|
Effective: December 1, 2006 |
|
|
15.05.05ar1 - Types of Other Insurance Coverage for MinnesotaCare (Archive) |
Archived: September 1, 2009 |
Clients with current other insurance coverage or other insurance coverage within the past four months are not eligible of MinnesotaCare. This section defines what other health coverage is and what it is not when applying the MinnesotaCare insurance barriers.
Medicare as Other Health Coverage.
Consider the following types of coverage as other health coverage for MinnesotaCare:
l Basic hospital insurance.
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 Other Health Coverage.
Medicare as Other Health Coverage
Medicare may be considered other health coverage and may be a bar to MinnesotaCare eligibility.
Exception: Group 1 children.
l People who are eligible for Part A at no cost may not refuse or drop coverage to become eligible for MinnesotaCare.
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. She could enroll in Part B without Part A by paying only the Part B premium.
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 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 he could get better coverage 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.
Do not consider the following types of coverage as other health insurance when determining whether someone meets the insurance barrier requirements.
Note: Some of these types of coverage may be a potential source of third party liability. See Documenting Insurance Coverage for more information on what needs to be documented 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/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 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 GAMC.
l TRICARE.
TRICARE, formerly known as CHAMPUS, provides coverage to active-duty members of the armed forces and their dependents.
People eligible for TRICARE may choose among three options:
n TRICARE standard, which provides the same benefits as CHAMPUS.
n TRICARE Prime, which is similar to a managed care plan.
n TRICARE Extra, which allows enrollees to seek care at discounted prices from providers in the TRICARE network.
See Applying for Other Benefits for more information when MinnesotaCare enrollees are required to apply for Medicare.