The MOCHA Center, Inc.
Let Us Help Navigate Your Path Towards Healthcare.
AIDS Drug Assistance Program (ADAP)
The AIDS Drug Assistance Program (ADAP) provides free medications for the treatment of HIV/AIDS and opportunistic infections. The drugs provided through ADAP can help people with HIV/AIDS to live longer and treat the symptoms of HIV infection. ADAP can help people with partial insurance or who have a Medicaid spenddown requirement.
Click here to find an ADAP location near you.
ADAP Plus (Primary Care)
ADAP Plus (Primary Care) provides free primary care services at selected clinics, hospital outpatient departments, office based physicians and lab vendors. The services include ambulatory care for medical evaluation, early intervention and ongoing treatment.
Click here to find an ADAP location near you.
HIV Home Care Program
The HIV Home Care Program provides coverage for home care services to chronically medically dependent individuals as ordered by their physician. The program covers skilled nursing, home health aide services, intravenous therapy administration, medications and supplies and durable medical equipment when ordered by a doctor for specific conditions. Services must be provided through a home care agency which has enrolled in the program.
ADAP Plus Insurance Continuation (APIC)
APIC can pay for commercial health insurance premiums for ADAP eligible clients. APIC will pay for the continuation of a cost effective policy for people presenting to the program who: have existing coverage purchased directly from an insurance company or agent, coverage through their employer where the employee contribution for the coverage creates a financial hardship or COBRA coverage when a person loses their job and cannot afford the premiums. Policies considered for payment must be comprehensive and provide full prescription and primary care coverage without annual coverage caps.
Medicaid
Medicaid is a program for New Yorkers who can’t afford to pay for medical care. You are eligible if you have high medical bills, you receive Supplemental Security Income (SSI), and you meet certain financial requirements.
Medicaid Spenddown
The Medicaid Excess Income Program is sometimes referred to as the “Spenddown program” or the “Surplus Income program”. ADAP can help people who have a Medicaid spenddown requirement. If your monthly income is over the Medicaid level, you may still be able to get help with your medical bills. The amount your income is over the Medicaid level is called excess income. It is like a deductible. If you are eligible for Medicaid except for having excess income and you can show that you have medical bills equal to your excess income in a particular month, Medicaid will pay your additional medical bills beyond that for the rest of that month. This includes outpatient care, doctor and dental visits, lab tests, prescription drugs, and long-term care in the community such as home care and assisted living. There are special rules for hospital stays.
Family Health Plus (FHP)
Family Health Plus is a public health insurance program for adults who are aged 19 to 64 who have income too high to qualify for Medicaid. Family Health Plus is available to single adults, couples without children, and parents who are residents of New York State and are United States citizens or fall under one of many immigration categories.
Family Health Plus provides comprehensive coverage, including prevention, primary care, hospitalization, prescriptions and other services. There are minimal co-payments for some Family Health Plus services. Health care is provided through participating managed care plans in your area.
Child Health Plus (CHP)
Children under the age of 19 who are residents of New York State are eligible for either Children’s Medicaid or Child Health Plus. Whether a child qualifies for Children’s Medicaid or Child Health Plus depends on gross family income. Children who are not eligible for Medicaid can enroll in Child Health Plus if they don’t already have health insurance and are not eligible for coverage under the public employees’ state health benefits plan. Some children who were covered by employer-based health insurance within the past six months may be subject to a waiting period before they can be enrolled in Child Health Plus. Determining whether your child is subject to a waiting period will depend on your household income and the reason your child lost employer-based coverage.
Healthy New York
As a result of the Health Care Reform Act of 2000, the state of New York established Healthy NY. Healthy NY supports comprehensive and quality health care and insurance for employees and owners of small businesses (50 or fewer employees) in New York, their dependents and other qualified family members. Healthy NY also aids sole proprietors and those whose employers do not offer health insurance as part of an employment package in New York.
Several packages are available through the program, some with limited and some with no prescription coverage. There is a pre-existing condition limitation wherein if an applicant has been either treated for or diagnosed with in the previous six months, that condition may be excluded from coverage for up to a year. This period will be reduced or waived if the individual had prior insurance coverage and did not break that coverage for longer than 63 days.
Elderly Pharmaceutical Insurance Coverage (EPIC)
Elderly Pharmaceutical Insurance Coverage (EPIC) Program is available for New York State residents 65 or older with annual income under $35,000 (single) or $50,000 (married). Participants must also join a Medicare Part D plan (with limited exceptions). Seniors with moderate incomes pay a low quarterly fee, and participate in the Fee Plan. Seniors with higher incomes must meet an annual deductible, and participate in the Deductible Plan. Those who pay a fee or those who have met their deductible pay a co-payment at the pharmacy when purchasing prescriptions.
Medicare Part D
Medicare is a Federal health insurance program that pays for hospital and medical care for elderly and certain disabled Americans. The program consists of two main parts for hospital and medical insurance (Part A and Part B) and two additional parts that provide flexibility and prescription drugs (Part C and Part D). Medicare Part D is a prescription drug plan administered by one of several private insurance companies, each offering a plan with different costs and lists of drugs that are covered.
Participation in Part D requires payment of a premium and a deductible. Pricing is designed so that 75% of prescription drug costs are covered by Medicare if you spend between $250 and $2,250 in a year. The next $2,850 spent on drugs is not covered, but then Medicare covers 95% of what is spent past $3,600. ADAP can help pay for Medicare parts B and D premiums , deductibles.
Medicare Advantage
Medicare Advantage Plans are health plan options (like an HMO or PPO) approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called “Part C” or “MA Plans.” Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. This means they must cover at least all of the services that Original Medicare covers. However, each Medicare Advantage Plan can charge different out-of-pocket costs. These are usually co-payments but can also be coinsurance and deductibles.
Private Health Insurance
APIC can pay for commercial health insurance premiums for ADAP eligible clients. APIC will pay for the continuation of a cost effective policy for people presenting to the program who: have existing coverage purchased directly from an insurance company or agent, coverage through their employer where the employee contribution for the coverage creates a financial hardship or COBRA coverage when a person loses their job and cannot afford the premiums. Policies considered for payment must be comprehensive and provide full prescription and primary care coverage without annual coverage caps.
New York Bridge Plan
. . . is New York State’s Pre-existing Condition Insurance Plan (PCIP), Providing individual coverage to eligible New Yorkers with a preexisting health condition who have not had health coverage for at least six months.
Once a person is enrolled, there is no waiting period and , medical coverage begins immediately.
This program is administered by Group Health Incorporated (GHI), a state-wide insurance carrier providing quality health insurance to New Yorkers since 1937.
For Eligible New Yorkers – To be eligible to apply, you must:
- Be a legal US resident
- Be a resident of New York State
- Have one or more pre-existing medical condition(s) listed
- Not have had health care coverage for the last six months.
There is no minimum age to qualify — even newborns may be enrolled if they meet the eligibility requirements. However, once you turn 65 years of age and have Medicare coverage, you will no longer be Eligible for the NY Bridge Plan. Applicants who transfer from another State’s PCIP program will be eligible if they are a resident of New York. With no more than a 180-day break in coverage from their prior PCIP coverage.
Rates
With the NY Bridge Plan, your eligibility is not based on income. In fact, the NY Bridge Plan offers premium rates that are significantly lower than other individual coverage, plus low copayments and no deductibles. Premium rates are standardized depending on where you live. These rates are for individuals only, as there is no family or dependent coverage offered with the NY Bridge Plan. If other family members qualify, they may also apply for coverage separately. Accepted members will be billed individually and be fully responsible for paying the monthly premium. For individuals who meet the eligibility criteria, ADAP can pay the premiums and copayments.
Call for More Information:
To schedule a free and confidential health care screening, with one of our Health Access Specialist you can call (716) 852-1142.
Discussion
No comments yet.