“Q & A” From Dawn’s Cases on Medicare Savings Programs, Did you Know…

I get questions every day that help me in continued research for best outcomes, or to be able to offer right solutions, or that simply help me to stay on top of current healthcare issues that my clients, who are caregivers mostly, must face in their caregiving journeys. I always want to be better equipped to help them. By studying current Medicare trends and protocols, in between case work, I can better navigate the ever increasing chaotic health care system we must live and survive in. Even though I am a registered nurse by trade, case and care management experience has taught me to study Medicare almost daily- which in fact, I do! Questions about Medicare coverage come up quite frequently, and sadly, loved ones find out that Medicare alone, doesn’t cover costs for personal care-givers or long term care. In some cases with home health a patient may (or may not) get a personal caregiver for a certain length of time for maybe an hour a day, if that- and even this is coordinated by the particular agency, if that agency so happens to utilize certified nursing assistants on staff. Only Medicaid covers long term care or “custodial” type care for long term, while Medicare covers acute or “skilled care.” Once loved ones caring for older Americans realize this, then typically, the next questions involve how to get an aging person who is chronically ill, on an “income based” insurance product such as Medicaid. The answer is not that simple, but can be explained in this way to “keep it simple.”

Medicaid is a medical health insurance program funded by Federal and State governments that pays costs for certain individuals and families with low income and/or limited resources; whereas Medicare is a medical health insurance for those persons age 65 and older, no matter the socioeconomics.

I advise my clients to go on the medicare.gov website to learn all that they can about the benefits that older persons are entitled to and to also learn about their “Medicare Rights.” I spend many days doing the same since Medicare policies and protocol changes along with the economy and politics that rule the day. Medicare explains how persons over 65 can also get extra help paying Medicare premiums or co-pays and the like by a variety of programs. However, it will take a little time out of your day to tap into the information on line about helpful resources if you are a Medicare beneficiary. First of all, put https://www.medicare.gov/ on your “Favorites!”

You want to find out as much as you can about “Dual Eligible Beneficiaries…” This describes beneficiaries eligible for both Medicare and Medicaid. The term includes beneficiaries enrolled in medicare Part A and/or Part B and receiving full Medicaid benefits and/or assistance with Medicare’s extra cost, or out of pocket costs.

Medicare’s “Medicare Learning Network” explains in easy to read terms how there are Four Major Medicare Savings Programs (MSP’s):

  1. QMB- Qualified Medicare Beneficiary program helps pay premiums, co-insurances and any co-pays for Part A claims.
  2. SLMB- Specified Low Income Medicare Beneficiary program helps pay Part B premiums.
  3. QI- Qualifying Individual program also helps low income families pay for Part B premiums.
  4. QDWI- Qualified Disabled Working Individual program helps pay Part A claims.

Here is some more information on the QMB progarm I found helpful for many of my clients on the medicare.gov/blog site, dated May 5, 2019:

“If you’re among the 7.5 million people in the  Qualified Medicare Beneficiary (QMB) Program , Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments. If a provider asks you to pay, that’s against the law.

If you get a bill for these charges:

  1. Tell your provider or the debt collector that you’re in the QMB Program and can’t be charged for Medicare deductibles, coinsurance, and copayments. If you’ve already made payments on a bill for services and items Medicare covers, you have the right to a refund.

Note: To make sure your provider knows you’re in the QMB Program, show both your Medicare and Medicaid or QMB card each time you get care. You can also give your provider a copy of your Medicare Summary Notice (MSN). Your MSN will show you’re in the QMB Program and shouldn’t be billed.

Log in to your MyMedicare.gov account at any time to view your MSN or sign up to get your MSNs electronically.

  1. If your provider won’t stop billing you, call us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.We can confirm that you’re in the QMB Program. We can also ask your provider to stop billing you, and refund any payments you’ve already made.
  2. If you have a problem with a debt collector, you can send a complaint to the Consumer Financial Protection Bureau (CFPB) online or call the CFPB toll-free at (855) 411-2372. TTY users can call (855) 729-2372. CFPB will forward your complaint to the debt collection company and work to get you a response from them.”

You can also watch Medicare & You: Ways to Save Money on youtube.com.

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