|
Effective: February 1, 2009 |
|
|
04.45ar3 - Medicare and Minnesota Health Care Programs (MHCP) (Archive) |
Archived: June 1, 2011 |
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.
MinnesotaCare (MCRE) and Medicare.
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.
General Assistance Medical Care (GAMC) and Medicare.
People who are entitled to premium-free Medicare Part A or enrolled in Medicare Part B are ineligible for MinnesotaCare. These applicants or enrollees cannot establish or keep MinnesotaCare eligibility by refusing or failing to sign up for Medicare coverage.
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.
People who are age 65 or older who qualify for Medicare but must pay a premium for Medicare Part A may enroll in MinnesotaCare. However, these people may also be eligible for MA and the Qualified Medicare Beneficiary (QMB) program. QMB would pay their Medicare Part A and B premiums through the buy-in.
MA with QMB would provide more benefits at a lower cost than MinnesotaCare. Contact the household to determine if the applicant or enrollee wants to apply for MA and QMB. This is a choice, not a mandatory referral to MA and Medicare.
See Medicare and Medicare Part A for information about who qualifies for Medicare and who must pay a premium to get Medicare Part A.
MinnesotaCare clients who meet certain conditions must be referred to apply for Medicare. See Medicare as Other Health Care Coverage to determine who must be referred and the steps in the referral process.
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.
GAMC enrollees who qualify for Medicare may have an MA basis of eligibility. Evaluate MA eligibility for these people.
GAMC enrollees who qualify for Medicare must enroll in Parts A and B as a condition of their GAMC eligibility if it is cost effective. See Cost Effective Health Care Coverage - MA and GAMC and Steps in Cost Effective Determination.
GAMC enrollees with Medicare may also be eligible for a Medicare Savings Program (MSP). However, an enrollee cannot be enrolled concurrently in both GAMC and an MSP. The enrollee must choose between those programs.
Example:
Gene is a GAMC enrollee. He is not certified disabled, but has End-Stage Renal Disease (ESRD) and has Medicare Part A. Gene is eligible for GAMC and eligible for the Qualified Medicare Beneficiary (QMB) program.
Action:
If Gene chooses to stay in GAMC:
n Determine if Gene’s Medicare Part B premium can be reimbursed as cost-effective. His premium may be higher due to a penalty if he failed to enroll in Part B when his Medicare entitlement began. Make a cost-effective referral to the DHS Benefit Recovery Section (BRS).
n Track his case and refer him to sign up for Medicare Part B at the next general enrollment period (January 1 through March 31.) See Referrals to Medicare.
n Gene qualifies for Medicare Part D because he has Medicare Part A. GAMC enrollees are not automatically eligible for the Extra Help subsidy. He will need to apply to SSA for the Extra Help subsidy.
n Refer Gene to the Senior Linkage Line® for help applying for the Extra Help subsidy and choosing a Medicare Part D plan. Because Gene has Medicare, GAMC will not pay for any prescription drugs that are covered under Medicare Part D.
If Gene chooses to enroll in QMB instead of GAMC:
n Gene does not have to wait for the general enrollment period to enroll in Medicare Part B through the buy-in. QMB will pay his Part B premiums and all other Medicare cost-sharing. Gene already has Medicare Part A, so he does not need to go to SSA to sign up for Medicare.
n Once QMB is approved, Gene will automatically qualify for the Extra Help subsidy.
n Refer Gene to the Senior Linkage Line® for help choosing a Medicare Part D plan.
See Medicare Part D and Minnesota Health Care Programs (MHCP) for more information on how these programs work together.