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Medicare Buy-In Program
Tracey Cousineau, LSW-C, Outreach Manager
06/22/2007
Since I wrote the
article on the Medicare Buy-In Program, I have been receiving a number
of questions regarding whether or not a person who has the Buy-In or
Savings plan, also need a supplemental policy (Medigap or other private
plan). As with all health
insurance decisions, people need to consider their unique situation.
Below is some information that may be helpful for people with
Medicare to know before making a decision to keep or drop other health
insurance coverage.
The first step in
making a decision would be to confirm what program you are eligible for;
QMB, SLMB or QI.
QMB is a MaineCare benefit. QMB benefits
cover Medicare Part A and B co-insurances and deductibles
(or co pays) provided by MaineCare providers, including out-of-state
providers with MaineCare agreements. SLMB and QI only
provide Part B coverage. The programs you qualify for will be indicated
on the Eligibility Notice from the
Office
of Integrated Access and Support (OIAS)/Department
of Human Services (DHHS). If there is any
doubt regarding your eligibility, the information must be confirmed with
the Eligibility Worker at the DHHS Regional Office.
The Bangor DHHS office number is
800-432-7825.
People
may choose to keep their private supplement or Medigap policy.
If this is the case, insurance coverage will be billed secondary to
Medicare.
People
who are newly eligible for QMB benefits may suspend their Medigap policy
for up to 24 months and must request the suspension within 90 days of
becoming eligible for QMB.
A person who cancels rather than suspends their policy or fails to meet
the timelines for having a policy suspended may not have a right to have
their Medigap policy reinstated with ‘guaranteed issue’ if they become
ineligible for QMB. It is
very important to note that Non-standardized Medicare supplement plans
issued prior to 1991 cannot be suspended and may have better benefits
than standardized Medigap plans.
A person cannot re-enroll in a non-standardized plan if coverage
is cancelled. If a person loses QMB eligibility within the suspension
period, their suspended Medigap policy (or a substantially equivalent
policy) will be reinstituted.
The Medigap policy is automatically reinstated effective as of
the date of the QMB termination as long as the request to have the
policy reinstituted is made within 90 days of losing QMB and the person
begins paying their premium.
A person who fails to meet the timelines for having a policy
reinstituted may not have a right to have their Medigap policy
reinstated with ‘guaranteed issue’
People who have
health coverage through a group medical plan, through an employer,
retirement plan or other group, should check with their plan’s benefit
administrator to determine the impact of QMB eligibility.
Receiving QMB benefits may reduce a VA pension amount because
calculating the amount of VA pension includes the person’s out-of-pocket
expenses for health care and prescription drugs.
QMB members who are also enrolled in a Medicare Advantage Plan
need to be aware that at this time the
MA Plans are not required to coordinate
with State Medicaid programs. The Member does not lose QMB
benefits. Consumers who get billed for services they don’t normally pay
for out-of-pocket need to work out their issues with the Plan and the
State.
Please contact
Tracey Cousineau at Health Access Network, 794-6700 or 1-888-426-4584
for more information regarding HAN services.