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Effective: December 1, 2006 |
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04.45.10ar1 - Referrals to Medicare (Archive) |
Archived: February 1, 2009 |
Enrollees and some applicants eligible for Minnesota Health Care Programs (MHCP) must apply for Medicare if it appears they might be eligible. 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 1-800-MEDICARE (1-800-633-4227).
l Checking the Medicare website - www.medicare.gov.
l Contacting the local Social Security Office, (call 1-800-772-1213 for the nearest office).
l Calling the Railroad Retirement Board (RRB) at 1-800-833-4455 if receiving or going to receive railroad retirement.
MinnesotaCare (MCRE) – Additional Referral Information.
MA – Additional Referral Information.
Medicare Referral – Good Cause.
Clients may enroll in Medicare during Medicare’s open enrollment period, also known as ”r;General Enrollment for Medicare.” Open enrollment for Medicare is January through March of each year.
Clients who enroll during open enrollment become eligible for Medicare on July 1 of the same year.
For information on Medicare Part D open enrollment see Medicare Part D.
Refer the following enrollees to apply for Medicare, if the client:
l Is a U.S. citizen and is age 65 or over.
l Is a noncitizen who meets all of the following:
n Is lawfully admitted for permanent residence.
n Has lived continuously in the U.S. for five years or more prior to the month of Medicare application.
n Is age 65 or over.
l Has End-Stage Renal Disease (ESRD), which means either the person:
n Had a kidney transplant.
n Is receiving continuous dialysis due to permanent kidney failure.
l Has ALS, also known as Lou Gehrig’s Disease.
l Is currently receiving disability benefits from RSDI or the RRB and has been entitled to receive these benefits for the last 22 months or more.
MinnesotaCare – Additional Referral Information
There are additional policy points to follow for MCRE Medicare Referrals.
l People who are eligible for Part A at no cost may not refuse coverage to gain or continue MCRE eligibility.
Example:
Zeke is eligible for Part A at no cost and may also choose to enroll in Part B with a premium. He prefers MCRE because he can get better coverage at a lower premium.
Action:
Because Zeke is eligible for Part A at no cost, he is not eligible for MCRE and may not refuse or drop coverage to become eligible.
l Do not automatically assume that a person who refused Medicare coverage in the past did so to get or maintain MCRE. Review case facts to make that determination.
l MCRE clients who are denied coverage from Part A without a premium, and who can only get Part A by paying a premium, are not required to apply for or accept Part A or Part B.
Example:
Harriet refused Part A coverage five years ago because she could not afford the premium she would have to pay for signing up after it was initially offered to her. She would now be required to pay the premium plus considerable penalties (which creates a larger monthly premium) to obtain Part A. She applies for MCRE.
Action:
Harriet did not refuse Part A to gain MCRE coverage. If Harriet meets all other eligibility factors, approve MCRE.
l Clients who must pay a premium for Part A may drop Medicare coverage (Part A and Part B) to be eligible for MCRE.
Example:
Rosa is a 65-year old LPR. She does not have sufficient work quarters to qualify for Part A at no cost and must 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:
If Rosa chooses to enroll in either Part A or Part B, she is ineligible for MCRE because of having other coverage. However, she is not required to apply for or accept either Part A or Part B because she has a premium for Part A. If she is already enrolled in Part A, Part B or both, she may drop the coverage and become eligible for MCRE after a four-month wait.
MA – Additional Referral Information
MA requires an individual who only qualifies for Part A by paying a premium to apply for Part A. If cost-effective, the premium will be paid by MA. If not eligible for payment by MA, the individual can choose not to be enrolled or to use the premium to meet a spenddown.
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 enrollee to apply for Medicare:
Note: These steps should also be followed 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 is not currently receiving Medicare. Do not approve eligibility until confirmation of the application to Medicare is received.
1. Determine if the client is eligible for the Buy-In.
2. Complete and send the client a referral to apply for Medicare along with a county-addressed return envelope. Enrollees must take the referral letter and the county-addressed return envelope to SSA when they apply for Medicare.
There are two letters that can be sent depending on if the client is eligible for the Buy-In or not.
a. Clients who qualify for the Buy-In do not have to wait for open enrollment to apply for Medicare. Complete and send the client the Medicare Buy-In Referral Letter (DHS-3439) and a county-addressed return envelope requesting the client apply within 60 days.
Note: The MMIS User Services Help Desk sends email to workers requesting this letter be sent to MA enrollees who are SSI recipients, three months before the enrollee’s 65th birthday.
b. Clients who do not qualify for the Buy-In must wait for open enrollment to apply for Medicare. Complete and send the client the Medicare Application Referral Letter (DHS–3444) at open enrollment and request the client apply within 60 days.
Note: This includes referring clients who have previously failed to enroll on a timely basis or who have refused Medicare coverage.
Clients have 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 Social Security Administration (SSA) of their application for Medicare.
Note: Contact the client after 30 days to determine if they need more time. Send a second letter if necessary.
3. Process QMB eligibility upon receipt of the letter. Do not process retroactive SLMB eligibility even if the referral form shows a Medicare begin date in a past or current month.
4. Complete the following for clients who do not comply with application for Medicare unless there is good cause:
l Clients under age 18:
Close MHCP eligibility for certain caretakers who live in the same household as the child and who fail to apply for Medicare for the child.
n Close effective the next available month giving 10-day notice.
n Close eligibility for the following caretakers:
n Biological/Adoptive parent.
n Relative caretaker with legal custody.
n Legal guardian.
l Clients age 18 and over: Close MHCP eligibility for the client who fails to apply for Medicare effective the next available month giving 10-day notice.
Medicare Referral – Good Cause
Clients may establish good cause for not complying with a referral to apply for Medicare.
Good cause means there were circumstances beyond the client’s control or that the client could not reasonably foresee which prevents or prevented the client from applying for Medicare. It is established on a case by case basis.
Standard grounds for good cause include but are not limited to:
l An illness which prevents the client from applying.
l An incapacity preventing the client who has no legal representative from applying.
l The client previously applied, was denied and reasons for denial have not changed.
l The client cannot apply until open enrollment.
Good cause can be established for a specified or indefinite period of time, or it can excuse a client from applying for Medicare.