13 Jun 2012

Health care law helps Iowa residents receive care in their communities

By Julie Brookhart

Iowa will receive resources made available by the Affordable Care Act - the health care law - to help seniors and people with disabilities live in their communities, the Centers for Medicare & Medicaid Services (CMS) announced today. These resources will help ensure Iowa residents can choose to live at home rather than in a nursing home or other facility.

The Iowa award, projected at $61.8 million, is a vital component of a broad State-based approach to expand community-based care provided by the Affordable Care Act's Balancing Incentive Program.

"The health care law is giving many seniors and people with disabilities the freedom to continue to live in their homes and communities, rather than in a nursing home," said Marilyn Tavenner, CMS acting administrator.  "We are pleased that Iowa is one of many States working to expand community services and supports."

While federal Medicaid law requires States to pay for institutional care for the elderly or persons with disabilities who may need assistance with their activities of daily living, Medicaid coverage for home or community-based services is optional.  And while all States have opted to provide such coverage, consumer demand frequently exceeds the State's available resources.

The health care law offers States additional resources through an increase in their federal Medicaid matching rates for home and community-based services, if a State commits to increasing access to these services.  A total of $3 billion is available to States under the Affordable Care Act's Balancing Incentive Program.

The Administration strongly supports ensuring that people with Medicaid can get the support they need to continue to live in their communities. While most Medicaid dollars for long-term services and supports still go to institutions, the national percentage of Medicaid spending on home and community-based services has more than doubled from 20 percent in 1995 to 43 percent in 2009.

States are eligible for the Balancing Incentive Program if less than 50 percent of their total long-term care spending goes toward home and community-based services.  The enhanced Medicaid payments must be spent increasing the availability of home and community-based services for Medicaid beneficiaries with long-term needs.  The Iowa Department of Human Services Balancing Incentive Program, in partnership with community organizations throughout the State, plans to further develop the systems of community-based care that serve seniors and individuals with behavioral health needs, physical disabilities, and intellectual disabilities.

For more information on the Balancing Incentive Program please visit: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Balancing/Balancing-Incentive-Program.html

 

# # #

23 May 2012

Medicare Q & A from the federal Medicare Agency - The Centers for Medicare & Medicaid Services

By Julie Brookhart

MAKING MEDICARE MAKE SENSE

Answers To Some of The Most Commonly Asked Medicare Questions

Q: Who Pays First If I Have Medicare and Other Health Coverage?

A: If you have Medicare and other health coverage, each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide who pays first. The "primary payer" pays what it owes on your bills first, and then your provider sends the rest to the "secondary payer" to pay. In some cases, there may also be a "third payer." Whether Medicare pays first depends on a number of things, including the situations listed in the chart below. However, this chart doesn't cover every situation. Be sure to tell your doctor and other health care provider's insurance specialist/billing staff if you have coverage in addition to Medicare. This will help them send your bills to the correct payer to avoid delays. Note: Paying "first" means paying the whole bill up to the limits of the payer's coverage. It doesn't always mean the primary payer pays first in time.

If you have questions about who pays first or if your coverage changes, call the Medicare Coordination of Benefits Contractor (COBC) at 1-800-999-1118. TTY users should call 1-800-318-8782. For example, if you need to find out about Medicare's coverage of End Stage Renal Disease and how it works with other insurance the COBC will answer your questions.   Also, to better serve you please have the following information ready when you call: your Medicare number (located on your red, white, and blue Medicare card) and one additional piece of information, such as your Social Security Number (SSN), address, Medicare effective date(s), or whether you have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) coverage.

Below is a summary chart of who likely pays first. If you would like a copy of the Medicare booklet referenced in the chart, titled, "Medicare and Other Health Benefits: Your Guide to Who Pays First," call 1-800-633-4227, (which is 1-800-Medicare), and ask for CMS Product Number 02179, and tell them the title of the booklet.

Please note: In some cases, if you are entitled to, but don't have, the first payer coverage, the second payer won't cover you.  This can be vital information to know in some employer retiree plans and COBRA cases.  For instance, if you are 65 and older, and retired, and you do not enroll in Medicare, it is possible that your retiree coverage won't cover you.  Check with your retiree plan to be sure.

 

If You:

Situation

Pays First

Pays Second

See Page (s) (in publication no. 02179)

Are covered by Medicare and Medicaid

Entitled to Medicare and Medicaid

 

Medicare

Medicaid, but only after other coverage (such as employer group health plans) has paid

8

Are 65 or older and covered by a group health plan because you or your spouse is still working

Entitled to Medicare

The employer has 20 or more employees

 

The employer has              less than 20 employees*

 

Group health plan

 

 

 

 

 

 

Medicare

 

Medicare

 

 

 

 

 

 

Group health plan

 

8

 

 

 

 

 

 

9

Have an employer group health plan after you retire and are 65 or older

 

Entitled to Medicare

 

Medicare

 

Retiree coverage

 

10-11

 

Are disabled and covered by a large group health plan from your work, or from a family member who is working

 

Entitled to Medicare

The employer has 100 or more employees

 


The employer has less than 100 employees

 

 

Large group health plan

 

 

 

 

 

 

Medicare

 

Medicare

 

 

 

 

 

 

 

Group health plan

 

 

12

 

 

 

 

 

 

 

12

 

Are 65 or over OR disabled and covered by Medicare and COBRA coverage

 

Entitled to Medicare

Medicare

COBRA

22-23

Have been in an accident where no-fault or liability insurance is involved

Entitled to Medicare

No-fault or liability insurance for services related to accident claim

Medicare

13-15

Are covered under worker's compensation because of a job-related illness or injury

Entitled to Medicare

Workers' compensation for services related to worker's compensation claim

Usually doesn't apply. However, Medicare may make a conditional payment.

15-19

Are a veteran and have Veterans' benefits

Entitled to Medicare and Veterans' benefits

Medicare pays for Medicare-covered services.                     

 

Veterans' Affairs pays for VA-authorized services.

 

Note: Generally, Medicare and VA can't pay for the same service.

Usually doesn't apply

19-20

 

Are covered under TRICARE

Entitled to Medicare and TRICARE

Medicare pays for Medicare-covered services.

 

TRICARE pays for services from a military hospital or any other federal provider.

 

 

TRICARE may pay second.

 

20-21

 

*If your employer participates in a plan that is sponsored by two or more employers, the rules are slightly different.

 

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