HAP's monthly Conference Calls are an opportunity to partner with the SHIP network to improve the capacity of the SHIPs. Through the SHIP Shout Out feature, we answer the questions and comments raised during the SHIP Shout Out section of each month's call. We provide additional resources that we hope are useful in your work with beneficiaries. The SHIP Shout Out also is an opportunity for you, the SHIPs, to use your own expertise to share solutions for other SHIPs.
All Hands on Deck: Get Ready for the AEP
How does the Monthly Cost Estimator on the Plan Finder work?
HAP created a new tutorial to walk through the different features and components of the Monthly Cost Estimator. This fact sheet includes screen shots showing clients in 2009 and 2010 as well as those with and without Extra Help.
If you have any questions or comments about this tutorial, please contact us.
Does the Plan Finder ever show the lowest copayments ($1.10/$3.30) for full dual-eligible beneficiaries?
No, even if beneficiaries indicate they have Medicare and Medicaid, the Plan Finder does not distinguish them from other full LIS beneficiaries. The reason for this issue may be that full dual-eligible beneficiaries in some states may have income above 100 percent of FPL, due to spend-down or waivers. Only full duals with income below 100 percent FPL qualify for the lowest copayments. All other duals, including those in Medicare Savings Programs, qualify for copayments of $2.50/$6.30.
Unfortunately, the Plan Finder does not distinguish these separate levels within full LIS. If you have any questions about using the Plan Finder, please contact us.
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What is the difference between suspended and suppressed plans?
Suspended plans currently not allowed to enroll beneficiaries — CMS has suspended their marketing and enrollment processes. Suppressed plans have incorrect information in the data files they submitted to CMS. The Plan Finder has these plans in the list of plans as placeholders. The details about these plans currently are unavailable while these are suppressed. Suppression is a short-term solution.
What is the payment methodology for MSPs?
For two Medicare Savings Programs — Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Medicare Beneficiaries (SLMB) — the federal government provides funding to states at the same match rate that it uses for individuals with full Medicaid benefits. For the Qualified Individual (QI) program, the federal government allocates each state a fixed amount of funds, and no state match is required. Unlike QMB and SLMB, when a QI grant runs out, individuals who qualify may be turned away. For QMB and SLMB, if an individual applies and qualifies, the state must provide the benefit.
Please explain the legislation that changes the resource limit for Medicare Savings Programs.
The Medicare Improvements for Patients and Providers Act (MIPPA), signed into law on July 15, 2008, encompasses significant changes and opportunities for Medicare beneficiaries, particularly those who are low-income. Section 112 of MIPPA amended the language of the Social Security Act to increase the resource level for Medicare Savings Programs (MSPs). MIPPA changed language specific to eligibility qualifications for the Qualified Medicare Beneficiary (QMB) program — Section 1905(p)(1)(C) of the Social Security Act.
However, the other Medicare Savings Programs (Specified Low-Income Medicare Beneficiaries, or SLMB, and Qualified Individuals, or QI) are established by Section 1902(a)(10)(E)(iv) of the Social Security Act. The Act states that beneficiaries eligible for these two MSPs would otherwise qualify for QMB, except for the fact their income exceeds the QMB level. This means that the resource levels for the SLMB and QI program reflect the resource levels for QMB; changes to resource levels for QMB will be mirrored in the resource levels for SLMB and QI.
If you have any questions about MIPPA's impact on MSPs, please contact us.
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