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Effective: December 1, 2006 |
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04.45ar1 - Medicare and Minnesota Health Care Programs (MHCP) (Archive) |
Archived: March 1, 2007 |
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 MA/GAMC and Medicare Part D for more information on how these programs work together.
MinnesotaCare (MCRE) and Medicare.
People who are Medicare beneficiaries are ineligible for MinnesotaCare.
Exception: Medicare beneficiaries who are children under age 21 and whose household income is equal to or less than 150% FPG may be eligible, because Medicare coverage is considered underinsured.
These children are likely eligible for MA. Contact the household to determine if the children want to apply for MA.
MinnesotaCare clients who meet certain conditions must be referred to apply for Medicare. See Referrals to Medicare to determine who must be referred and the steps in the referral process.
Review Insurance to determine how Medicare affects MCRE eligibility.
Medical Assistance and Medicare
MA clients who meet certain conditions must be referred to apply for Medicare. See Referrals to Medicare to determine who must be referred and the steps in the referral process.
Some people who are eligible for or receiving Medicare may qualify for 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. Please see The Buy-In for more information.
Review Cost-Effective Insurance to determine how Medicare, a federal health insurance program, affects MA eligibility if the client is not on a Medicare Savings Program (MSP) or the buy-in.
See MA/GAMC and Medicare Part D for more information on how the MA program and Medicare Part D work together.
Eligibility for MA-EPD requires enrollment in Medicare Part B even if the individual does not qualify for the Buy-in or has to pay a penalty.
MA-EPD enrollees are automatically eligible for Extra Help for Medicare Part D with a full subsidy. See MA/GAMC and Medicare Part D 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 MA/GAMC and Medicare Part D.
Persons who no longer qualify for MA 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 RSDI or Railroad Retirement benefit while in the IMD.
A GAMC enrollee who also receives or has been determined eligible for Medicare should have their eligibility reviewed for MA eligibility, as the client is likely to have an MA basis of eligibility.
Enrollment in Medicare Part D is not required for people eligible for Medicare, as a condition of GAMC eligibility. However, GAMC cannot pay prescription drug costs for enrollees who fail or refuse to enroll in, or opt out of, Medicare Part D.
Note: GAMC will continue to pay some specific drug costs for full-benefit dual eligibles, such as over-the-counter drugs currently covered by GAMC.
See MA/GAMC and Medicare Part D for more information on how these programs work together.