits the holder, spouse, children and parents to enter.
The Annual Pass is valid for entrance fees only; it does not cover use fees - e.g., fees
for camping or parking. (It is particularly useful for persons planning visits to several Park
System areas.) The pass may be purchased in person or by mail from a National Park
Service or Forest Services office, or at a Park System area, which charges an entrance fee.
The Annual Pass is valid for a 12-month period. It is not refundable or transferable.
American the Beautiful - National Parks and Federal Recreational Lands Pass Senior Pass (For persons age 62 and older) - The American the Beautiful - National Parks
and Federal Recreational Lands Pass - Senior Pass is a lifetime entrance permit for persons
age 62 or older, to national parks, monuments, historic sites, recreation areas, and national
Wildlife refuges which charge entrance fees. It also provides the pass holder a 50% discount
66
RECREATION
Parks and Recreations Areas, cont.
on federal use fees charged for facilities and services such as parking, camping, boat
launching, etc. The pass can only be obtained in person at the park. The pass is nontransferable and generally does NOT cover or reduce special recreation permit fees or fees
charged by concessionaires.
The American the Beautiful - National Parks and Federal Recreational Lands
Pass (Access Pass) (For Blind and Permanently Disabled Persons) - The American the
Beautiful - National Parks and Federal Recreational Lands Pass (Access Pass) is a free
lifetime entrance permit to those national parks, monuments, and recreation areas, which
charge entrance fees. It is issued to persons who have been medically determined to be
blind or permanently disabled, and as a result are eligible to receive benefits under federal
law. The pass also provides the pass holder a 50% discount on federal use fees charged for
facilities and services such as parking, camping, boat launching, and specialized interpretive
services. The pass is free and can only be obtained in person at the park. The pass is
available at most federally operated recreation areas. Medical proof of permanent disability
or blindness must be supplied.
America the Beautiful - National Parks and Federal Recreational Lands Pass Volunteer Pass - Free - The America the Beautiful - National Parks and Federal
Recreational Lands Pass - Volunteer Pass - is for volunteers acquiring 500 service hours on a
cumulative basis. This pass is the equivalent of the Annual Federal Lands Pass and is issued
as a thank you for hard working volunteers in our national parks. Volunteering is an American
tradition that has made an immeasurable contribution to communities, organizations, and
individuals throughout the country. The major objective of the program is to utilize this
67
RECREATION
Parks and Recreations Areas, cont.
voluntary help in such a way that is mutually beneficial to the National Park Service and the
volunteer.
The Federal Duck Stamp is a mandatory permit to hunt waterfowl and can be
purchased at most post offices, many national wildlife refuges, and local sporting goods
stores. The stamp is also available online at www.duckstamp.com or by calling the Federal
Duck Stamp Office at 703-358-2000. For an additional fee, a Golden Eagle sticker may be
purchased and affixed to a National Parks Pass to cover entrance fees at not only national
parks, but also at sites managed by the U.S. Fish and Wildlife Service, the U.S. Forest
Service, and the Bureau of Land Management. The Golden Eagle sticker is valid until the
expiration of the National Parks Pass to which it is affixed.
For information on any American the Beautiful - National Parks and Federal
Recreational Lands Pass contact: National Park Service, 200 Chestnut St., U.S. Custom
House Building, Philadelphia, PA 19106, toll-free at 1-877-465-2727 or website
www.nps.gov.
National Parks Located in New Jersey:

Delaware Water Gap Recreation Area, Kittatinny Point, NJ/PA

Gateway National Recreation Area, Sandy Hook, NJ/NY

Great Egg Harbor Scenic and Recreational River, Mays Landing, NJ

Morristown National Historical Park, Morristown, NJ

New Jersey Coastal Heritage Trail Route, Newport, NJ

Paterson Great Falls National Historical Park, Paterson, NJ

Pinelands National Reserve, New Lisbon, NJ

Statue of Liberty/Ellis Island National Monument, Liberty State Park, NJ/NY
68
RECREATION
Parks and Recreations Areas, cont.

Thomas Edison National Historical Park, West Orange, NJ
The NJ Senior Citizen Park Pass is available for purchase at Morristown National
Historical Park’s (NHP) Washington’s Headquarters unit at 30 Washington Place, Morristown
at the park’s Jockey Hollow Visitor Center and Thomas Edison National Historical Park, 211
Main Street, West Orange 07052.
For additional information on New Jersey's State historic sites or parks, call
1-800 843-6420 or 609-984-0370. Text telephone users call NJ Relay Services at
1-800-852-7899 or visit website www.njparksandforests.org.
TAX BENEFITS
Federal Income Tax Benefits
In general, the federal income tax laws apply to all taxpayers regardless of age.
However, there are certain provisions, which give special treatment to older persons. At age
65, the standard deduction, if you do not itemize deductions, is increased for both single
taxpayers and married taxpayers filing jointly. The Internal Revenue Service (IRS) also
allows an addition to the standard deduction for blindness, regardless of age.
Persons with low income, who are age 65 or under 65 and on permanent and total
disability, may be eligible for a Tax Credit for the Elderly. You are a qualified individual for
this credit if you are a U. S. citizen or resident at the end of the tax year, and meet eligibility
guidelines.
For further information, please consult IRS Publication 524, "Credit for the Elderly or
Disabled." This publication may be obtained by calling the IRS Publications/Forms toll-free
telephone 1-800-829-3676 or download at www.irs.gov/publications/p524/index.html.
69
TAX BENEFITS
Sale of Principal Place of Residence - Persons age 55 or older selling their principal
place of residence may exclude from their gross income up to $250,000 for single filers or
$500,000 for joint filers of the capital gain on a one-time basis, provided they owned and
occupied the residence for two of the five years ending on the date of sale. IRS Form 2119
must be filed with the Internal Revenue Service the year in which the property is sold.
Taxpayer Advocate Service - While the IRS is improving its systems and providing
better service, some taxpayers still have difficulty obtaining solutions to a problem or an
appropriate response to an inquiry. To make sure that all taxpayer problems receive equal
consideration, the taxpayer advocate service provides someone to speak for them within the
service-- an advocate. Taxpayers facing significant hardships due to an action or inaction on
the part of the IRS may now apply to the IRS for assistance. This service of the IRS may be
requested through filling out IRS Form 911. For further information, call the IRS toll-free
number, 1-877-777-4778 or visit website www.irs.gov.
IRS Tax Counseling/Assistance - Through the Tax Counseling for the Elderly (TCE)
program, IRS-trained volunteers assist individuals age 60 and over with their tax returns at
various neighborhood locations. In addition, certain volunteer income tax assistance aides
(VITA) have been trained to help older persons with their tax returns.
For further information regarding site locations, please contact your Area Agency on
Aging/ADRC.
For more information on TCE call 1-800-829-1040.
To locate the nearest AARP Tax-Aide site in your community during the tax season,
call 1-888-AARP-NOW (1-888-227-7669) or visit www.AARP.org/taxaide.
70
VETERANS' BENEFITS
For veterans of service with the armed forces of the United States, there are services
and programs offered by the U.S. Department of Veterans Affairs (VA), especially for those
who are wartime veterans.
There are eligibility or other requirements connected with the various benefits. You
may be eligible if you were discharged under other than dishonorable conditions and you
served 90 days or more of active duty with at least 1 day during a period of wartime. In
addition to federal benefits, there are also benefits and services available to eligible veterans
who are residents of NJ. These benefits are provided by the NJ Department of Military and
Veterans' Affairs.
VA Welcoming Vets Home - Welcome home and thank you for your service to our
country! The Department of Veterans Affairs (VA) has launched its “Returning Veterans;
website – www.oefoif.va.gov - to welcome home veterans. The website is a social, veteran
–centric web site focusing on their needs and questions. Following are some of the benefits
VA provides.
Veterans' Pensions -To qualify for veterans compensation and pensions, you must
have a service related disability and have received an honorable discharge. Veterans who
served in a war, whose incomes are low, will not be considered totally disabled and eligible
for a pension unless the VA determines that they are not employable.
Disability Compensation - The VA pays compensation on disabilities incurred in, or
aggravated by, military service. Wartime Veterans with service-connected disabilities with
limited income who are no longer able to work may qualify. Some income is not counted
toward the yearly limit, but eligibility requirements include family income. The VA payments
will be the difference between your family income and the yearly income limit, which
describes your situation.
71
VETERANS' BENEFITS
Medical Care - VA Health Care Programs offer quality care in the most efficient
manner. The goal is to prevent and lessen the burden of disability on older, frail chronically ill
patients and their families/caregivers, and to maximize each patient's independence.
Eligibility for VA outpatient treatment, inpatient care and nursing home care is subject to
various constraints and restrictions.
Veterans who may be eligible for the US Department of Veterans Affairs' (VA) health
benefits should call for information toll-free at 1-877-222-8387. If there is a medical
emergency or need for immediate crisis counseling, please go to your nearest medical facility
emergency room or call 911. Veterans’ Crisis Intervention Hotline 1-888-899-9377, Suicide
Hotline 1-800-273-TALK (1-800-273-8255) counselors are available 24 hours a day.
Prescription Drug Coverage - You may be eligible for the VA low-cost prescription
drug program if your present illness is not service connected. If you are being provided
treatment, necessary prescriptions will also be provided. A co-payment is charged for each
30 day or less supply of medications provided on an outpatient basis for the treatment of a
nonservice-connected disability. Veterans with a service-connected disability rated 50% or
more and veterans who meet income requirements are exempt from paying this co-payment.
Home Loans - VA guaranteed loans are made by private lenders, such as banks or
mortgage companies to eligible veterans for the purchase of a home which must be for
their own personal occupancy. The VA offers home loan guarantees as protection against
default.
Homelessness - As part of the national VA effort to assist homeless veterans, grants
have been awarded to non-profit and local government agencies to develop or expand
programs to provide services to homeless veterans. Eligible transitional projects serve
72
VETERANS' BENEFITS
Homelessness, cont.
veterans in need of housing and supportive services, and provide outreach and referral,
vocational counseling, rehabilitation and community support.
Death Benefits - Death benefits may be provided to eligible widow(er)s, and children
of qualified veterans. Survivors may also take advantage of burial expense assistance burial flags, headstone or grave markers, burial plot in a national cemetery, memorial
markers, or memorial plots. If the death is service related VA will pay up to $1,500 toward the
burial expenses. If the death is nonservice related, VA will pay up to $300 toward burial and
funeral expenses and a $150 plot interment allowance.
Denial of Benefits - Persons who have been denied veterans' benefits, or had their
payments or services stopped or reduced, have certain appeals procedures available free of
charge. Contact the VA for information.
Other Services, Benefits - Other services or benefits to veterans which may be
provided through the VA include: dental care, prosthetic devices, special assistance to the
blind, grants for specially adapted housing, federal employment preference, and Military
Exchange & Commissary Privileges.
Uniformed Services Beneficiaries - All uniformed services beneficiaries 65 years of
age or older who are eligible for Medicare must be enrolled in Medicare Part B to use the
pharmacy program. They will be able to use the military's National Mail Order Pharmacy
Program to buy a 90-day supply of a drug or a 30-day supply of brand-name prescription
drugs, or a 30-day supply of generic prescription drugs. For those outside of the TRICARE
network, you can get prescriptions mail order or a non-network retail benefit that has a
deductible and a co-payment. If you are near a base pharmacy and get your prescriptions
there, they will be free.
73
VETERANS' BENEFITS
Uniformed Services Beneficiaries, cont.
For information about TRICARE call 1-877-874-2273 or for TRICARE pharmacy
information 1-877-363-6337.
During a Special Enrollment Period, uniformed services retirees were given the
opportunity to enroll in Medicare Part B, TRICARE Prime (the military's managed-care plan)
or choose a civilian provider with no penalties imposed. Eligible retirees who turned down
enrollment in Medicare Part B during this "open enrollment" period are ineligible for
TRICARE benefits.
TRICARE For Life - the Medicare-wraparound coverage for TRICARE beneficiaries
entitled to Medicare Part A and purchase Medicare Part B. Payment of the monthly
Medicare premium is required. Supplemental insurance policies may not be necessary as
TRICARE programs offer comprehensive health benefits. For services covered by Medicare
and TRICARE, TRICARE will pick up whatever costs, fees, or deductible Medicare does not.
For services not covered by Medicare or TRICARE, you are responsible for the
entire bill.
For TRICARE eligibility information and other military retiree benefit questions, please
call 1-800-538-9552 or visit website www.tricare.osd.mil.
Veterans’ Information - To contact the U.S. Department of Veterans Affairs’ (VA)
telephone 1-800-827-1000.
Additional VA Assistance
For the VA Health Benefits:

Service Center, call toll-free at 1-877-222-VETS (8387); TDD - 1-800-829-4833

Caregivers Support - 1-855-260-3274

Education & Training - 1-888-442-4551
74
VETERANS' BENEFITS
Additional VA Assistance, cont.

Family Caregivers Support - 1-855-260-3274

Headstones/Markers - 1-800-697-6947

Life Insurance - 1-800-669-8477

Special Issues - 1-800-749-8387

VA Inspector General - 1-800-488-8244
Information and assistance may also be obtained from the NJ Department of Military &
Veterans' Affairs, Eggerts Crossing Road, PO Box 340, Trenton, NJ 08625-0340, telephone
toll-free 1-888-8NJ-VETS (1-888-865-8387) or 609-530-6868 or visit the website
www.nj.gov/military or www.va.gov.
VOLUNTEER OPPORTUNITIES
THE CORPORATION FOR NATIONAL AND COMMUNITY SERVICE (CNCS)
The Corporation for National and Community Service engages Americans in service
through Senior Corps, AmeriCorps, and Learn and Serve America. CNCS explore, develop,
and model effective approaches for using volunteers to meet the nation's human needs, and
conducts and disseminates research that helps develop and cultivate knowledge that will
enhance the overall effectiveness of national and community service programs. The
corporation helps to meet local needs through a wide array of service opportunities.
The National Senior Service Corps - or SENIOR CORPS - Serving through local
sponsoring agencies and organizations, the SENIOR CORPS connects today’s seniors with
the people and organizations that need them most. Older adults have the opportunities to
make a difference to others and get things done in the community as mentors, coaches or
companions to people in need, or contribute their job skills and expertise to community
75
VOLUNTEER OPPORTUNITIES
The National Senior Service Corps - or SENIOR CORPS, cont.
projects and organizations. Volunteers for SENIOR CORPS must be 55 years of age or over.
Those who meet certain income guidelines may receive a small stipend.
Foster Grandparent Program (FGP) - provides stipends, transportation and other
support services to low-income elders working as part-time volunteers who provide
one-on-one assistance to children with special and exceptional needs. They serve children
who have disabilities, those who are abused and neglected, and teen parents and their
children. Some members care for children who are HIV-positive or addicted to drugs. You
serve as mentors to youth and help children learn to read, provide one-on-one tutoring, and
guide children at a critical time in their lives. You give the kind of comfort and love that sets a
child on the path toward a successful future.
Retired and Senior Volunteer Program (RSVP) - The program provides a variety of
opportunities for retired persons aged 60 or older to participate more fully in the life of their
community through significant volunteer service. Retired or semi-retired persons serve in a
variety of agencies, organizations, and institutions designated as volunteer stations. These
include courts, schools, libraries, day care centers, hospitals, nursing homes, Boy and Girl
Scout offices, economic development agencies, and other community service centers.
RSVP volunteers serve without compensation, but may be reimbursed for such expenses as
transportation.
Senior Companion Program (SCP) - The Senior Companion Program (SCP) offers
part-time volunteer community service opportunities for low-income persons age 60 and over.
The volunteers work in community service activities serving adults with physical, mental or
emotional impairments. They assist primarily homebound frail elderly persons and others
with special needs. Services may include short-term acute care assistance, non-medical
76
VOLUNTEER OPPORTUNITIES
Senior Companion Program (SCP), cont.
personal care and social/recreational activities. Volunteers receive a modest stipend and
other benefits.
Program Availability - Not every county in NJ offers opportunities to serve in FGP,
RSVP or SCP programs. To find out if any of these programs are available in your area,
contact Senior Corps, 44 South Clinton, Suite 312, Trenton, NJ 08609-1507, 609-989-2246,
Fax: 609-989-2304 or, 1201 New York Avenue, NW, Washington, DC 20525, 1-202-6065000, TTY: 1-800-833-3722.
PEACE CORPS
There is no upper age limit for service with the Peace Corps. The Peace Corps
actively recruits older persons to serve as senior volunteers. Persons accepted as volunteers
agree to spend at least two years assisting people of developing countries with meeting their
basic needs for food, health care, shelter, education, and economic development. While
volunteers continue to do important work like bringing clean water to communities and
teaching children, today's volunteers also work in areas like HIV/AIDS awareness, information
technology, and business development. Volunteers are trained for living in different cultures
and in the jobs they will do.
Volunteers receive a monthly living allowance, health services, and vacation. In
addition, there is a readjustment allowance set aside by the Peace Corps, payable upon
completion of service. Some student loans are eligible for deferment and some for partial
cancellation. A life insurance policy is optional, but all volunteers are covered by the Federal
Employees Compensation Act for disabilities incurred in training and during service. By itself,
service with the Peace Corps will not affect a volunteer's Social Security benefits, or federal
civil service/military pension. Service as a volunteer is counted as time in service for the
77
VOLUNTEER OPPORTUNITIES
PEACE CORPS, cont.
purpose of accruing years employed by the federal government. To have time spent as a
volunteer count toward federal retirement; a volunteer must be employed with the federal
government for at least one year following service with the Peace Corps. Unlike other
international volunteer programs, there is no fee to participate in the Peace Corps.
Information - Call the Peace Corps Recruiting Office, toll-free, at 1-800-424-8580, or
contact Peace Corps, 201 N. Varick St., Suite 1025, New York, NY 10014, 212-352-5440, Fax
212-352-5441, [email protected]
SCORE PROGRAMS
Service Corps of Retired Executives (SCORE) is a volunteer program of the U.S.
Small Business Administration (SBA). Through SCORE, volunteer business executives with
management and technical expertise are connected with owners/managers of small
businesses needing management counseling. SCORE volunteers provide confidential
business mentoring services, both in person and online. Volunteering as a SCORE mentor
means you are joining a community of volunteers who are committed to helping small
business owners succeed.
SCORE volunteers work in their home communities or nearby. They provide their
services without charge but are reimbursed for out-of-pocket expenses. Almost any small
independent business not dominant in its field can apply to SCORE. The approach is
completely confidential, person-to-person, and at no cost to the small business. A business
does not have to have a SBA loan to qualify nor even to be in operation yet. Pre-business
consulting is an important part of these services.
78
VOLUNTEER OPPORTUNITIES
SCORE Programs, cont.
To find out the location of the office nearest you, and the day(s) and hours of
operation, contact the SCORE Northwest, Central or Southern office. The addresses of these
offices are as follows:
U.S. Small Business Administration (SBA)
Northwest NJ SCORE
c/o CCM Morristown
30 Schuyler Place - Suite 220,
Morristown, NJ 07960
973- 442-6400
Central Jersey SCORE
Raritan Valley College
14 Vogt Drive
Bridgewater, NJ 08807
908-526-1200 (8235)
E-mail:
[email protected]
rsey-score.org
Southern New Jersey
SCORE
Burlington County
College
100 Technology Way
Mount Laurel, NJ 08054
856-457-8372
1-800-634-0245 - www.score.org
AMERICORPS
AmeriCorps (the domestic Peace Corps) is the national service program that provides
people of all ages and backgrounds with education awards in exchange for a year or two of
community service.
To find out more about AmeriCorps and other national service programs, please contact
New Jersey National & Community Service, 44 South Clinton, Suite 312, Trenton, NJ 08609,
609-989-2246 www.state.nj.us/state/programs/dos_program_americorps.html.
VOLUNTEERS IN SERVICE TO AMERICA (VISTA)
Volunteers in Service to America (VISTA) is a volunteer program for persons 18 years
of age or older to work with low-income persons to assist them in improving the conditions of
their lives. VISTA volunteers are assigned to local sponsors who may be state or local public
agencies, or private non-profit organizations. They live and work among the poor, sharing their
skills and experience in areas such as: drug abuse, literacy, employment training, food
79
VOLUNTEER OPPORTUNITIES
VISTA, cont.
distribution, shelter for the homeless, neighborhood revitalization, domestic violence, health
outreach and education, and senior nutrition.
For more information on the VISTA program, contact the NJ Corporation for National
Service, 44 South Clinton Ave., Suite 312, Trenton, NJ 08609, telephone 609-989-2246.
To learn more about National Service call 202-606-5000 or TTY 1-800-833-3722.
The Corporation for National and Community Service leads the national call to service
initiative.
For further information contact Corporation for National and Community Service, 1201
New York Avenue, NW, Washington, DC 20525, 202-606-5000, TTY: 1-800-833-3722,
e-mail: [email protected] or visit NationalService.gov or Serve.gov.
Appendix
Area Agencies on Aging/ADRC
ADRC TOLL-FREE 1-877-222-3737
ATLANTIC COUNTY DIVISION OF INTERGENERATIONAL SERVICES 1-609-645-7700
Ext. 4700, Shoreview Building, Office 222, 101 South Shore Road, Northfield 08225
BERGEN COUNTY DIVISION OF SENIOR SERVICES 201-336-7400
One Bergen County Plaza, 2nd Floor, Hackensack 07601-7000
BURLINGTON COUNTY OFFICE ON AGING 609-265-5069
County Office Building, 49 Rancocas Road, PO Box 6000, Mt. Holly 08060
CAMDEN COUNTY DIVISION OF SENIOR and DISABLED SERVICES 856-858-3220
Parkview on the Terrace, 700 Browning Road, Suite 11, West Collingswood 08107
CAPE MAY COUNTY DEPARTMENT OF AGING & DISABILITY SERVICES
609-886-2784/2785, Social Services Building, 4005 Route 9, South, Rio Grande 08242
CUMBERLAND COUNTY OFFICE ON AGING & DISABLED 856-453-2220/2221
Administration Building, 800 East Commerce Street, Bridgeton 08302
ESSEX COUNTY DIVISION OF SENIOR SERVICES 973-395-8375
900 Bloomfield Avenue, Verona 07044
GLOUCESTER COUNTY DIVISION OF SENIOR SERVICES 856-384-6900
115 Budd Boulevard, West Deptford, NJ 08096
HUDSON COUNTY OFFICE ON AGING 201-369-4313
595 County Avenue, Building 2, Secaucus 07094
HUNTERDON COUNTY DIVISION OF SENIOR, DISABILITIES AND VETERANS SERVICES
908-788-1361/1362/1363, 4 Gaunt Place, Bldg. 1, P.O. Box 2900, Flemington 088222900
81
AREA AGENCIES ON AGING/ADRC, cont.
MERCER COUNTY OFFICE ON AGING 609-989-6661/6662
640 South Broad Street, P.O. Box 8068, Trenton 08650
MIDDLESEX COUNTY OFFICE OF AGING AND DISABLED SERVICES 732-745-3295
John F. Kennedy Square, 5th Floor, New Brunswick 08901
MONMOUTH COUNTY DIVISION ON AGING, DISABILITIES & VETERANS SERVICES
732-431-7450, 21 Main and Court Center, Freehold 07728
MORRIS COUNTY DIVISION ON SENIORS, DISABILITIES AND VETERANS 973-285-6848
340 West Hanover Avenue, Ground Floor, PO Box 900, Morristown 07963-0900
OCEAN COUNTY OFFICE OF SENIOR SERVICES 732-929-2091
1027 Hooper Avenue, Building #2, P.O. Box 2191, Toms River 08754-2191
PASSAIC COUNTY DEPARTMENT OF SENIOR SERVICES, DISABILITIES & VETERANS’
AFFAIRS 973-569-4060, 930 Riverview Drive, Suite 200, Totowa, NJ 07512
SALEM COUNTY OFFICE ON AGING 856-339-8622
98 Market Street, Salem 08079
SOMERSET COUNTY AGING AND DISABILITY SERVICES 908-704-6346
27 Warren Street, First Floor, PO Box 3000, Somerville 08876-1262
SUSSEX COUNTY DIVISION OF SENIOR SERVICES 973-579-0555
Administrative Center, 1 Spring Street, 2nd Floor, Newton 07860
UNION COUNTY DIVISION ON AGING 908-527-4870
County Administration Building, Elizabeth 07207
WARREN COUNTY DIVISION OF AGING & DISABILITY SERVICES 908-475-6591
165 County Road, Suite 245, Route 519 South, Belvidere 07823-1949
82
SUMMARY OF TOLL-FREE TELEPHONE NUMBERS USED IN
THIS PUBLICATION
Aging and Disability Resource Connection (ADRC)...….….…
1-877-222-3737
Area Agency on Aging/ADRC (AoA).……..…………...…..
1-877-222-3737
Citizen Information Center (Federal)(FCIC).....…….....……
1 800 FED-INFO
(1-800-333-4636)
Civil Service Retirement (Federal)...………..….…….……
1-888-767-6738
Continuing Coverage After Leaving Employment (COBRA)..…
1-866-444-EBSA
(1-866-444-3272)
Direct Deposit (Social Security)..…........…..……….……
1-800-333-1795
Division on Civil Rights (NJ)………………..……….……
1-800-830-0647
Employee Benefits Security Administration (DOL)..…….……
1-866-444-3272
Employee Plans Technical & Actuarial Division (IRS).….……
1-877-829-5500
Equal Employment Opportunity Commission (U.S.) (EEOC)..…
1-800-669-4000
FamilyCare (NJ Medicaid).………………..…..…….……
1-800-356-1561
Food Stamp Program
(Supplemental Nutrition Assistance Program (NJ SNAP)) 1-800-687-9512
SNAP (Food Stamp) Fraud Activity..…….…..……….……
1-800-424-9121
Health Benefit Plans (Federal).……………..……….……
1-866-275-7922
Health Centers (Federal Qualified) - Medicare (FQHCs).…..…
1-800-328-3838
Health Coverage Tax Credit………………..……….……
1-866-626-4282
Historic Sites or Parks (New Jersey)…….....………...……
1-800 843-6420
……………..……………..………..……
TTY
1-800-852-7899
Homeless/Homeless Prevention...…………..……….……
1-866-889-6270
Housing and Mortgage Finance Agency (New Jersey)……..
1-800-NJ-HOUSE
(1-800-654-6873)
83
SUMMARY OF TOLL-FREE TELEPHONE NUMBERS, cont.
Housing and Urban Development (US HUD)................……
1-800-669-9777
Housing Call Resource Center (HUD)..…….......…….……
1-800-955-2232
Housing Lists.…………...……………..…...…….……
1-800-792-8820
Internal Revenue Service (IRS) Publications.………….……
1-800-829-3676
Life Insurance...………………………..………....……
1-800-669-8477
Low Income Home Energy Assistance Program (LIHEAP)...….
1-800-510-3102
Meal Services (Programs Providing).....……..……….……
1-877-222-3737
Medicare.…….…………………………..……….…
1-800-MEDICARE
(1-800-633-4227)
Medicare TTY.………….....…..………….......……1-877-486-2048
Military & Veterans' Affairs (NJ)...…....................………
1-888-8NJ-VETS
1-888-865-8387
New Jersey Primary Care Association (NJPCA).…...….……
1-800-328-3838
NJ Protect (Pre-existing Condition Insurance) Contacts
………..……….…...…
..……….…..…
AmeriHealth of New Jersey 1-866-681-7368
Horizon Blue Cross Blue Shield of NJ 1-888-551-2130
Nutrition Programs (Senior).………………..……….……
1-877-222-3737
Parks (American the Beautiful)
Federal Recreational Lands Pass.…..…...…….……
1-877-465-2727
Patients' Rights, Quality of Care Complaints.………….……
1-800-624-4557
Peace Corps.…………………………..……...….……
1-800-424-8580
Pension Benefit Guaranty Corporation (PBGC) (Federal).……
1-800-400-7242
Pension Counseling Center.………………..……….……
1-800-355-7714
Pension Plan Administration (Federal)...…..……...….……
1-800-736-2444
84
SUMMARY OF TOLL-FREE TELEPHONE NUMBERS, cont.
Pension Plan Regulations (ERISA) (Private Federal)...………
1-877-829-5500
Pension Rights Center…………………..………....……
1-800-355-7714
Personnel Management (U.S.) .……..…...........…….…… 1-888-767-6738
Prescription Help Rx4NJ.…………………..……….……
1-888-793-6765
Railroad Retirement Board.……….………..……….……
1-877-772-5520
Railroad Retirement Medicare Information.…………………
1-877-772-5772
Reverse Mortgage Education Program
(AARP).………........................................……
1-800-209-8085
National Council on Aging (NCOA)…...............……
1-800- 510-0301
Senior Medicare Patrol Project (SMP of NJ).....……….……
1-877-767-4359
Service Corps (National) - or SENIOR CORPS.……….……
1-800-942-2677
Service Corps of Retired Executives (SCORE)..……….……
1-800-634-0245
Small Business Administration (SBA) (U.S.)......……….……
1-800-634-0245
Social Security.…………………………..……….……
1-800-772-1213
Social Security TTY..………………..……….……
1-800-325-0778
.….……………………………..……….
1-800-749-8387
State Health Insurance Assistance Program (SHIP)…….……
1-800-792-8820
Special Issues
Supplemental Nutrition Assistance Program (SNAP Fraud)
(Food Stamp Fraud)...............................................1-800-424-9121
Tax-Aide Sites (AARP)…………………………….……
1-888-227-7669
Taxpayer Advocate Service (Internal Revenue Service (IRS)....
1-877-777-4778
Taxpayer TDD……….........……..……….…...…
1-800-829-4833
Tax Counseling/Assistance - Internal Revenue Service (IRS)…
1-800-829-1040
TRICARE.……………………………..……….…...…
1-877-874-2273
.
85
SUM
MMARY OF
F TOLL-FR
REE TELEP
PHONE NUMBERS, co
ont.
TRIC
CARE Eligibility………………
………..…
……...….……
1-8
800-538-95
552
TRIC
CARE Pharrmacy.……
……….…
…………...………..……
1--877-363-63
337
TRICAR
RE TTY.……………
…………...………..……
1--866-626-42
282
Univ
versal Service Fund (U
USF)......…
……..........………..……
1--866-240-13
347
Vete
erans’ Inforrmation
Crisis In
ntervention Hotline.….………. .……….……
1-8
888-899-93
377
General Information.……….………...………..……
1--800-827-10
000
Headsto
ones/Marke
ers.………
…………...………..…… 1-8000-697-69447
Inspecto
or General.…………
…...……..……….…… 1-8800-488-82444
Health Benefits
B
Service Cente
er.……... ……….…
……
1-8
877-222-VE
ETS
(1-8
877-222-838
87)
Life Insu
urance.……
…………
…………...……….…… 1-800-669-84777
Special Issues.……………
…………..……….…… 1-8800-749-83887
………..…
………...…
……
Suicide Hotline.……………
1-8
800-273-TA
ALK
(1-800-273-825
55)
Wea
atherization
n Assistance
e Program....…......
.
.........….……
1-866-551-71
165
86
For information on benefits, programs and services provided to older persons by the State
of New Jersey, please consult our companion publication, STATEWIDE BENEFITS FOR
OLDER PERSONS.
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