Medical financial assistance

Medical expenses can be overwhelming. Below are some resources to assist.

Hospital Care Assistance Program (HCAP)

The Hospital Care Assurance Program, or HCAP, offers help with unpaid hospital bills to Ohioans at or below the federal poverty level and who are ineligible for Medicaid coverage. This program also provides funding to hospitals that have a disproportionately high share of uncompensated care costs for services to indigent and uninsured Ohioans. HCAP is a state and federal program administered by the Ohio Department of Medicaid.

Adena Health System participates in the Hospital Care Assistance Program (HCAP). This program has an application process. To be eligible, you need to apply at the hospital where they are receiving care. To connect to Adena's program, click here.  This will take you to the Financial Assistance page for Adena where current HCAP and Charity Care guidelines are posted. 

Medicare Extra Help

About the program (for a patient information page, click here)

Medicare Extra Help is a low-income subsidy that offsets the cost of prescription drugs on a patient's Medicare Part D plan. If the patient's resources are below a certain threshold, s/he may qualify for assistance.  Extra Help is worth about $5,300 per year for each beneficiary.

There are two financial criteria for Extra Help. The first is income. The second is based on resources. Patients are potentially eligible if:

  • Income—Individual, $20,385 or married, $27,465)
  • Resources—combined savings, investments, and real estate are not worth more than $16,630 individual or $33,240, if married and living with a spouse. The following resources do NOT count: home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.
  • If the annual income is higher, the patient may still be able to get some help if they support other family members who live with them or have earnings from work.

The Extra Help program assists people with limited resources and lower incomes in paying for Medicare Part D prescription drug coverage. Receiving Extra Help with your Medicare Part D can:

  • Eliminate the Medicare Part D late enrollment penalty
  • Reduce your out-of-pocket costs for prescription drugs
  • Eliminate monthly Medicare Part D premiums
  • Reduce or eliminate annual Medicare Part D deductible
  • Eliminate the coverage gap, also known as the donut hole

As Extra Help removes the donut hole, your prescriptions will not cost more when the patient exceeds the annual spending limit. The program saves beneficiaries nearly $5,000 in Medicare Part D costs per year. If the patient is eligible for Medicaid or any of the following Medicare Savings Programs, s/he automatically qualifies.

With Extra Help, each generic prescription costs no more than $4.15, and each brand-name prescription does not cost more than $10.35.

How to apply for assistance:

Applying for Extra Help is easy. Complete the Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020) using one of these methods:

  • Apply online at www.ssa.gov/extrahelp
  • Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an application.
  • Apply at the local Social Security office.

Some documents needed (as applicable) to complete the application are:

  • Social Security card;
  • bank account statements, including checking, savings, and certificates of deposit;
  • Individual Retirement Accounts (IRA), stocks, bonds, savings bonds (including book entry securities*), mutual funds, other investment statements;
  • tax returns;
  • payroll slips; and
  • most recent Social Security benefits award letters or statements for Railroad Retirement benefits, Veterans benefits, pensions and annuities.

The following are examples of resources. If applicable, information about resources is also needed to apply.

  • Real estate (primary residence excluded)
  • Money in bank accounts (checking, saving)
  • Stocks
  • Bonds
  • Mutual funds
  • Individual Retirement Accounts (IRAs)
  • Any cash

The following do not count as resources:

  • Primary residence
  • Vehicle(s)
  • Personal belongings
  • Burial expenses
  • Interest on money slated for use as burial expenses

After applying, Social Security will review the application and send a letter to the applicant to notify them is they qualified (or not) for Extra Help. After qualifying, s/he can choose a Medicare prescription drug plan. If no plan is selected, the Centers for Medicare & Medicaid Services will do it for the applicant. The sooner the patient joins a plan; the sooner s/he will begin receiving benefits. If s/he isn’t eligible for Extra Help, s/he can still enroll in a Medicare prescription drug plan.

If the applicant disagrees with the decision made about  his or her eligibility for Extra Help, an Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs needs completed. 

Note: If the applicant did not enroll in Medicare Part D when s/he first became eligible, the late enrollment penalty will be waived if approved for the program.

Additional Resources and information

For more information, please review the following links or contact Social Security at 1-800-772-1213.

Ohio Medicaid

Ohio Medicaid programs help individuals take an active role in their health care by improving access to care. Applicants must qualify for assistance (financial need). Eligibility criteria is listed below. To apply, visit Ohio's Benefit Page.

Who Qualifies for Coverage?

The following individuals may qualify for Medicaid coverage in Ohio:

  • Be a United States citizen or meet Medicaid non-citizen requirements
  • Individuals with low-income
  • Pregnant women, infants, and children
  • Older adults
  • Individuals with disabilities

 To be eligible for coverage, you must:

Non-U.S. citizens may be eligible for Alien Emergency Medical Assistance or Refugee Medical Assistance.

SRS Medicaid

Specialized Recovery Services Medicaid is a version of Medicaid with different eligibility criteria (medical need and financial) than traditional Medicaid. This may be an option for eligible patients who did not qualify for traditional Medicaid.

Individuals diagnosed with a serious and persistent mental illness, a diagnosed chronic condition, or who are active on the solid organ or soft tissue transplant waiting list may be eligible for the Specialized Recovery Services (SRS) program. Services available through the SRS program include recovery management, individualized placement and support, and peer support. Individuals eligible for the SRS program also receive full Medicaid coverage.

You may be eligible for the SRS program if:

  • You have income below $2,742 per month ($32,904 per year);
  • You are 21 years of age or older;
  • You have been diagnosed with a severe and persistent mental illness, are actively on the solid or soft transplant waiting list or have a diagnosed chronic condition, which includes certain malignancies, HIV/AIDS or immune deficiencies, end stage renal disease (ESRD), sickle cell anemia, cystic fibrosis, hemophilia or if you have had a previous organ transplant;
  • You need help with medical appointments and/or activities of daily living;
  • You have been determined to meet the definition of disability used by the Social Security Administration for purposes of SSI or SSDI (this does not apply if you are under 65 with ESRD, or over 65 with certain diagnosed chronic conditions or actively on the solid or soft transplant waiting list); and
  • You do not live in a nursing facility, hospital or similar setting.

If you are eligible, you may get these Medicaid-covered services in addition to your current Medicaid health care coverage:

  • Recovery Management - Assistance developing a plan of care specific to your needs
  • Individual Placement and Support (IPS) - Supported Employment - Help finding and keeping a job
  • Peer Support - Support from others with similar life experiences

To learn more, visit the Specialized Recovery Services website.