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Effective: December 1, 2006 |
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15.10.05.15 - Never Cost Effective |
Archive |
The following policies are not cost effective and do not require a cost effective referral:
l Medicare Supplement policies with or without drug coverage for people who are disabled or are 65 and older, and who are MA and Medicare eligible.
Note: If a client’s Medicare supplement policy is not cost effective, the client may request suspension of the Medicare supplement policy for up to 24 months during a period of MA enrollment.
m The suspension allows the person to re-enroll in the policy without reapplying if MA ends during the suspension.
m The policyholder must request the suspension from the insurer within 90 days of the effective date of MA enrollment.
l Medicare Part C (Medicare Advantage) products, with or without prescription drug coverage for people age 65 and over and MA and Medicare eligible.
l For people age 65 and over who are MA and Medicare eligible, group health insurance products, such as those offered by employers, unions or retiree plans that either:
n Do not include prescription drug coverage.
n Include prescription drug coverage that is not considered creditable drug coverage.
l Hospital indemnity policies which provide cash payments for each day in a hospital or nursing facility if the client is not currently collecting benefits.
l Minnesota Comprehensive Health Association (MCHA) policies.
n Minnesota statutes prohibit MA and GAMC from paying MCHA premiums.
n MA/GAMC enrollees may carry MCHA coverage at their own expense but are not required to do so as a condition of eligibility.
l The Medicare Part B premium for MA-EPD clients who meet the following criteria:
n Total income, not counting spousal income, is greater than 200% FPG.
n Have an increased Medicare Part B premium amount.
n Are not eligible for QMB, SLMB, QI, QWD or the Buy-In.
Example:
Steve receives MA-EPD and Medicare Part B at an increased premium rate due to late enrollment. His income is over 200% FPG. Steve is not eligible for QMB or SLMB because household income exceeds the limits for those programs.
Action:
Steve’s Medicare Part B premium does not need to be referred for a cost effective review because his income is over 200% FPG.
For additional cost effective coverage information see the following sections:
l Cost Effective Health Care Coverage - MA and GAMC.