*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: June 1, 2014 |
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04.45 - Medicare and Minnesota Health Care Programs (MHCP) |
Archived: June 1, 2016 (Previous Versions) |
Medicare is considered health insurance from another source for Minnesota Health Care Programs (MHCP). Due to third-party liability (TPL) requirements, clients must cooperate with referrals to Medicare.
See Medicare Part D and Minnesota Health Care Programs (MHCP) for more information on how these programs work together.
Medical Assistance (MA) and Medicare.
MA for Employed Persons with Disabilities (MA-EPD) and Medicare.
Minnesota Senior Health Options (MSHO) and Medicare
Institutions for Mental Diseases (IMD) and Medicare.
Medical Assistance (MA) and Medicare
MA enrollees who qualify for Medicare must enroll in Parts A and B as a condition of their MA eligibility. When an MA eligible person does not qualify for automatic payment of Medicare premiums, the person may be required to enroll in Medicare if the premiums are found to be cost effective. See Referrals to Medicare to determine who must be referred to apply for Medicare and the steps in the referral process.
MA enrollees who qualify for Medicare may be eligible for a Medicare Savings Program (MSP) or the buy-in. The buy-in is the process of having some of the client’s Medicare costs paid by state- and federally funded MA if they meet certain criteria. See Medicare Savings Programs (MSP) and The Buy-In for more information.
See Medicare Part D and Minnesota Health Care Programs (MHCP) for more information on how the MA program and Medicare Part D work together.
To be eligible for MA-EPD, people who qualify for Medicare Parts A and/or B must enroll, even if the individual does not qualify for the buy-in or has to pay a penalty. Counties must reimburse Medicare Part B premiums for MA-EPD enrollees who meet all of the following:
l Are enrolled in Medicare Part B.
l Do not qualify for the Medicare Savings Programs.
l Have income that does not exceed 200% FPG.
MA-EPD enrollees are automatically eligible for Extra Help for Medicare Part D with a full subsidy. See Medicare Part D and Minnesota Health Care Programs (MHCP) for information on other benefits for these enrollees.
MA applicants and enrollees who have Medicare must be enrolled in Medicare Part A and Part B in order to enroll in MSHO. If they are enrolled in one Part but not the other, they cannot enroll in MSHO until enrollment through SSA is completed for the missing Part.
DHS uses CMS Medicare enrollment status information to determine if a client is enrolled in Medicare Part A and Part B for MSHO purposes.
For information on MSHO and Medicare Part D, see Medicare Part D and Minnesota Health Care Programs (MHCP).
Residence in an IMD does not affect a person’s Medicare coverage. However, residence in an IMD does affect MA and MSP coverage.
People who no longer qualify for federally funded MA and are switched to program IM because of residence in an IMD cannot continue enrollment in an MSP. The MSP must be closed. The county will reimburse the enrollee for Medicare premiums deducted from their Social Security or Railroad Retirement benefit while in the IMD.
See Institutions for Mental Diseases (IMD) for more information.