Area Agency on Aging of Dane County | Elder Benefit Specialist Program

Elder Benefit Specialist Program:
A Legal Services Program of the Area Agency on Aging of Dane County

Elderly Benefits SpecialistsThe Dane County Elder Benefit Specialist Program is administered by the Area Agency on Aging (AAA) of Dane County and is co-located and operated in partnership with the Dane County Aging and Disability Resource Center (ADRC). The EBS Program provides legal advice/representation for senior adults (age 60+) residing in Dane County that are faced with benefit, housing and other disputes or denials, complications, changes in benefits, claims not paid, and other similar issue groups that have an economic or socially isolating effect on the older adult.

Elder Benefit Specialists receive in-depth, on-going legal training. Elder Benefit Specialists (EBS), along with their program attorneys at the Greater Wisconsin Agency on Aging Resources (GWAAR) and AAA management, prioritize legal case work based on client need.


EBS High Priority List:

  • Appeal or reduction of benefits with approaching deadline (60 days or less), or past deadline
  • Medicare Advantage appeal (60 day appeal window)
  • Medicaid appeal (45 day appeal window – no late appeals)
  • Eviction notice or pressing housing issue
  • Social Security or SSI overpayment (60 day appeal window)
  • Pharmacy/drug coverage issue – immediate need for medication
  • Court proceedings
  • Other issues on a case by case basis

EBS Normal Priority List:

  • Original Medicare appeal (120 day appeal window)
  • Original Medicare or Medicare Advantage Plan billing issue
  • FoodShare appeal (90 day appeal window)
  • Private insurance appeal or billing problem
  • Pharmacy/drug coverage issue – no immediate need for medication
  • Social Security or SSI Disability initial application (Per DHS, EBS can only accept disability appeal cases if client has rejection letters from 2 attorneys who practice disability law within 100 mile radius of client’s home)
  • Medicaid Disability Application (MADA)
  • Debt collection issue
  • Other issues on a case by case basis

Elder Benefit Specialist Program Referral Process

Potential EBS clients that are new to the program should first contact the ADRC Information & Assistance helpline by calling (608) 240-7400. An I & A Specialist will discern their particular issue, in many cases assist the client to resolve the issue, or escalate their issue to an EBS through an internal referral to the program if necessary.

Medicare and Medicare D Enrollment

Due to the high volume of legal cases handled by the Elder Benefit Specialists, regular Medicare and Medicare D enrollment and annual reenrollment using the Plan Finder should be referred to the local Focal Point Case Manager. This information can be learned by contacting the ADRC. If clients do not want to utilize a focal point Case Manager, they can also call the Wisconsin Medigap Helpline. They provide counseling on Original Medicare, Medicare supplement insurance, employer-based coverage, Medicare Advantage, and related topics. Toll free: 1.800.242.1060. For Medicare D related benefits, call toll free: 1.855.677.2783.


Address:
2865 N. Sherman Avenue
Northside Town Center
Madison WI, 53704
*Located inside the ADRC

608-261-9930
608-240-7402

Email: AAA@countyofdane.com

Hours of Operation:
Mon - Fri, 7:45 am to 4:30 pm

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