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Effective: January 1, 2012 |
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04.45.10ar5 - Referrals to Medicare (Archive) |
Archived: October 1, 2012 |
Enrollees and some applicants eligible for Minnesota Health Care Programs (MHCP) must apply for Medicare Parts A and B if it appears they might qualify. This section provides policy on when and how to refer a client to apply for Medicare.
Clients can find out how to apply by:
l Calling or visiting the web site of a Medicare Contact.
l Calling the Railroad Retirement Board (RRB) at (800) 833-4455 if they receive or will receive railroad retirement.
MinnesotaCare - Additional Referral Information.
Medical Assistance (MA) - Additional Referral Information.
Medicare Referral - Good Cause.
People who qualify for Medicare may enroll during their initial enrollment period, or during the general enrollment period from January 1 through March 31 of each year. Generally, people cannot enroll in Medicare outside of these periods.
Exception: People who enroll in Medicare through the Buy-In or a Medicare Savings Program do not have to wait for the next general enrollment period to enroll. See the Steps for Medicare Referral below.
Refer applicants and enrollees to apply if they appear to qualify for Medicare.
Refer people who qualify due to turning 65 to apply for Medicare at age 64 and 10 months.
Note: Do not refer people only enrolled in Part A to enroll in Medicare Part B or add them to the Buy-in if they have primary coverage under an employer group health insurance plan through their own current employment or their spouse’s current employment. People can refuse Part B when informing SSA of such coverage and will not be assessed penalties when they do enroll in Part B.
Refer people who receive disability benefits from Social Security or the Railroad Retirement Board to apply for Medicare when they have received the benefits for the last 22 months or more.
Note: Do not refer people to SSA who have Medicare Part A or Part B only or previously had Medicare. These people are already known to SSA and do not need to reapply to get Medicare through the Buy-In.
MinnesotaCare - Additional Referral Information
There are additional policy points to follow for MCRE Medicare Referrals.
l People who are eligible for premium-free Medicare Part A may not refuse to apply or turn down this coverage to gain or continue MCRE eligibility.
Example:
Zeke is a MCRE enrollee who is turning age 65. He qualifies for premium-free Medicare Part A and can enroll in Part B with a premium, but he wants to stay on MCRE because he can get better coverage at a lower premium.
Action:
Once Zeke qualifies for premium-free Medicare Part A, he is not eligible for MCRE even if he refuses or drops his Medicare coverage.
l MCRE clients who can only get Part A by paying a premium, are not required to apply for or accept Medicare Part A or Part B.
Example:
Harriet failed to sign up for Medicare Part A coverage when she turned age 65 five years ago. She did not have enough work credits to qualify for premium-free Medicare Part A, and she could not afford the premium. Harriet would now be required to pay the Part A premium plus late enrollment penalties (which would create a larger monthly premium) to obtain Part A. She applies for MCRE.
Action:
Harriet must pay a premium to get Medicare Part A. She can refuse Part A and still be eligible for MCRE. Approve MCRE if Harriet meets all other eligibility factors.
Note: Harriet may be eligible for MA and the Qualified Medicare Beneficiary (QMB) program to pay her Medicare premiums and other cost sharing. This may provide more comprehensive coverage at a lower cost than MinnesotaCare. Contact Harriet to determine if she wants to apply for MA and QMB. This is a choice, not a mandatory referral to MA and Medicare.
l People who must pay a premium for Medicare Part A may drop Medicare coverage (Parts A, B, C and D) to be eligible for MCRE after a four-month wait.
Example:
Rosa is a 65-year old lawful permanent resident (LPR) who has lived continuously in the United States for 10 years. She does not have sufficient work credits to qualify for premium-free Medicare Part A.
Action:
Rosa is ineligible for MCRE if she enrolls in Medicare because she has other health care coverage. However, if she decides not to enroll in Medicare, she may be eligible for MCRE. If Rosa is already enrolled in Medicare Part A, Part B or both, she may drop the coverage and become eligible for MCRE after a four-month wait.
Note: Rosa may be eligible for MA and QMB to pay her Medicare premiums and other cost sharing. This may provide more comprehensive coverage at a lower cost than MinnesotaCare. Contact Rosa to determine if she wants to apply for MA and QMB. This is a choice, not a mandatory referral to MA and Medicare.
Medical Assistance (MA) - Additional Referral Information
MA requires that certain people who must pay a premium to get Medicare Part A must apply for Medicare.
l Some people may be eligible for the Qualified Medicare Beneficiary (QMB) program to pay Medicare Part A and B premiums through the buy-in.
l Reimburse Medicare Part A premiums for people who are not eligible for QMB, but whose Medicare Part A premium is cost effective.
l People can choose not to enroll in Part A if they are not eligible for QMB, and the Part A premium is not cost effective. They can also choose to enroll in Part A and Part B and then use the Medicare premiums toward meeting a spenddown.
The MMIS User Services Help Desk processes a monthly report that identifies MA enrollees who receive SSI, three months in advance of their 65th birthday. Refer these MA enrollees to apply for Medicare before their 65th birthday to ensure ongoing prescription drug coverage and continuing MA eligibility. Follow the Steps for Medicare Referral for people who are eligible for the buy-in, upon receipt of an e-mail from the DHS MMIS Help Desk identifying an enrollee as potentially eligible.
See Medicare Part D and Minnesota Health Care Programs (MHCP) for information about the benefit change notice that is issued to MA enrollees when they qualify for Medicare.
MA-EPD clients eligible for Part B must apply and enroll to continue MA coverage, even if they are required to pay the premium themselves.
Follow these steps to refer an applicant or enrollee to apply for Medicare:
Note: Do not approve eligibility for an applicant 18 and over, or for the caretaker of an applicant under age 18, who was previously referred to Medicare as an MHCP enrollee but did not apply, and does not currently have Medicare. Follow these steps for referral and approve eligibility when the applicant submits confirmation of the Medicare application.
1. Determine if the person is eligible for the Buy-In or a Medicare Savings Program (MSP).
n If the person is eligible for the buy-in or a Medicare Savings Program:
Determine if the person has previously had Medicare. Do not refer a person to SSA if they have previously had Medicare. The person is already known to SSA and will be enrolled in Medicare through the buy-in or the Medicare Savings Program without having to apply, unless a current TPQY shows Medicare eligibility has ended for any reason other than failure to make a premium payment.
n If the person is not eligible for the buy-in or MSP:
m Refer a person who would only qualify for Medicare with payment of a Part A premium, to DHS Benefit Recovery for a cost effective analysis.
m Refer a person who qualifies for premium-free Part A to SSA to apply, whether or not the person had Medicare in the past.
2. Check TPQY in MAXIS and any Centers for Medicare and Medicaid Services (CMS) alias information on the RMSC screen in MMIS to ensure there are no discrepancies in the person’s name or date of birth. If there is a discrepancy, include this information with the referral to SSA to ensure the error is resolved. See POLI TEMP TE02.07.326 for instructions.
3. Complete and send to the client the appropriate referral letter to apply for Medicare and a county-addressed return envelope. The person must take the referral letter and the county-addressed return envelope to SSA when they apply for Medicare.
The two referral letters are used as follows:
a. People who qualify for the Buy-In or a Medicare Savings Program do not have to wait for the general enrollment period to apply for Medicare. Complete the County Agency Section of the Medicare Buy-In Referral Letter (DHS-3439) and send it to the person along with a county-addressed return envelope. Request return of the form, completed by SSA when they apply for Medicare within 30 days.
b. People who do not qualify for the Buy-In or a Medicare Savings Program must wait for the next general enrollment period to apply for Medicare.
m Track the case until the next January.
m Complete the County Agency Section of the Medicare Application Referral Letter (DHS-3444) in January and send it to the person with a county-addressed return envelope. Request the return of the form, completed by SSA when they apply for Medicare within 30 days.
4. Allow people 60 days from the date referred to apply for Medicare and return either the confirmation portion of the letter sent to them, or another type of confirmation from the SSA of their application for Medicare.
Contact the client after 30 days to determine if they need more time. Send a second letter if necessary and continue to track for an additional 30 days.
5. Process Medicare Savings Program eligibility upon receipt of the letter or other confirmation that the person applied for Medicare.
Do not approve retroactive SLMB eligibility for any enrollee who had MA in the retro months and who must pay a monthly premium to get Medicare Part A, even if the referral form shows a Medicare begin date in a past or current month. This includes MA enrollees who only receive SSI benefits and who are turning age 65. Approve prospective QMB eligibility only for these enrollees. An exception to this rule exists when the initial DHS-3439 referral sent has stated MSP eligibility would be approved for a specific date that is now in the past due to delays in the enrollee's ability to meet with SSA.
6. A person who fails to cooperate with applying for Medicare is ineligible for all Minnesota Health Care Programs. Send a notice that denies or terminates benefits to people who do not comply with application for Medicare unless there is good cause.
n People under age 18:
Close MHCP eligibility effective the next available month after giving 10-day notice for the following caretakers who live in the same household as the child and who fail to apply for Medicare for the child.
m Biological or adoptive parents.
m Relative caretaker with legal custody.
m Legal guardian.
n People age 18 and over:
Close MHCP eligibility for the person who fails to apply for Medicare effective the next available month giving 10-day notice.
Medicare Referral - Good Cause
People may establish good cause for not complying with a referral to apply for Medicare.
Good cause means there were circumstances beyond the person's control or that the person could not reasonably foresee which prevents or prevented them from applying for Medicare. It is established on a case by case basis.
Grounds for good cause include, but are not limited to:
l An illness which prevents the person from applying.
l An incapacity preventing the person who has no legal representative from applying.
l The person previously applied, was denied and reasons for denial have not changed.
l The person cannot apply until the next General Enrollment Period (GEP).
Good cause can be established for a specified or indefinite period of time, or it can excuse a person from applying for Medicare.