As your life changes, so will the programs that you may qualify for. You can contact

The WellFund at anytime of the year or at any stage of your life for help with healthcare coverage enrollment. Patient Advocates are here to help you now and in the future as your partner in care.

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Patient Advocates Help You Qualify for State/ Federally Funded Programs such as:

Hospital Presumptive Eligibility (HPE)

Hospital Presumptive eligibility is a process that offers short-term coverage of health care services for those with limited incomes who are not currently receiving Medicaid. The goal of HPE is to make sure that those who appear eligible, based on basic information, have immediate access to health care. Your short-term coverage will end if you do not complete an Indiana application for health coverage or are found to be ineligible based upon your full application.

 

Medicaid

Most Medicaid beneficiaries are eligible for membership in an Ohio Medicaid

managed care plan. 

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In Ohio, most individuals who have Medicaid must join a managed care plan to receive their health care. Managed care plans are health insurance companies that are licensed by the Ohio Department of Insurance and have a provider agreement with the Ohio Department of Medicaid to provide coordinated health care to Medicaid beneficiaries. These managed care plans work with hospitals, doctors and other health care providers to coordinate care and to provide the health care services that are available with an Ohio Medicaid card. If you have Medicaid, and are in a managed care plan, you need to get most of your health care from health care providers that work with your managed care plan.

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Marketplace (ACA)

The Health Insurance Marketplace (also known as the “Marketplace” or “exchange”) is a service that helps individuals who earn too much to qualify for Medicaid but still need help with coverage costs, shop for and enroll in affordable health insurance.

 

Individuals can compare health insurance plans, get answers about your health care insurance, find out if you are eligible for tax credits for private or health programs. In some cases, individuals may receive premium assistance to cover monthly fees.

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Medicare Savings Program (MSP)

Medicare Savings Program is a Medicaid-administered program to help low-income individuals cover some of their out-of-pocket costs for Medicare like Medicare Part A and Part B premiums, deductibles, copayments and coinsurance. Certain programs may even help cover the cost of prescription drugs (Part D).

 

There are four types of Medicare Savings Programs:

• Qualified Medicare Beneficiary (QMB) Program,

• Specified Low-Income Medicare Beneficiary (SLMB) Program,

• Qualifying Individual (QI) Program

• Qualified Disabled and Working Individuals (QDWI) Program.

*Benefits vary for each program, but all of them, with the exception of the QDWI Program, help pay for Medicare Part B premiums.

 

To qualify, individuals must have or be eligible for Medicare Part A and have income and resources below a certain threshold.

*The income and resource requirements are different for each of the four Medicare Savings Programs and may change from year to year.

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Social Security Benefits

Supplemental Security Income is financial assistance provided by the federal government to eligible individuals with disabilities. SSI pays benefits based on financial need.  It is designed to help aged, blind, and disabled people, who have little or no income to provides cash to meet basic needs for food, clothing, and shelter.

 

If a disability results in an individual being unable to work for at least 12 months or until death, they may be entitled to these benefits. Some children with disabilities may qualify for Social Security Income.

 

Depending on income and assets, children may qualify for immediate SSI payments as early as the date of birth until attainment of age 18 if they are diagnosed with certain medical conditions that result in marked and severe functional limitations.​​​​