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Effective: December 1, 2006 |
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24.15.15ar1 - H Bills (Archive) |
Archived: January 1, 2010 |
"H" bills are one type of health care expense. H bills are the first bills applied to the client’s spenddown. After H bills, M bills are the next type of health care expenses to apply.
For information which affects all health care expenses see Health Care Expenses.
Federally-Funded MinnesotaCare Premiums.
State-Funded MinnesotaCare Premiums.
GAMC - Hospital Only (GHO) Inpatient Hospital Co-Payments.
H bills include:
l Premiums.
n Health insurance premiums.
n Indemnity policy premiums.
n Medicare premiums.
n MA-EPD obligations.
n MinnesotaCare premiums, both federally and state-funded.
l GHO inpatient hospital co-payments.
H bills must be verified. Deduct the actual gross amount of the expense; do not round or truncate.
For information on when to apply H bills to the spenddown see the following sections:
l Automated Monthly Spenddown.
Allow a health insurance premium to be used to meet a spenddown, if it meets all of the following criteria:
l It is verified as being paid on a monthly basis rather than on a quarterly basis or some other interval.
l It is paid by the client or a financially responsible relative living with the client for any allowable household member.
l It is not paid by or reimbursed by a third party.
Health insurance premiums cannot be used as a health care expense if the client receives cost effective reimbursement through MA.
Note: If the client is able to meet the spenddown amount with health care expenses other than with the health insurance premium, consider whether it would be more advantageous to the client to reimburse cost effective insurance premiums or to apply the premiums to the spenddown.
A client may need only part of the health insurance premium amount to meet the spenddown amount. If this is the case, follow these steps:
1. Apply the amount needed to the spenddown.
2. Reimburse the balance of the premium if it is determined cost effective.
Example:
Randy has a spenddown amount of $55. He has an $85 health insurance premium. He needs only $55 of the premium to meet the spenddown.
Action:
Apply the $55 to the spenddown and evaluate the policy for cost effectiveness. If the policy is cost effective, reimburse the $30 balance to Randy.
Allow a Medicare premium to be used to meet a spenddown, if it meets all of the following criteria:
l It is paid by the client or a financially responsible relative living with the client for any allowable household member.
l It is not paid by or reimbursed by a third party.
Medicare premiums cannot be used as a health care expense if the client is reimbursed by either:
l The Medicare Savings Programs (MSP).
l The Buy-In.
Note: If the client is able to meet the spenddown amount with health care expenses other than with the Medicare premium, consider whether it would be more advantageous to determine MSP or Buy-In eligibility or to apply the premium amount to the spenddown.
Do not allow the deduction of the Medicare Part D premium if the client is receiving Extra Help to pay the premium amount.
l See Medicare Part D for more information on Extra Help.
l Clients receiving Extra Help may pay an addition premium cost above the benchmark premium amount for greater Part D coverage. Allow the premium amount paid in excess of the benchmark premium amount. See MA/GAMC and Medicare Part D for information on how Extra Help affects a spenddown or LTC income calculation.
l See Medicare Part D Benchmark Plans for more information on plans available to clients receiving Extra Help and the benchmark premium costs.
An indemnity policy is an insurance policy that pays benefits directly to people for each day of hospitalization or for a specified injury. It may cover certain costs not covered by other insurance and does not always limit benefits to paying for medical expenses. See Third Party Liability (TPL) for more information.
Indemnity policy premiums can be used as a health care expense if the policy benefits are limited to payments for medical expenses.
MA-EPD premiums can be used as a health care expense if it is paid by the client or a financially responsible relative living with the client for any allowable household member.
Federally-Funded MinnesotaCare Premiums
The following MinnesotaCare Major Programs receive federal funding:
l FF: Citizen or qualified non-citizen parents and relative caretakers.
l LL: Citizen and qualified non-citizen children and pregnant women.
Premiums paid for by clients receiving federally funded MinnesotaCare can be used as a health care expense if:
l A client has MinnesotaCare eligibility for months that overlap with MA eligibility.
l A household has a combination of MA eligible members and MinnesotaCare eligible members at the same time.
Note: Do not deduct managed care capitation payments for federally funded MinnesotaCare clients. For more information see MinnesotaCare Expenses.
The following MinnesotaCare Major Programs receive state funding:
l BB: Non-pregnant adults without children, regardless of citizenship.
l JJ: Legal guardians, foster parents and noncitizen parents and relative caretakers who do not qualify for federally funded health care coverage.
l KK: Non-citizen children and pregnant women who do not qualify for federally funded health care coverage. For more information see Citizenship and Immigration Status.
Premiums paid for by clients receiving state funded MinnesotaCare can be used as a health care expense if the premiums are more than the managed care capitation payments. For more information see MinnesotaCare Expenses.
GHO inpatient hospital co-payments can be used as a health care expense if the client verifies the amounts and dates of co-payments for which they are responsible.
Note: Do not apply any GHO-paid hospital bills to the MA spenddown.
l GHO enrollees have a $1,000 co-payment for each inpatient admission, regardless of income.
l GHO does not have spenddown provisions.