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Effective: February 1, 2011 |
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24.15.15ar3 - H Bills (Archive) |
Archived: June 1, 2011 |
"H" bills are a type of health care expense. H bills are the first bills applied to the client’s spenddown.
For information that affects all health care expenses see Health Care Expenses.
Federally-Funded MinnesotaCare Premiums.
State-Funded MinnesotaCare Premiums.
H bills include:
l Premiums.
n Health, dental and long-term care (LTC) insurance premiums.
n Indemnity policy premiums.
n Medicare premiums.
n MA-EPD obligations.
n MinnesotaCare premiums, both federally and state-funded.
H bills must be verified. Deduct the actual gross amount of the expense; do not round or truncate.
For information on applying H bills to a certain medical spenddown type see the following sections:
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.
Note: Apply the premium payment only in the month the payment is made if the premium is paid quarterly or some other interval rather than monthly.
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.
Do not allow health insurance premiums 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 a cost effective 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.
Example:
Randy has a spenddown amount of $55. He has an $85 health insurance premium, which has been determined to be cost effective. He needs only $55 of the premium to meet the spenddown.
Action:
Apply the $55 to the spenddown. 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 additional 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.
There are many different types of indemnity policies or insurance that can cover more than health care expenses.
One type of indemnity policy compensates the insured person for health care expenses. This is the only type of indemnity policy for which premiums can be used as a health care expense and deducted from the spenddown amount.
Another type of indemnity policy pays benefits directly to people for each day of hospitalization or for a specified injury to replace lost income. 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.
Note: The type of indemnity policy that reimburses the insured for expenses other than health care expenses while they are unable to work due to an injury or illness is not TPL. Count these payments as unearned income.
MA-EPD premiums can be used as a health care expense if paid by the client or a financially responsible relative living with the client for any allowable household member who has a spenddown.
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: Guardians, foster parents and noncitizen parents and relative caretakers who do not qualify for federally funded health care coverage.
l KK: Noncitizen children and pregnant women who do not qualify for federally funded health care coverage. For more information see Citizenship and Immigration Status.
Premiums paid 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.