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Cost Sharing PDF Print E-mail

Facts

What is cost sharing?
To be able to provide more consumers with needed services, it is now a requirement that consumers, who are above certain income limits, pay for a portion (cost share) of the services they receive from the Area Agency on Aging.
Do all consumers have to pay for their services?
No, the cost is based on the consumer's income. Most individuals whose monthly income is less than $1,064 per month or $1,426 for a couple will receive their services free of charge.
Is there a charge for all services?

The following services are not affected by cost sharing:

  • Home-Delivered Meals
  • Care Management
  • Assessment
  • Protective Services
Services to which cost sharing may apply:
  • Home Support
  • Personal Care
  • Protective Services
What is counted as income?

If you have filed a Federal Income Tax Return, your cost share fee will be based on your adjusted gross income. Consideration is given if there are significant unreimbursed medical expenses. Non-taxable income such as Social Security will also be added to the adjusted gross income. If you did not file a Federal Income Tax Return, the following lists includes the types of income that will be considered:

  • Social Security Benefits
  • Wages, salaries, tips
  • Private Pensions, annuities and union benefits
  • Government retirement pensions
  • Veteran's pensions
  • Railroad retirement, Disability
  • Dividends or interest from stocks, bonds, savings, etc.
  • Alimony and child support
  • Boarder/Roomer or Net (gain or loss) Rental Income
  • Public Assistance or SSI grants
  • Net (gain or loss) self-employment income
  • Unemployment compensation
  • Estate and trust funds
  • Black Lung Benefits
  • Workman's Compensation Payment

The following types of income will not be considered as income for the cost sharing program:

  • Low Income Home Energy Assistance
  • Food stamps
  • Medicare, Medicaid, FCSP and PACE
  • Income Tax refunds
  • Property Tax and rent rebates.
Must I provide to the Agency copies of all my income?

Though our staff must view proofs of income, you are not required to provide us with copies.

Consumers who do not wish to disclose (or verify) income may receive services at a cost share rate of 100%.

What if my financial situation changes?
Your income will be verified yearly, but we encourage you to call us if you have a significant increase or decrease in your monthly income in which case mid-year adjustments can be made.
How and when will I be billed?
You will be informed in writing what your estimated monthly cost sharing co-pay will be. The Agency on Aging will mail to you a bill monthly for the services you received. The bill will be payable upon receipt.
What happens if I don't pay the bill?
Paying for services is a shared responsibility between the Area Agency on Aging and the consumer. The Agency will need to terminate its financial support if the consumer's share is not received according to the payment schedule.
Is there a limit on how much service I can receive?
Generally a service plan cost cap of $625 per month will be established. Your care manager will explain this cap to you.
Is there an exception to the $625 limit, if I need more help?
Your care manager can authorized exceptions to this cap if there are special needs such as a high need for personal care or when consumers are "nursing home appropriate."

Additional Service Choices for Those Who Are "Nursing Home Appropriate"

There are additional service options open to persons who are at least 60 years of age who are also "nursing home appropriate." Nursing home appropriate persons are given consideration for the PDA Waiver or PDA Bridge programs, through which extensive care plans are available. (Generally individual total care plan costs are allowable if the care plan will cost less than nursing home placement would cost). The Waiver and Bridge programs can offer home health services including registered nurses, therapists and more.

Qualifying for PDA Waiver versus PDA Bridge is determined by the applicant's income and assets. PDA Waiver services are cost free while PDA Bridge consumers cost share at a 50% rate until they become financially eligible for the PDA Waiver Program.

 
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