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Day 6 & 7 Public Benefits. Review. Medicare. For people 65+ and under 65 with a disability 4 parts of Medicare Part A: Hospital Insurance Part B: Medical Insurance Part C: Medicare Advantage Plans Part D: Prescription Drug Coverage Part A & B called Original Medicare - PowerPoint PPT Presentation
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Medicare For people 65+ and under 65 with a disability 4 parts of Medicare
• Part A: Hospital Insurance• Part B: Medical Insurance• Part C: Medicare Advantage Plans• Part D: Prescription Drug Coverage
Part A & B called Original Medicare• Automatic enrollment if getting SS benefits, must enroll if not• Premiums always for Part B, only for A if not enough credits• Not comprehensive coverage, has coverage gaps• Out-of-pocket costs for A & B change yearly- see chart
3
Three Enrollment Periods Initial Enrollment Period (IEP): 7 months surrounding 65th
birthday month (month earlier if birthday on 1st of month)• Date of enrollment determines effective date of Medicare
Special Enrollment Period (SEP): 8 months following loss of coverage from “active” employment
General Enrollment Period (GEP): Jan 1st – March 31st of each year • July 1st effective date
4
Delaying Part B Enrollment Individuals may choose to have just Medicare Part A while they are
ACTIVELY working or are covered under a spouse who is ACTIVELY working
Once ACTIVE employment coverage has ended, must take Part B coverage within 8 months to avoid a penalty (there is no 8 month period for retiree coverage)
If the employer has <20 employees or <100 employees if the beneficiary has a disability, then the individual may need Part B because Medicare should pay first and Employer Group Health Plan (EGHP) second• Beneficiaries should confirm with their employer if Part B is needed
5
Late Enrollment Penalty Penalty for Part A: Capped at 10% of premium and goes away
after penalized for twice the length of time the person delayed enrollment• Only for voluntary enrollees (paying for A) who don’t enroll in
Part A when initially eligible
Penalty for Part B: 10% of premium for each full 12 month period the individual delayed enrollment
• Penalty for Part B not capped and is a lifetime penalty except: Under 65 beneficiaries with a penalty will have the
penalty removed and will have a “clean slate” when they turn 65
6
Medicare Pays for reasonable and medically necessary services There are coverage gaps in Medicare including: Part A in-patient hospital deductible Part A daily co-payment for in-patient hospital days 61-90 Part A daily co-payment for in-patient hospital days 91-150 Part A daily co-payment for SNF days 21-100 Part B annual deductible Part B co-insurance (usually 20%) First three pints of blood Coverage outside the United States
7
Two Options For Supplementing Medicare
Step 1: Decide how you want to get your coverage
PART AHospital
Insurance
PART BMedical
Insurance
PART CCombines Part A, Part B
and usually Part D
ORIGINAL MEDICARE MEDICARE ADVANTAGE PLAN
OR
PART D Stand Alone PDP
PART DIncluded in Part C
Step 3: Decide if you need to add supplemental medical coverage
MEDIGAPSupplement Core or Supplement 1 plan
ENDIf you join a Medicare Advantage
Plan with drug coverage (MAPD), you cannot join another drug plan and
you don’t need and cannot be sold a Medigap policy
Step 2: Decide if you need a Prescription Drug Plan
&
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Medigap vs.Medicare Advantage
Original Medicare + Medigap Supplement 1 Medicare Advantage Plan
Higher premiums but no co-pays Generally lower premiums but
has co-pays Freedom to choose doctors May be restricted to network
No referrals necessary May need referrals for
specialists Some routine services not
covered (vision, hearing) May include extra benefits
(vision, hearing, fitness)
Covered anywhere in US Emergency services ONLY
outside service area
9
Part D Must have Part A and/or Part B to be eligible
2 ways to get prescription coverage:1. Medicare Prescription Drug Plans (PDPs); also known as
stand alone plans2. Medicare Advantage (Part C) Plans with drug coverage
Part D is voluntary, but eligible beneficiaries who do not enroll may be subject to a penalty• Must have “creditable coverage” to avoid penalty
10
Part D Enrollment Initial: Mimics Part B 7 month period Open: Oct 15th – Dec 7th, coverage effective Jan 1st Special: Refer to SEP chart for applicable situations MADP: Jan 1st – Feb 14th Late: Penalty is 1% of the national base beneficiary premium for EACH
MONTH the beneficiary:• Did not enroll in a Medicare PDP when they were first eligible AND:
Had no prescription drug coverage OR Had coverage that was not considered “creditable OR Had a lapse in creditable coverage of 2 full months (63 days)
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Part D Formulary The prescription benefit includes a list of “covered drugs” and this
list is called the “formulary”
If the insurer is very selective about which drugs are to be covered, then it is sometimes referred to as a “closed formulary”. If the formulary is open to all drugs but places drugs into different cost sharing categories or “tiers”, it is referred to as an “open formulary”
Each plan must meet formulary standards. The formulary must include and cover certain drugs or certain classes of drugs. Medicare has established a category of excluded drugs
12
Extra Help Federal assistance program to help low-income and low-asset Medicare
beneficiaries with costs related to Medicare Part D
Extra Help subsidizes:• Premiums• Deductibles• Copayments• Coverage Gap “Donut Hole” • Late Enrollment Penalty• Does NOT subsidize non-formulary or excluded medications
Apply through Social Security Administration
13
Prescription Advantage Massachusetts’ State Pharmacy Assistance Program (SPAP)
Provides secondary coverage for those with Medicare or other “creditable” drug coverage (i.e. retiree plan)
Provides primary prescription coverage for those who don’t qualify for Medicare
Benefits are based on a sliding income scale only– no asset limit!
Level of assistance provided is determined by gross income
Different income limits for under 65 and 65 and over
Members are provided a SEP (one extra time each year outside of open enrollment to enroll or switch plans)
14
SHINE and Public Benefits
SHINE counselors screen individuals for potential eligibility for health/prescription-related public benefit programs, provide education about the benefits, and may assist in the application process
Counselors do not guarantee that an individual will be eligible for these programs; this decision can only be made by the benefit program
16
Supplemental Security Income (SSI)
Federal income supplement program funded by general tax revenues to help aged, blind, and people with disabilities who have little or no income
Needs based program Provides cash to meet basic needs for food, clothing, & shelter Different income supplements for various living arrangements Apply through Social Security office Automatic enrollment into MassHealth
17
MassHealthMedicaid= National public health insurance program
MassHealth= Massachusetts Medicaid program
Public health insurance program for low- to medium-income residents of Massachusetts
Administered by state Medicaid agencies within broad parameters established by federal regulations
Overseen by the Centers for Medicare & Medicaid Services (CMS)
18
SHINE and MassHealth
SHINE focus is on MassHealth ONLY AS IT RELATES TO MEDICARE BENEFICIARIES
Benefit programs and eligibility criteria may differ for individuals who are not entitled to Medicare
19
Dual-Eligible
Medicare beneficiaries who are enrolled in MassHealth Standard are referred to as dual-eligible
Dual-eligibles can receive assistance paying for Medicare premiums, deductibles, co-insurance, and co-pays
Dual-eligibles receive the many MassHealth covered services that Medicare beneficiaries typically do not receive
20
Dual-Eligible's and Part D Dual-eligibles MUST enroll into a Medicare Part D plan
If beneficiary does not enroll into a plan within 60 days, they will be auto-assigned to a plan
Best to avoid this: Auto-assigned plan may not be lowest cost and formulary may not list all of beneficiaries drugs
Dual-eligibles automatically “deemed eligible” for Full Extra Help, regardless of income and assets
21
Dual-eligible's and Part D, cont. MassHealth will cover a drug that Medicare does not pay for
• Will NOT cover a drug that Medicare does pay for but is not listed on the beneficiaries plan formulary
MassHealth is always the payer of last resort• Will NOT provide primary prescription drug coverage for dual-
eligible's Dual-eligibles not yet enrolled into Part D may receive their
prescription drugs at the Extra Help co-pay amounts by using the Limited Income Newly Eligible Transition Program (LINET)
22
Limited Income Newly Eligible Transition Program (LINET)
Provides immediate prescription drug coverage for people with Medicare who are at the pharmacy counter and qualify for Extra Help, but aren’t yet enrolled in a Medicare drug plan• Also covers prescriptions that eligible people filled within the last 30
days
Covers all Part D covered drugs; No prior authorization or network pharmacy restrictions during the time period covered by this program
Will be charged the reduced co-payment based on the level of Extra Help they are eligible for
Program administered by Humana
23
MassHealth Standard Eligibility Determining eligibility for MassHealth is a complex process SHINE may screen for potential eligibility, educate clients about
MassHealth benefits, assist in the application process• Should not guarantee eligibility; this decision should be left to
MassHealth Must be a Massachusetts resident
• Defined as someone living in Massachusetts and intends to stay Different eligibility requirements for applicants age 65 and older and
those under age 65
24
Financial Eligibility 65+ For married couples living together, eligibility usually based on the
combined income and assets of both members of the couple Must meet both income and asset guidelines in order to qualify for
MassHealth Standard• Income eligibility: Countable income at or below 100% of the Federal
Poverty Level (FPL)
• Asset eligibility: $2,000 or less in countable assets ($3,000 for a couple) To determine income:• Take gross countable income and subtract 2 deductions: Unearned
income disregard and Earned income disregard
25
Income Disregards Unearned income disregard is a $20 deduction from the household’s
total countable unearned income. Married couples receive only one $20 deduction from their combined countable income
Earned income disregard is calculated by subtracting $65 from the individual’s gross earned income, and dividing the remainder by 2. Married couples in which both people are working will both receive separate earned income disregards
All disregards already calculated in the Pink Sheet (Eligibility Guidelines for Health/Prescription-Related Public Benefits Programs)
26
Income:Countable VS. Non-Countable
Countable Income•Social Security benefits•Railroad Retirement
benefits•Pensions•Earned income•Rental income•Federal veteran pensions
& disability compensation• Interest income
Non-countable Income
• Cash assistance from SSI or the Department of Transitional Assistance (DTA)• Income-in-kind (e.g., gifts)• Income from a reverse
mortgage• Veterans’ Aid & Attendance
benefits• Chapter 115 benefits for
veterans27
Assets:Countable VS. Non-CountableCountable Assets
• Bank accounts• Whole life insurance
policies, when total face value of all policies is over $1,500• Individual retirement
accounts (IRA)• Stocks and bonds• Second homes/cars• RVs/Boats
Non-countable Assets
• Primary residence and 1 car• Personal belongings & home
furnishings• Term life insurance policies• Whole life insurance policies
with total face value $1,500 or less
• Burial plot • $1,500 burial-only account• Irrevocable burial contract 28
Financial Eligibility Under Age 65 NO asset limits Income limit is 133% of the FPL Earned income disregard and unearned income disregard not
used Modified Adjusted Gross Income (MAGI) used instead of gross
income• Applicant receives an income deduction equivalent to 5% of the FPL
MAGI already calculated in the Pink sheet
30
Examples of MassHealth Covered Services
• In/Out-patient hospital services• Emergency hospital services• Skilled nursing facility• Home health care • Case management services• Clinic services• Diagnostic services• Dental services • Programs for all-inclusive care for
the elderly (PACE)• Personal care services (PCA)
• Hospice care• Medical Transportation• Occupational therapy • Optometrist services• Physical therapy• Podiatrist services• Preventative services• Private duty nursing• Prosthetic/orthotic devices• Psychologist services• Rehabilitative services• Respite care
31
Applying For MassHealth Best for the individual, spouse, family member to complete the application;
counselors can assist when needed 2 application types:
• Application for Health Coverage and Help Paying Costs (ACA-2) In general used by applicants under age 65
• Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (SACA-2)
For applicants 65 and older Pink sheet indicates which application is used for each MassHealth
program
32
Application Processing Applications sent to and processed at the Central Processing Unit or
MassHealth Enrollment Centers (MEC) If an application is received and requires further verification, applicant will
receive a Request for Information with a deadline by which to return the needed documentation
Retroactive Coverage:• Applicants age 65 and older can receive retroactive coverage up to 3 full
calendar months prior to the date of application• Applicants under age 65 can receive retroactive coverage beginning 10
days prior to the date of application Does not apply to MassHealth Senior Buy-in
33
Payment For Services
MassHealth is always the payer of last resort
Any other insurance plan, including Medicare or employer-based health plans, must pay first before MassHealth will pay.
34
Special MassHealth Programs In addition to the MassHealth Standard benefits
and eligibility criterion just discussed, there are several MassHealth programs that provide various levels of benefits for individuals who meet specialized eligibility guidelines
These programs act like Medicare Supplements (Supplement 1), covering co-pays and deductibles and offering additional benefits
35
Medicare Savings Programs: MassHealth Senior Buy-In
Federally referred to as the Qualified Medicare Beneficiary (QMB)
• Eligibility Be entitled to Medicare Income at or below 100% of the FPL Assets at or below the designated limits (change yearly)
• Benefits Payment of Medicare Part A & B premiums Payment of deductibles and co-pays Deemed eligible for Full Extra Help
36
Medicare Savings Programs:MassHealth Buy-In
Federally referred to as Specified Low-income Medicare Beneficiary (SLMB) and Qualified Individual 1 (QI-1)*
QI-1 subject to periodic federal funding appropriation
• Eligibility for SLMB and QI-1 Be entitled to Medicare Have income at or below: QI-1= 135% of the FPL SLMB=120% of the FPL Assets at or below the designated limits (change yearly)
• Benefits Payment of Medicare Part B premium Deemed eligible for Full Extra Help
37
Buy-In ForPart B Late Enrollees
Late enrollees for Medicare Part B who qualify for the Senior Buy-in (QMB) or Buy-in (SLMB/QI-1) may enroll in Part B outside of the General Enrollment Period
The effective date of Part B coverage would not be earlier than the Buy-in start date
The individual’s late enrollment penalty will be paid for by MassHealth
38
Caretaker Relative Eligibility
• Must meet the definition of a caretaker relative: Adult of any age who is primary caregiver for a child (can be related to the child by blood, adoption, marriage, or be the spouse/ex-spouse of one of these relatives). Must live in same home as the child and neither of the child’s parents can be living in the home
• Must have income at or below 133% of the FPL Benefits
• Eligible individuals will receive MassHealth Standard benefits• Payment of Medicare Part A & B premiums, deductibles and co-pays• Deemed eligible for Full Extra Help
39
CommonHealth Eligibility
• Must have a disability• Must be ineligible for MassHealth Standard• Must currently be working at least 40 hours per month, or currently working and worked
at least 240 hours in the past 6 months MassHealth flexible on what “work” is
Must be paid work; cannot be volunteer Individuals under age 65 can waive the work requirement if they meet a one-time
deductible
• NO financial eligibility requirements Individuals with incomes above 150% of the FPL will pay a monthly premium relative to
their income
40
CommonHealth, cont Benefits provided
• Benefits similar to MassHealth Standard including payment for Part A and B co-payments and deductibles
• Deemed eligible for Full Extra Help
Benefit NOT provided• Automatic payment for Part B premium
Individuals must separately meet the qualifications for Buy-in in order for MassHealth to pay premiums
41
Frail Elder Waiver Allows elders eligible for nursing home care who want to remain at home to
get the services & supports to be able to live safely
Eligibility• Be age 60 or older• Be clinically eligible for nursing home care & receive services from the
ASAP’s home care program• Have income at or below 300% of the Federal SSI Rate• Have assets at or below $2,000
Only counts the income & assets of the applicant even if married; any assets over $2,000 limit allowed to be transferred to non-applying spouse
42
Frail Elder Waiver, cont Benefits
• Payment of Medicare Part A & B deductibles and co-pays• Deemed eligible for Full Extra Help• No co-pays for prescription drugs• Supportive services (ex. Personal care, homemaking, meals)
To Apply• To apply the individual should be referred to their local Aging Service
Access Point (ASAP) ASAP staff will evaluate the applicant for clinical eligibility
43
Health Safety Net (HSN) Pays for medically necessary services at Massachusetts community health centers (CHCs)
and hospitals 2 levels of eligibility: Full and Partial
Eligibility• Must be a Massachusetts resident
Non-residents may receive emergency or urgent care only
• Full Health Safety Net Income must be at or below 200% of FPL
• Partial Health Safety Net Income must be above 200% but at or below 400% of FPL Individual will be assessed an annual deductible
44
Health Safety Net, cont. Benefits
•Low co-pay prescription coverage Prescription must be filled at a HSN pharmacy
•Will pay for allowed services not covered by Medicare, as well as Medicare co-pays, coinsurance, and deductibles
Services must be delivered/ billed through a hospital or community health center that has an HSN program
•Can pay for services up to 6 months prior to approval
HSN is NOT considered “creditable coverage” for Medicare Part D therefore use of the HSN pharmacy benefit does not protect a beneficiary from the Part D late enrollment penalty
45
Senior Care Options (SCO) Combines MassHealth Standard coverage with social support services
and coordinated care to help individuals maintain their health and live in the community
Eligibility• Be 65 or older• Qualify for MassHealth Standard • Live in a designated service area of a SCO plan• NOT be diagnosed with End Stage Renal Disease• NOT be an inpatient in a chronic rehabilitation hospital
46
SCO, cont. Benefits
• No co-pays or deductibles• Coordination of health care• Prescription drugs without a co-pay• Comprehensive dental, including dentures• Transportation• Specialized geriatric support services• Adult day care• 24 hour access to medical support• Home care services• Family caregiver support
•
47
One Care Managed care option that provides all Medicare & MassHealth services along with
additional care coordination and support services to dual-eligible individuals with disabilities• Members can only receive covered services through plan’s network of contracted
providers• One Care is not available in all counties
Eligibility• Be age 21-64• Have Medicare Parts A & B• Have MassHealth Standard or CommonHealth
Cannot also be enrolled in SCO, PACE, Frail Elder Waiver, or other MassHealth waiver program
48
One Care, cont. Benefits
• All guaranteed Medicare and MassHealth benefits as well as: No premiums, deductibles, or co-pays Services coordination by an interdisciplinary care team Part D Coverage and no co-pays for prescription drugs Enhanced behavioral health and substance abuse services Long-term support Home modification Comprehensive dental Hearing aids Transportation
49
Program Of All-Inclusive Care For The Elderly (PACE)
Provides community based care & services to people age 55+ who would otherwise require nursing home level of care• Team of health care professionals provide integrated care plan to keep
individual safe at home Eligibility
• Be age 55 or older• Be clinically eligible for nursing home care• Income at or below 300% of the Federal SSI Rate, assets at or below $2,000• Live in the service area of a PACE organization
PACE is not available in all regions of the state
50
PACE, cont. Benefits
• No premiums, deductibles or co-pays for dual-eligible's; Medicare only beneficiaries will have monthly premium
• Provides all services covered by Medicare and MassHealth Standard
• Provides functional, social, and psychological services to help individuals safely remain in their homes
• Part D coverage through the PACE plan
51
MassHealth Personal Care Attendant (PCA) Program
Program that helps people with long-term disabilities live independently at home by giving member funds to hire a personal care attendant (PCA) to help with activities of daily living (ADL’s)
Eligibility• Be age 65 or older• Have a permanent and long-lasting disability• Must need assistance with at least 2 ADL’s
ADL examples: Dressing, eating, bathing, walking• Income at or below 133% of the FPL• Assets at or below $2,000 for an individual or $3,000 for a couple
52
Long Term Care (LTC) MassHealth
Pays the nursing home the difference between the patient private paid amount and Medicaid established rate for nursing home care. Requires clinical eligibility.
Financial Eligibility• No income limit; applicant just must have monthly income insufficient to pay
for nursing home costsTo prevent impoverishment of community spouse, spouse may be able to
keep some of applicants income, called the monthly maintenance needs allowance
• Assets limited to $2,000Community spouse allowed to keep all assets (not counting the primary
residence) up to a certain amount
53
Review1. What does “dual-eligible” mean?
2. What are the different types of MassHealth applications and which application is used for which MassHealth program?
3. What MassHealth programs are specifically for individuals with a disability?
4. What is Health Safety Net and what does it provide?
5. What benefits are available from One Care?
54
Case Study 1:Anna Stetick
Anna: 73 year old retired widow lives in senior housing Income: Social Security $1250/month (Net) Assets: $3300 in her checking account, $9,000 in savings Anna tells you that she moved here from Florida one month ago. She
was in a MA plan in Florida and knows she needs to pick a plan in Massachusetts. She also knows she will lose her Part D coverage with the Florida plan and was told she can’t enroll in a plan in Massachusetts until open enrollment and will have a penalty. She wants to know if she can get on MassHealth to pay for her prescriptions.
• How would you help her?
55
Case Study: 2Robin Hood
Robin: 76 years old single, retired, living in senior housing Income: Social Security: $1,133/month (Net) Assets: $2500 in savings, $1000 in checking, car valued at $4000. He
has a life insurance policy with a face value of $10,000 and a cash surrender value of $1200
Insurance: Medicare A & B effective 3/1/03 and currently enrolled in the BCBS PPO plan
A friend told Mr. Hood to talk to a SHINE counselor about getting on MassHealth.
• How would you help him?
56
Case Study: 3Donna Wannago
Donna: 77 year old retired widow who lives in senior housing Income: Social Security $816/month (Net) Assets: $1500 in savings, $200 in checking, life insurance policy with a face
value of $1200, car valued at $4000 Insurance: Medicare A & B effective 1/22/02 & Medex Bronze Donna signed up for a Part D plan during open enrollment although she
wasn’t taking any drugs at that time. She said she she chose the least expensive plan. She is worried about paying the Part D premium along with her Medigap . Her doctor just put her on medication and she doesn’t know how she will be able to pay for it during the gap in coverage under Part D.
• How would you help her?
57
Case Study 4:Polly Gimmee
Polly meets with you on May 10th. She tells you she is 64 and has been on MassHealth due to a disability for the past 19 months. She says she is turning 65 in July and will be enrolled in Medicare effective July 1st. She will be receiving a Social Security check in the amount of $1102. A friend told her that her MassHealth might change when she turns 65. She is worried about her health care coverage if MassHealth does change particularly because she takes several medications and has no other income or assets to use to pay for them. She wants to know if it’s true that MassHealth might not continue to cover her. • How would you help her?
58
Case Study 5:Mel Kontent
Mel meets with you at the SHINE office. He is very confused about the Medicare Prescription Drug Program. He tell you he takes several medications and gets some coverage through his Medicare Advantage HMO plan and that he used to get additional coverage through Prescription Advantage. He did fill out the application for Extra Help that Prescription Advantage told him to complete, but he received a letter that he was denied. He tells you he cannot afford his co-pays for his drugs since he lost his Prescription Advantage.
• How would you help him?
59
Case Study 6:Martin Eyz
Mr. Eyz retired at age 65 and is collecting Social Security. He has Medicare and Medex Bronze. He takes no medications and never signed up for Part D. Mr. Eyes recently took a part-time job at the local Whypaymore to supplement his income. He lives in senior housing, so his rent is affordable. Mr. Eyes tells you that he is having a difficult time paying for his health insurance and was told by a friend that he should apply for MassHealth which would cover his medical expenses. Mr. Eyes tells you that he gets $750/month from Social Security and $300/month from his job at Whypaymore. He has $600 in a checking account and $1,400 in a CD. • Is he eligible for MassHealth?
60
Case Study 7:Arthur Ritis
Arthur calls for assistance. He received an Eligibility Review Form (ERV) from MassHealth to complete. He doesn’t understand why he received the form since he is not on MassHealth. He had applied in the past but was denied because he was over income ($1596.40/month). He tells you he is homebound and called because he cannot come in for an appointment.
• How would you help him?
61
Case Study 8:Ben Hurr
Ben is 57 years old. He has been on Medicare A & B since January. He was on a few inexpensive medications that he was filling at Wal-mart at little cost. His meds are changing and he now has a few expensive brands. His income is $1,900/month, and he has partial Health Safety Net. An advocate at the community center suggested he see a doctor at the community health center in a nearby town so that he can fill his prescriptions at the health center. She told him he can sign up for Part D at the next Open Enrollment Period.
• What additional information would you provide?
62
Case Study 9:Charlie Horse
Charlie meets with you for help with his prescription coverage. He is in a Blue Cross PPO Medicare Advantage plan with prescription coverage. He takes several medications, one of which, Procrit, is quite expensive. His plan has been covering it, but he will be in the donut hole soon and is concerned because he can’t afford to pay the full price for his drug. He tells you he used to be in Prescription Advantage but that ended in January. He says his monthly income of $1,585 makes him ineligible for any benefit programs. He is not a veteran.
• How would you help him?
63
Case Study 10:May B. Poor
May will be 65 and retiring in 2 months and will not have retiree coverage available through her former employer. She just heard about Medicare Part D. She only takes 1 drug now and doesn’t really want coverage. However, she heard she will pay a penalty if she enrolls at a later date should her drugs increase, as she believes they might. She is concerned about the monthly premium along with the premium for health insurance. She states that her only income will be Social Security and the amount she’ll receive will be $1,120/month. She tells you her savings are minimal and she has no other assets other than her home and a car. She wants to know if there is any way she can cut down on her health care costs or avoid taking Part D as she feels the additional premium will put her over the edge. • How would you help her?
64
Public Benefits Quiz1. List the MassHealth Buy-In programs and the benefits they provide.
2. To be eligible for MassHealth an individual cannot own a home. True or False
1. When determining an individual’s eligibility for Supplemental Security Income (SSI), their living arrangements are considered.
True or False
4. If a Medicare beneficiary has MassHealth, do they need to purchase a Medicare Supplement or join a Medicare Advantage Plan?
Yes or No Why?
65
Public Benefits Quiz, cont.5. What are the major differences between MassHealth for
individuals under 65 and those 65 and over?
6. What resources are counted in the asset test for people over 65 who apply for MassHealth while living in the community?
7. An individual whose assets are too high for MassHealth Standard can spend down assets in order to qualify on medical expenses only.
True or False
66