*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: February 1, 2013 |
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15.05.05 - Types of Other Health Care Coverage for MinnesotaCare |
Archived: June 1, 2016 (Previous Versions) |
Some clients who currently have certain types of other health care coverage or who have had certain types of other health care coverage within the past four months are not eligible for MinnesotaCare. This section explains which types of other health care coverage are a barrier to eligibility for MinnesotaCare.
Other Health Care Coverage Barriers to MinnesotaCare.
Medicare as Other Health Care Coverage.
Not Other Health Care Coverage.
Other Health Care Coverage Barriers to MinnesotaCare
Clients who currently have or have had in the past four months the following types of other health care coverage are subject to the current other health care coverage barrier and the four-month rule.
l Basic hospital coverage.
l Medical-surgical coverage.
l Major medical coverage.
l Health Maintenance Organization (HMO) coverage.
l Medicare Supplement policies.
l Minnesota Comprehensive Health Association (MCHA).
l Vision, dental, or prescription drug coverage offered as part of a comprehensive package.
l CHAMPVA.
l Medicare Part A and Part B.
Note: For more information on Medicare in general see Medicare. For more information on how Medicare affects MinnesotaCare eligibility see Medicare as a Barrier to MinnesotaCare.
Limited Benefit Plans cap annual benefits at low amounts and are typically not licensed as health insurance in Minnesota. Submit these plans to HealthQuest for evaluation as other health care coverage for MinnesotaCare purposes.
Medicare as a Barrier to MinnesotaCare
Being eligible for or receiving Medicare may be a barrier to MinnesotaCare eligibility.
Exception: Children under 21 with household income at or below 200% FPG or who meet the Children's Health Plan Exception may have current Medicare coverage and receive MinnesotaCare.
l People who are eligible for Part A at no cost may not refuse or drop coverage to become eligible for MinnesotaCare. They are ineligible for MinnesotaCare unless they meet the exception above.
Use the Medicare Application Referral Letter (DHS-3444) to refer the client to the Minnesota regional Social Security Office.
l Clients who must pay premiums for Part A:
n Are not required to apply for or accept Part A or Part B.
n May drop Medicare coverage to be eligible for MinnesotaCare, including clients who are enrolled in Part B only. However, the four-month rule will apply.
Example:
Rosa is a 65-year-old Lawful Permanent Resident (LPR). She does not have sufficient work quarters to qualify for Medicare Part A at no cost. She would have to pay over $300 per month to enroll.
Action:
Rosa is not required to apply for or accept either Part A or Part B because she must pay for Part A coverage.
m If Rosa chooses to enroll in either Part A or Part B she is ineligible for MinnesotaCare because of having other health care coverage.
m If she is already enrolled in Part A, Part B or both, she may drop the coverage and become eligible for MinnesotaCare after a four-month wait.
Example:
Zeke is eligible for Medicare Part A at no cost and may also choose to enroll in Part B with a premium. He prefers MinnesotaCare because coverage is available at a lower premium.
Action:
Zeke is not eligible for MinnesotaCare because he is eligible for Part A at no cost. He may not refuse or drop coverage to become eligible for MinnesotaCare.
Other Health Care Coverage Not a Barrier to MinnesotaCare
Clients who currently have or have had in the past four months the following types of other health care coverage are not subject to the current other health care coverage barrier and the four-month rule.
Note: Some of these types of coverage may be a potential source of third party liability. See Reporting Other Health Care Coverage for more information for clients who have these types of coverage.
l Dental, vision, or prescription-only coverage that is not part of a comprehensive package including basic hospital and medical-surgical coverage.
l Workers' Compensation.
l Indemnity policies which pay a fixed amount for each day of hospitalization or nursing home confinement.
l Long-term care or nursing home-only policies.
l Disability insurance.
l Cancer insurance.
l Access to facilities which provide free health care to people who qualify, such as Indian Health Centers and community clinics.
l Access to care through the Department of Veterans Affairs (VA), if the person wants to enroll in MinnesotaCare.
Note: Do not require people who have access to care through the VA to enroll in MinnesotaCare under the All or Nothing Rule if they do not want MinnesotaCare.
Consider VA benefits to be other health care coverage for people who have access to services through the VA and do not wish to enroll in MinnesotaCare.
l Medical expense accounts which an employee funds with pre-tax dollars.
l Auto, homeowners', or other liability insurance that pays medical expenses resulting from an accident.
l MA.
l TRICARE.
l Health care coverage received in another state through a state or federally funded health care program.
See Applying for Other Benefits for more information when MinnesotaCare enrollees are required to apply for Medicare.