In the course of working with many of our disabled and aged patients, we will run into patients that qualify for Medicare coverage that have not enrolled in that coverage.  Many of them believe that they are not eligible for Medicare or cannot afford the part B premium and have dis-enrolled from that coverage.  We can help many of these patients obtain not only Medicaid, but also Medicare.

The first group of patients that we identify are those enrolled in Medicare part A (hospital insurance coverage), but whose income exceeds Medicaid for Aged, Blind and Disabled guidelines.  Patients enrolled in Medicare part A and are within income and resource guidelines for Med 4 categories  can enroll in Medicare Part B ( Medical insurance – Dr. and OP services and supplies) at any time as they qualify for a Special Enrollment Period with Medicare.  They may be subject to a penalty for not signing up at the appropriate time; however they may be eligible for the state to assist with a Buy-In.

Frequently, this will involve the advocate educating not only the patient, but also the local DFR staff.

Start by filing an application for health care coverage online with FSSA.  In some local offices, you may still be able to fax in a paper application for QMB/SLMB coverage.  Gather the necessary income and resource verifications as well as a copy of the patient’s picture ID and Medicare card and submit this to the FSSA document center.  It will be important to set up a reminder for yourself to contact FSSA within 10 days of submission of this application as these applications may be denied without processing as the local office will assume the applicant is over income for traditional Medicaid and may be under the misunderstanding that the applicant must have Medicare part B to qualify for QMB/SLMB.  The following policy manual cites will make it easier for DFR staff to understand why we are applying for this coverage:

1610.30.00 QUALIFIED MEDICARE BENEFICIARY (MED 4)

1610.35.00 SPECIFIED LOW-INCOME MEDICARE BENEFICIARY

3470.05.00 QMB/QDW/SLMB/QI BUDGETING PROCEDURE (MED 4)

3480.00.00 BUY-IN PROCEDURES AND EFFECTIVE DATES (MED)

Link to full policy manual.

It is important to complete the application for QMB/SLMB prior to applying for Medicare as the establishment of enrollment in a Medicare Savings Plan (QMB/SLMB) is what creates a Special Enrollment Period. 

Once the Med 4 coverage has been established, the most expedient process is to contact the buy-in office directly.  The contact is:

Etta Mae Dowdell

Buy-In Analyst

Indiana Medicaid/HP Enterprise 

 (1) Dial 317 488 5000 option #8

 (2)Then dial extension 1231005

 Email Address:  etta.dowdell@fssa.in.gov

 

How to assist a SSI recipient in gaining Medicare

The second type of patient that we can assist is those patients 65 and older who receive SSI benefits and Medicaid.  These patients are entitled to Medicare parts A and B when they turn 65, but they are frequently unaware of this as they are not automatically enrolled as the rest of the population is.  It is a multi-step process, but at the end of it the patient will have Medicare A, B, D and Medicaid.  This dual eligibility is valuable to our clients as it allows access to additional federal dollars for their care.

This process starts with an application for Medicare part B filed online.  Be careful to explain that the patient is only interested in coverage that they can get for free and include the patient’s active RID number in the comment section of the application.  It is important to communicate with the patient that Social Security may advise them that the cost of Medicare coverage will exceed $400 per month, but they should let Social Security know they only want the part B with state buy-in.  Most Social Security field workers are completely unfamiliar with this process and trying to protect recipients from losing a large portion of their checks.  You may need to speak with the local field office staff directly to let them know what level of coverage you are trying to establish.

Once the Part B is established, the advocate should file an application for health coverage online with FSSA or fax in the QMB/SLMB paper application if the local office allows.  The state of Indiana is also supposed to pay for the Part A premium for SSI recipients when they become eligible for Medicare, but this process is virtually unknown at the local level, so again, the advocate will lead the charge with educating local DFR staff.  At this point, the advocate should be able to verify SSI related Medicaid coverage and Medicare part B on the interchange.  When the QMB/SLMB coverage has been approved, the advocate will then contact the buy-in office to establish the state buy-in of the Medicare Part A premium.

This process can take several months of tracking, but the state will frequently buy-in the individuals retroactively up to a year in Medicare coverage.

It is important to note that all penalties for not having Medicare coverage at age 65 are waived for recipients who have any category of Medicaid coverage, so the age of the patient should not prevent the advocate from assisting these patients.

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What are the different parts of Medicare?

The Medicare program has four parts:

Part A (hospital insurance): Hospital insurance helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care.

The other three parts of Medicare require premium payments, and if you don’t enroll when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have coverage. Also, you may have to wait to enroll, which will delay coverage.

Part B (medical insurance): Medical insurance helps pay for doctors’ services and many other medical services and supplies that hospital insurance does not cover.

Part C (Medicare Advantage plans): If you have Medicare Parts A and B, you can join a Medicare Advantage plan. Medicare Advantage plans are offered by private companies and approved by Medicare. These plans generally help you pay the medical costs not covered by Medicare Part A and B.

Part D (prescription drug coverage): Prescription drug coverage helps pay for medications doctors prescribe for treatment.