The Centers for Medicare and Medicaid Services (CMS) falls under the U.S. Department of Health and Human Services and provides four primary services for the country's Medicare and Medicaid programs: administration of Medicare health plans; Medicare financial management; Medicare fee for service operations; Medicaid and children's health, survey and certification and quality improvement. 

About Heyday

We are a virtual and in-home healthcare practice dedicated to improving the primary care experience for older adults. We founded Heyday Health because we saw the health system leaving our elderly loved ones behind and were driven to create a better solution. Our mission is to transform how, when, and where we deliver care to achieve exceptional outcomes.

Medicare.gov has all of the information and tools you need for questions or help with Medicare. You can:

• enroll in Medicare online
• compare and enroll in Medicare health or prescription plans
• find and compare doctors
• check to see if a test or service is covered by Medicare
• chat with a Medicare representative
• research and compare nursing homes and home health agencies
• get extra help with medical and prescription drug costs
• get a new Medicare card

Medicare Nursing Home Compare

Use the site to obtain a free copy of A Guide to Choosing a Nursing Home.You can search the site to obtain and compare nursing home information from all parts of the country, including their performance at their last Medicare state survey.

Medicare Plan Finder

Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area.  

Use Medicare's Plan Finder to find and compare Medicare Advantage (Part C) plans available in your area.  Have the enrollee's zip code ready.

You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Part A and Part B deductibles, coinsurance, and copayments if you meet certain conditions.

Medicare Savings Programs

There are four kinds of Medicare Savings Programs

1. Qualified Medicare Beneficiary (QMB) Program
2. Specified Low-Income Medicare Beneficiary (SLMB) Program
   If you have income from working, you may qualify for SLMB benefits even if your income is higher than these limits.
3. Qualified Individual (QI) Program
   You must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. (You can't get QI benefits if you qualify for Medicaid).
4. Qualified Disabled and Working Individuals (QDWI) Program
   The QDWI program helps pay the Part A premium. You may qualify if any of the following apply to you:

Are a working disabled person under 65
Lost your premium-free Medicare Part A when you went back to work
Aren't getting medical assistance from your state
Meet the income and resource limits required by your state

How to Apply for Medicare Savings Programs

Many people do not know or understand if they qualify for Medicare Savings Programs.  Council on Aging can help.  Call us at 513-721-1025 for help in determining your eligibility. 

If you qualify for a Medicare Savings Program in your state, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.

A Medicare Quality Improvement Organization, handling quality of health care issues including:

• Inpatient hospital, outpatient service, skilled nursing facility and home health care
• Your rights as a patient, including premature discharge issues
• Care in a Medicare Advantage Plan

Their Web site includes a section for seniors and their families.

Ohio Senior Health Insurance Information Program (OSHIIP)

OSHIIP provides free health insurance information and services for Ohioans with Medicare. They will answer your questions about any of the matters listed below.

• Medicare health coverage for seniors and for people under age 65 with disabilities
• Medicare prescription drug plans
• Medicare Advantage Plans (example: HMOs and PPOs)
• Medicare supplemental insurance
• Financial assistance programs for people with limited income
• Long-term care insurance
• Home health care coverage
• Retiree health plan coverage

Toll-free Hotline

OSHIIP's Medicare experts speak with hundreds of callers daily. They provide objective, accurate information and assistance. Call toll-free from anyplace in the USA: 1-800-686-1578

Local volunteer counselors

OSHIIP is involved in your neighborhood.

• OSHIIP has trained and certified more than 800 volunteers across the state
• Volunteer counselors are experts on Medicare and related health insurance matters
• A local volunteer can meet with you in person or speak with you over the telephone 

Want to become an OSHIIP volunteer?

Without volunteers, OSHIIP could not fulfill its mission. Dedicated people are needed to be volunteers in all parts of Ohio. As a volunteer, you will:

• Learn about Medicare in a free 22-hour course
• Help people in your community
• Have the satisfaction of taking part in a truly worthy cause

For more information, contact OSHIIP about the next training course in your area.  Call 1-888-686-VOLS or email oshiipmail@insurance.ohio.gov.

Click here for an OSHIIP fact sheet.

Ohio SMP Is Seeking Volunteers

Did you know that one out of every seven Medicare dollars goes to fraud, waste and abuse? That Medicare fraud, waste and abuse cost you $13 billion?

To help address this national problem, Pro Seniors receives funding from the Administration on Aging for a Senior Medicare Patrol Project.  Named Ohio SMP this project helps older Americans be wiser health care consumers.  Seniors are taught to better understand their Medicare statements so they can detect potential fraud and errors and then take the appropriate steps to correct them.

At the heart of Ohio SMP are volunteers who are often retirees.  They educate groups of older Americans about illegitimate Medicare practices or provide individual assistance to those questioning the accuracy of their statements.  Presentations may be offered in the volunteer's own community at churches, retired professional organizations, social groups and other locations where seniors gather. Project staff is also available to assist in coordinating presentations.  In addition to the Administration on Aging, Ohio SMP has received strong support from the Council on Aging of Southwestern Ohio.

Anyone interested in volunteering may contact Jane Winkler at (513) 458-5523.

A Medicare contractor that provides Medicare Part B services and handles claims for:

• medical/professional services rendered in an office, inpatient or outpatient settings
• lab tests, x-rays, diagnostic tests
• ambulance transportation

Pro Seniors is a contracted provider of Council on Aging offering the following services: 

• legal assistance
• ombudsman services

More about Pro Seniors

Founded in 1975, Pro Seniors is a non-profit organization that provides free legal and long-term care help to older adults.  Pro Seniors offers Ohio residents age 60 and older the advice and information they need to solve their legal and nursing home, adult care facility, and home health care problems.

The Pro Seniors Mission
Pro Seniors is dedicated to helping older adults maintain their independence by empowering them, by protecting their interests, and by helping them access resources.

What Pro Seniors Offers
Pro Seniors Legal Hotline serves the State of Ohio.  By calling the Pro Seniors Legal Hotline, Ohio residents age 60 or older can receive free assistance over the telephone with a variety of legal or long-term care problems. In Greater Cincinnati, the number to call is (513) 345-4160.  In other parts of Ohio, call (800) 488-6070.  Find more information on the Legal Hotline by selecting the Legal Hotline link.

Legal Help
If you have a legal problem that cannot be resolved over the telephone, the Legal Hotline may refer you to a Pro Seniors staff attorney if you live in Butler, Clermont, Clinton, Hamilton or Warren County. Pro Seniors' staff attorneys handle problems that many private attorneys do not, such as Medicare, Medicaid, Social Security, other government benefits and pensions.  The Legal Hotline may also refer you to a private attorney who has agreed to accept cases at a reduced fee for clients with limited income.

Legal Information Pamphlets
Pro Seniors provides pamphlets on a variety of subjects, from Medicare and Medicaid to consumer fraud and food stamps.  You can find a complete list by selecting the Pamphlets link.

Long-term Care Ombudsmen
If you have a complaint about a nursing home, Pro Seniors can help.  The long-term care ombudsmen will investigate and work with you to resolve your concerns about nursing facilities in Butler, Clermont, Clinton, Hamilton, and Warren counties.  Pro Seniors ombudsmen also handle complaints about home care and adult care facilities.  You can find more information about the Ombudsman program by selecting the Ombudsman link. The Ombudsman can also help you choose the right care facility to meet your needs.

Volunteer Opportunities
If you are interested in assisting older people and have a few free hours each week, Pro Seniors offers a variety of volunteer opportunities.  For more information about our volunteer Ombudsman Program, select the Ombudsman  link.  If you are concerned about fraud and waste in the health care system, select the Ohio Seniors Fight Fraud  link to learn more about volunteering for this project.  If you are an attorney, you can assist callers to the Legal Hotline or conduct legal research.  Paralegals can provide valuable support to our legal staff. Volunteers also are needed to assist staff with mailings and other office projects.

The Social Security Act was signed into law by President Roosevelt on August 14, 1935. In addition to several provisions for general welfare, the new Act created a social insurance program designed to pay retired workers age 65 or older a continuing income after retirement.

The tops services offered by the Social Security Administration:

• Get or replace a Social Security card
• Apply online for retirement benefits
• Apply online for disability benefits
• Apply online for Medicare
• Apply for SSI, survivors or family benefits
• Estimate your retirement benefits
• Get Extra Help with Medicare prescription drug costs
• Locate a Social Security office
• Glossary of Social Security Terms

How to contact Social Security. 

For Medicare recipients, Social Security can help with:

• Medicare eligibility and enrollment
• Replacing a Medicare card
• Changing your address for Medicare
• Questions on Medicare premiums

Reporting Social Security Fraud

If you suspect Social Security fraud, contact the Office of Inspector General (OIG) using one of the following methods:

• Use the online Fraud Reporting form; 
• Call the Fraud Hotline number at 1-800-269-0271 (TTY 1-866-501-2101) between 10 a.m. to 4 p.m., Monday through Friday;  
• Send a fax: 410-597-0118 (standard long distance rates may apply); or 
• Write to: Social Security OIG Hotline
  P.O. Box 17785
  Baltimore, Maryland 21235-7785.

Social Security's Office of Inspector General takes reports of fraud very seriously.  Without sufficient identifying information, OIG will be unable to act on your allegation.  Therefore, be sure to include as much of the following information as you can when you call:

• Name, address, telephone number, and Social Security number of the person suspected of fraud.  Also include the individual's date and place of birth, father's name, and mother's birth name, if known;
• A complete description of the potential fraud incident; and 
• Your name, address, and telephone number.

Official Web site of US Department of Health and Human Services and the US Justice Department with information about Medicare Fraud, how to prevent it, and how to report it.