New grant focuses on providing assistance to at risk populations in 9 rural Missouri counties

New grant focuses on providing assistance to at risk populations in 9 rural Missouri counties

i Mar 11th No Comments by

Missouri CLAIM will provide a one-stop shop to provide screening and application help for multiple assistance programs

Jefferson City, Mo– The Missouri Department of Insurance announced a new grant from the National Council on Aging’s Center for Benefits Access (NCOA). The Benefit Enrollment Center (BEC) Grant provides funding for a twenty month period (January 2019 – September 2020) to the Department to implement a Benefit Enrollment Center in 9 rural Missouri counties.

Benefit Enrollment Centers (BEC) use person-centered strategies in a coordinated, community-wide approach to find and enroll Medicare beneficiaries—both seniors aged 65+ years and adults living with disabilities — who have limited income and resources to access available benefits, with the primary focus being on the following five core benefit programs:

  • Medicare Part D Extra Help (or Low-Income Subsidy, LIS)
  • Medicare Savings Programs (MSP)
  • Medicaid
  • Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps)
  • Low-Income Home Energy Assistance Program (LIHEAP)

A “person-centered” approach is one in which someone is screened for and assisted with applying for multiple benefits at one time, based on that individual’s needs. Currently the department’s CLAIM program assists Missourians with the first three of these core services through the State Health Insurance Program (SHIP) and the Medicare Improvements for Patients and Providers Act (MIPPA) funding. This additional grant will allow CLAIM to assist 1,000 individuals to apply for and receive much needed assistance for which they may qualify.

The BEC grant focuses on 9 rural counties, and senior and disabled individuals in those counties who are most in need of the services. The target area includes these central Missouri counties: Callaway, Camden, Cole, Laclede, Miller, Morgan, Moniteau, Osage and Pulaski. 

The total population in these targeted counties is 328,992, of which:

  • 15.77% are age 65 and older
  • 16.42% have a disability (higher than MO at 14.44% and the US at 12.52%)
  • 15.54% live at or below FPL. Per capita income is $23,004, below the MO average of $27,044;
  • Over 17.25% of the population receives Medicaid
  • 14.44% of the adult population, age 18-64, lacks health insurance

Current Medicare program data indicate there are 12,973 disabled individuals residing in this defined area, 15,881 are low-income, and 13,802 are estimated to need and be eligible for MSP.

About the Missouri Department of Insurance, Financial Institutions & Professional Registration

The Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) is responsible for consumer protection through the regulation of financial industries and professionals. The department’s seven divisions work to enforce state regulations both efficiently and effectively while encouraging a competitive environment for industries and professions to ensure consumers have access to quality products.

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Missouri Rx Changes Effective July 1, 2017

i Jun 20th No Comments by

Missouri Rx – Missouri’s State Pharmaceutical Assistance Program has been reauthorized by the state legislature for another 5 years until August, 28, 2022.  Missouri Rx works with a person’s stand alone Part D plan or Medicare Advantage plan to pay 50% of a person’s costs at the pharmacy.  Eligibility benefits for MO Rx benefit has been reduced to only those Medicare beneficiaries that are also enrolled into Medicaid. This change affects 64,000 enrollees. Our certified counselors can help you determine your options if you have lost this benefit. You have not lost your Medicare drug coverage.

Missouri Rx coverage will no longer pay 50% of the cost of Part D prescriptions for people enrolled in Medicare whose

  • Income $21,660 for a single person or $29,140 for a couple or
  • Enrolled into Extra Help from SSA sometimes called Low-Income Subsidy (LIS).

CLAIM Counselors can provide the following.

  • If you are affected by this change you have a Special Enrollment Period for two months to change your Part D plan. Counselors can assist with the comparison and enrollment into a another plan if this is your choice.
  • Counselors can screen and provide application assistance for Low-Income Subsidy through Social Security or Medicare Savings Program.
  • Check eligibility for Patient Assistance Programs to help cover some of your higher cost medications

www.rxassist.org – provides info and application links to assistance programs

www.needymeds.org – provides info and application links to assistance programs

www.rxoutreach.org  – discount purchasing program website

  • Other options may include talking with your doctor or going to a public health center that provides a sliding fee scale for prescriptions.

 

We encourage you to call or contact us to understand any options available to you.

May 2017 Medicare Minute

May 2017 Medicare Minute: Medicare Savings Programs

Script

Teaching Material

Handout

Medicare Minute

MEDICARE MINUTE PRESENTATION MATERIAL & TOPIC SCHEDULE

 

Each month, the SHIP Technical Assistance Center will distribute Medicare Minute presentation material, which will include:

 

  • Medicare Minute Script describing points the presenter should make during the presentation. Usually this includes 3 – 4 talking points along with “take action” steps and contact information. The Script could be used in presentations lasting 15 – 20 minutes.

 

  • Medicare Minute Teaching Material provides detail information to support the Medicare Minute Script. Each set of Teaching Material will include case studies that can be used to showcase a more “real life” application to the discussion topic. The Medicare Minute Teaching Material would be used for presentations of 30 – 60 minutes in length.

 

  • Medicare Minute Attendee Handout provides key information the attendee can review and retain at home. Attendees may receive paper copy handouts from the host site or be directed to the CLAIM website for access to the handout.

2019 Medicare Minute Topic Schedule (links to each month’s material in table)

Click here to download the Medicare Minute Presenter Checklist

Month Approved Topic   Month Approved Topic
January What’s New in 2019 July Medicare Savings Program 
February Medicare Enrollment and Election Periods August Medigaps 
March Medicare Coverage of Emergency/Urgently Needed Care September Fall Open Enrollment Period
April Medicare Coverage of Hospice Care  October Part A-covered Services
May Part B vs. Part D  November Accessing Supplemental Benefits 
June Original Medicare and Medicare Advantage Standard Appeals December Complaints, Grievances, and Beneficiary Resources 

 

2018 Medicare Minute Topic Schedule (links to each month’s material in table)

Month Approved Topic   Month Approved Topic
January What’s New in 2018? July Durable Medical Equipment (DME)
February Medicare Coverage of Preventive Services August Medicare Coverage of Home Health Care
March How Medicare Works with Federal and Military Benefits September Medicare’s Open Enrollment Period
April Explanations of Benefits (EOBs) and Medicare Summary Notices (MSNs) October Medicare Coverage of Mental Health Services
May Part D Appeals  November Original Medicare and Medicare Advantage Providers
June How to Afford Your Drug Costs December Speaking with your Doctor

 

2017 Medicare Minute Topic Schedule (links to each month’s material in table)

Month Approved Topic   Month Approved Topic
January What’s New in 2017 July Medicare and the Health Insurance Marketplace
February Special Enrollment Periods (SEPs) August Common Medicare Open Enrollment Notices
March Medicare Coverage of Hospital Stays September Open Enrollment Period
April How Medicare Works with Current Employer Insurance October Protecting Yourself from Enrollment Fraud
May Medicare Savings Programs November Discharge Appeals
June Medicare and Medicaid December Trouble Shooting Medicare

 

         2016 Medicare Minute Topic Schedule (links to each month’s material in table)

Month Approved Topic   Month Approved Topic
January What’s New in 2016 July Durable Medical Equipment
February Understanding Medicare Enrollment Periods August Planning Ahead: Advanced Directives and Long-term Care
March Medicare Preventive & Screening Services September Open Enrollment Period/Annual Election Period
April Medicare Notices & Appeals October Understanding Part D Plan Selection
May Medicaid & Other Programs that Make Medicare More Affordable November Medigaps
June Medicare Part A Covered Services December Who Pays First: Medicare & Other Types of Coverage

           

Source: Medicare Minute

 

2016 Medicare Parts A & B Premiums and Deductibles Announced

i Nov 12th No Comments by

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Part B Premiums/Deductibles

As the Social Security Administration previously announced, there will no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be “held harmless” from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90.

Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016.

“Our goal is to keep Medicare Part B premiums affordable. Thanks to the leadership of Congress and President Obama, the premiums for 52 million Americans enrolled in Medicare Part B will be either flat or substantially less than they otherwise would have been,” said CMS Acting Administrator Andy Slavitt. “Affordability for Medicare enrollees is a key goal of our work building a health care system that delivers better care and spends health care dollars more wisely.”

Because of slow growth in medical costs and inflation, Medicare Part B premiums were unchanged for the 2013, 2014, and 2015 calendar years. The “hold harmless” provision would have required the approximately 30 percent of beneficiaries not held harmless in 2016 to pay an estimated base monthly Part B premium of $159.30 in part to make up for lost contingency reserves, according to the 2015 Trustees Report. However, the Bipartisan Budget Act of 2015 mitigated the Part B premium increase for these beneficiaries and states, which have programs that pay some or all of the premiums and cost-sharing for certain people who have Medicare and limited incomes. The CMS Office of the Actuary estimates that states will save $1.8 billion as a result of this premium mitigation.

CMS also announced that the annual deductible for all Part B beneficiaries will be $166.00 in 2016. Premiums for Medicare Advantage and Medicare Prescription Drug plans already finalized are unaffected by this announcement.

To get more information about state-by-state savings, visit the CMS website at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-11-10.html.

Since 2007, beneficiaries with higher incomes have paid higher Part B monthly premiums.  These income-related monthly adjustment amount (IRMAA) affect fewer than 5 percent of people with Medicare. Under the Part B section of the Bipartisan Budget Act of 2015, high income beneficiaries will pay an additional amount. The IRMAA, additional amounts, and total Part B premiums for high income beneficiaries for 2016 are shown in the following table:

Beneficiaries who file an individual tax return with income: Beneficiaries who file a joint tax return with income:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $85,000 Less than or equal to $170,000

$0.00

$121.80

Greater than $85,000 and less than or equal to $107,000 Greater than $170,000 and less than or equal to $214,000

48.70

170.50

Greater than $107,000 and less than or equal to $160,000 Greater than $214,000 and less than or equal to $320,000

121.80

243.60

Greater than $160,000 and less than or equal to $214,000 Greater than $320,000 and less than or equal to $428,000

194.90

316.70

Greater than $214,000 Greater than $428,000

268.00

389.80

 

Premiums for beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax return from their spouse:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $85,000

$0.00

$121.80

Greater than $85,000 and less than or equal to $129,000

194.90

316.70

Greater than $129,000

268.00

389.80

Part A Premiums/Deductibles

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A annual deductible that beneficiaries pay when admitted to the hospital will be $1,288.00 in 2016, a small increase from $1,260.00 in 2015. The Part A deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. The daily coinsurance amounts will be $322 for the 61st through 90th day of hospitalization in a benefit period and $644 for lifetime reserve days. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 in a benefit period will be $161.00 in 2016 ($157.50 in 2015).

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to receive coverage under Part A. Individuals with 30-39 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $226.00 in 2016, a $2.00 increase from 2015. Those with less than 30 quarters of coverage pay the full premium, which will be $411.00 a month, a $4.00 increase from 2015.

 

Deductibles and Coinsurance for 2016

Part A Deductible and Coinsurance Amounts for
Calendar Years 2015 and 2016
Type of Cost Sharing 

2015

2016

Inpatient hospital deductible

$1,260

$1,288

Daily coinsurance for 61st-90th Day

315

322

Daily coinsurance for lifetime reserve days

630

644

SNF coinsurance

157.50

161.00

 

For more information on the 2016 Medicare Parts A and B premiums and deductibles (CMS-8059-N, CMS-8060-N, and CMS-8061-N), visit: https://www.federalregister.gov/public-inspection.  

Training Information

Cont Ed Schedule

CLAIM Time Webinar Schedule

IT Schedule (blue) 

**Don’t forget to let us know via email to claimcallcenter@primaris.org if you watch any recordings on this page. In order to receive training credit, please include the NAME and ORIGINAL DATE of the webinar in the email.**

  Past CLAIM Time Webinars                                  

  • May 23, 2019: “Miller’s Trust” (Recording) (PowerPoint)
  • April 25, 2019: “Missouri HealthNet and Medicare Savings Programs” (Recording) (PowerPoint)
  • March 13, 2019: “2019 MIPPA Numbers” (Recording)               
  • February 27, 2019: “New Director Intro & SHIP TA Center Info” (Recording)   
  • February 13, 2019: “Special Enrollment Periods” (Recording)
  • January 31, 2019: “CMS Unique IDs” (Recording)
  • December 12, 2018: “Reporting” (Recording)
  • September 19, 2018: “AEP & MIPPA” (Recording)
  • September 12, 2018: “AEP & MIPPA (for Newer Volunteers)” (Recording) 
  • August 24, 2018: “Helpful Resources” (Recording)
  • August 8, 2018: “MO HealthNet” (Recording)
  • July 27, 2018: “AmeriCorps” (Recording) 
  • June 22, 2018: “Patient Assistance Programs” (Recording; PowerPointHandouts)
  • June 14, 2018: “Medicare and Marketplace” (Recording) 
  • April 27, 2018: “Building Brand Champions” (Recording) 

  Past SHIP TA Webinars

Part D Extra Help (Low Income Subsidy)

i Jan 7th No Comments by

Part D Extra Help (Low Income Subsidy)

The most readily available assistance program for Medicare is the Part D Extra Help program. This pays for 85% or more of the costs that come with Medicare’s Prescription Drug Program (Part D). It is sometimes called the Low Income Subsidy program or LIS.

Extra Help has higher income and asset limits than programs such as Medicare Savings Programs and Medicaid. LIS offers assistance to beneficiaries by helping them pay a reduced amount for Medicare-covered prescriptions at the pharmacy. A beneficiary can be enrolled in a stand-alone Prescription Drug Plan or a Medicare Advantage plan with drug coverage. There are different levels of assistance that vary by income and asset levels. The lower the income and resource, the greater the help.

Who’s Eligible?

Individuals

Couples

Monthly Income

$1,535

$2,078

Resources*

$14,100

$28,150

*Resources include bank accounts, CDs, stocks and bonds. Your home and car are not included.

(Numbers current as of March 2018.)

Enrollment in Extra Help is done through the Social Security Administration. An application can be submitted online or a paper application can be requested by contacting CLAIM or visiting your local SSA office. Click here for help finding your local Social Security office.

You automatically get Extra Help if you:

  • have both Medicare and Supplemental Security Income (SSI), or
  • have both Medicare and Medicaid.

Programs to Help You Pay

i Jan 7th No Comments by

Programs to Help You Pay

There are several different types of programs that can assist Medicare enrollees with their out-of-pocket costs for services. Here you can find some basic information about some of these programs, where to get more information and where to enroll in them.

Part D Extra Help
For those with Medicare Part D making $18,456 or less yearly ($24,936 for married couples)* and meet certain resource limits.

MO HealthNet
Missouri’s Medicaid Program.

Medicaid Spend-Down
For those who nearly qualify for MO HealthNet, but earn too much.

Medicare Savings Programs
Three programs for those earning $16,632 or less yearly ($22,464 for married couples)* and meet certain resource limits. Provides help with Medicare Advantage and Medicare Parts A, B, and D.

*Dollar amounts are current until March 2019.

Other Drug Assistance Options

RxOutreach
A fully-licensed mail order pharmacy that is committed to making the use of prescription drugs safer and more affordable.

RxAssist
A comprehensive database of patient assistance programs, as well as practical tools, news, and articles that helps provide free medications to people who cannot afford to buy their medicine.

NeedyMeds
An information resource dedicated to helping people locate assistance programs to help them afford their medications and other healthcare costs.

Missouri Drug Card
As a resident of Missouri, you and your family have access to a statewide Prescription Assistance Program (PAP).

Other Programs

EyeCare America
EyeCare America is a public service program of The Foundation of the American Academy of Ophthalmology. It matches eligible seniors in need with volunteer ophthalmologists to provide a medical eye exam and up to one year of care with no out of pocket of the patient.

Choosing a Medicare Advantage Plan

i Jan 7th No Comments by

Choosing a Medicare Advantage Plan

Medicare Advantage Plans are an alternative form of Medicare benefits. You still have Medicare benefits, however by enrolling in a Medicare Advantage plan you are giving a private company permission to administer your Medicare benefits according to their rules. You are subject to the plan rules and cost sharing, not Medicare’s. Plans must provide the same services as Original Medicare.

It may help to print this page for reference.

To find Medicare Advantage Plans, you can use the Medicare Plan Finder from Medicare.gov. You should always compare Medicare Advantage Plans carefully before enrolling. Some important questions to ask yourself as you look at several plans include:

  • Insist on a simple outline of coverage. Know what you are buying and how it works. Is this an Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO) or a Private Fee-for-Servie Plan (PFFS)?
  • Are my prescription drugs covered?
  • What are my costs (premiums, doctor and hospital copays, out-of-pocket limit)?
  • Do I need to choose a primary care doctor?
  • Do I have to see a primary care doctor to get a referral to see a Specialist?
  • Does my providers (doctors, hospitals, etc.) accept the terms and conditions (payment) of this plan and are in network?
  • Can I return to Original Medicare at any time?
  • What other services does this plan offer (vision, dental, hearing)?

Don’t feel pressured to enroll right away. Open enrollment is October15th to December 7th.

Do not drop current insurance coverage until you are sure about your new coverage. Do not join more than one Medicare Advantage Plan. Do not buy a Medigap policy if you already have a Medicare Advantage plan. They will not work together.

Never buy from someone who claims to be from the government. The government does not sell insurance. Keep information on the agent or representative that enrolls you for future reference.

Do not enroll in a Medicare Advantage plan if you have MO HealthNet (Medicaid). Currently, MO HealthNet will not pay your plan co-payments unless you are enrolled in QMB or QMB Plus. Otherwise, you will be responsible for the co-payments.


Read the next section about Marketing Guidelines for Medicare Advantage Plans

Part A (hospital)

Part B (medical) 

Part D (prescription)

Medicare Savings Programs

i Jan 7th No Comments by

Medicare Savings Programs

Medicare Savings Programs are federal and state funded assistance programs that help pay for some Medicare expenses. For those that do not qualify for Medicaid (MO HealthNet) benefits, there may still be help for “payment of Medicare premiums.” These programs require that an individual have:

  • Income below 135% of the federal poverty level, and
  • Resources below $7,560 for a single person or below $11,340 for a couple.

If you qualify for any Medicare Savings Program, you automatically qualify for the Prescription Drug Extra Help program. Medicare will pay the premiums for a basic prescription drug plan, and pay for most covered prescription medications (except for small co-pays). The beneficiary will not have the gap in coverage, and if they reach the out-of-pocket maximum, Medicare will pay 100% of their covered medication costs.

Income requirements are current from April 2018 – March 2019.

The chart below details the three available programs and the assistance offered:

What It’s Called Maximum Income and Resources What It Pays For

QMB

Qualified Medicare Beneficiary

Single – $1,032

Couple – $1,392

  • Medicare Part A monthly premiums (when applicable)
  • Medicare Part B monthly premiums
  • Deductibles, copays, and coinsurance for Medicare Parts A and B, and Medicare Advantage plans.

SLMB

Specified Low-Income Medicare Beneficiary

Single – $1,234

 Couple – $1,666

          Medicare Part B monthly premiums.

QI-1 (SLMB-2)

Qualified
Individual-1

Single – $1,386

 Couple – $1,872

          Medicare Part B monthly premiums.

To apply for any of the Medicare Savings Programs, a MO HealthNet (Medicaid) application must be completed and submitted to your local Family Support Division office. Get the application here. If you have questions about your benefits, contact your local Family Support Division office. Click here to find your county’s Family Support Division office.