How We Help Beneficaries
 | |  | |  | |  | |  |
 | |  | |  | |  |
How We Help Medicare Beneficiaries
How we help individuals in our communities has evolved out of the recent changes
in the Medicare program. Medicare Solutions began conducting public forums in
early 2006 to help those in the community with the questions and concerns they
had about the government's new Medicare Plan D prescription drug plan. Early on
the settings were in a townhouse meeting format, but it became apparent to
effectively assist everyone that one-on-one evaluations were necessary as
everyone's individual situation determined how the new changes applied to them.
Out of the public forums we discovered that many individuals were ill informed,
confused and were not aware of the programs they were eligible for. The subsidies
designed to assist the lower income had, and still have, a low percentage of
participation (averaging 30%). It became obvious the lower income group were the
ones choosing between food and prescriptions (or going to the doctors) and were
not receiving the help they were eligible for.
Medicare Solutions, Inc. began focusing on assisting this segment of our
population. Statistics show 61% of dual eligible (Medicare/Medicaid) beneficiaries
have less than a high school education. 27% of individuals with lower income
responded to letters and applications sent out by Social Security in 2005 to apply
for lower income subsidy (extra help) to help pay for part D prescription drug
premiums and co-pays. Less than one third (about 30%) of individuals that qualify
for Medicare Savings Program (subsidizes Medicare Part B premium and/or
Medicare co-insurance and deductibles) are participating.
To address these needs we designed a Medicare "check up". During a "check up"
our Benefits Co-ordinators are able to help evaluate, one-on-one, a Medicare
Beneficiaries individual status in relationship to what programs are available in
their county and state. In the process we provide a whole cafeteria of related
services:
Understanding how these systems all inter-relate and work together is valuable in
helping us to assist each individual with how these systems apply to them on a
personal level.
Our Benefits Advisors are licensed and trained to not just help evaluate and
educate, but also assist with navigating the paperwork for the programs and
benefits described above.
How we help individuals in our communities has evolved out of the recent changes
in the Medicare program. Medicare Solutions began conducting public forums in
early 2006 to help those in the community with the questions and concerns they
had about the government's new Medicare Plan D prescription drug plan. Early on
the settings were in a townhouse meeting format, but it became apparent to
effectively assist everyone that one-on-one evaluations were necessary as
everyone's individual situation determined how the new changes applied to them.
Out of the public forums we discovered that many individuals were ill informed,
confused and were not aware of the programs they were eligible for. The subsidies
designed to assist the lower income had, and still have, a low percentage of
participation (averaging 30%). It became obvious the lower income group were the
ones choosing between food and prescriptions (or going to the doctors) and were
not receiving the help they were eligible for.
Medicare Solutions, Inc. began focusing on assisting this segment of our
population. Statistics show 61% of dual eligible (Medicare/Medicaid) beneficiaries
have less than a high school education. 27% of individuals with lower income
responded to letters and applications sent out by Social Security in 2005 to apply
for lower income subsidy (extra help) to help pay for part D prescription drug
premiums and co-pays. Less than one third (about 30%) of individuals that qualify
for Medicare Savings Program (subsidizes Medicare Part B premium and/or
Medicare co-insurance and deductibles) are participating.
To address these needs we designed a Medicare "check up". During a "check up"
our Benefits Co-ordinators are able to help evaluate, one-on-one, a Medicare
Beneficiaries individual status in relationship to what programs are available in
their county and state. In the process we provide a whole cafeteria of related
services:
 | Assist with informational needs. Many individuals simply have questions | |
| related to our field due to the complexity of the Medicare System. This segment of our population is overwhelmed by systems Federal (Medicare), State (Medicaid), and Healthcare (doctors, hospitals, labs, pharmacies, etc...). Being a knowledgeable source that covers such a broad spectrum and provides the service in a personalized manner is what our Medicare Solutions Benefits Coordinators are trained to do. Questions we cover include: |
- All facets of Medicare (Parts A, B, C & D)
- All facets of Medicaid (QMB, SLMB & QI-1)
- All facets of Social Security (SSDI, RSDI & SSI)
- All facets of Private Health Insurance (group health insurance,
Medicare supplements, retirement benefits,etc...) - All facets of heathcare in general
- Many other related issues
Understanding how these systems all inter-relate and work together is valuable in
helping us to assist each individual with how these systems apply to them on a
personal level.
| Assist in Evaluating if the individual is Eligible for any Subsidized Programs | |
| they are not Currently Receiving. |
- Low Income Subsidy - (aka Extra Help) From Social Security to
subsidize prescription co-pays and premiums. - Medicare Savings Programs - (AKA QMB, SLMB or QL-1) From the
department of Job and Family Services in individual's county, funded
by the state (subsidizes Medicare Part B premium, deductible and/or
co-insurance).
| Assist In Evaluating if the Current Medicare Part D Prescription Plan is | |
| working properly for the Individual. Statistics show individuals that are dual eligible are higher Rx users than the rest of the population. 4% of subsidized drug plans are chosen. The rest (96%) were auto enrolled by the states (Department of Jobs and Family Services) with no regard to matching up of current drugs taken by individuals to the formulary of the company they were enrolled with. 60% were enrolled in plans that did not cover all of their drugs. |
| Assist in Evaluating Part D Excluded Drug Issues That Need to be | |
| Addressed. Medicare determined that two classifications of drugs would not be covered by the New Prescription Drug Plan. These include Barbituates and Benzodiaziapines. MEDICAID will pay for these excluded drugs in many cases. Also some Part D enhanced plans will cover some excluded drugs as a part of their formulary. A common issue related to dual eligible individuals and Part D excluded drugs is out-of-pocket expense when the excluded drug either should be (Medicaid) or could be (Enhanced Plan) covered. Pharmacies often simply need appropriate billing information from Medicaid and individuals are reimbursed for out-of-pocket expenses. |
| Assist in Evaluating Individuals level of Understanding about Medicare Part | |
| C. (AKA Medicare Advantage Plans) The "Medicare and You" handbook sent to all Medicare beneficiaries has a chapter about this option within the Medicare system. For dual eligible beneficiaries there are plans called Special Needs Plans (SNP) within Part C of Medicare. Most dual eligible beneficiaries have limited if any knowledge about them. These can be a helpful option for certain individuals. Examples include individuals that have a spend down, those wanting wider range of doctors than Medicaid participating physicians, Veterans, and those with transportation needs. Some newer plans designed for Duel Eligible Individuals have enhanced dental, optical and hearing aid coverage to help pick up where Medicaid has cut back. |
| Assist New Medicare Beneficiaries in Navigating the System. Generally any | |
| individual who is getting ready to turn 65 or has been collecting disability benefits from Social Security (SSDI) for 24 months is entering what Medicare calls an Initial Enrollment Period (IEP). During this transition many individuals need help with being educated about what programs they are becoming eligible for and how to navigate the system. |
| Assist with any troubleshooting Needs. The New Medicare System has | |
| privatized the prescription drug coverage that was previously administered by each state (Medicaid) for dual eligibles. The integration of the New System with pharmacies, Medicare and numerous insurance companies who are contracted with the federal government to administer the Part D prescription coverage has left many falling through the cracks in the system. Our Benefits Advisors clear up many issues that can only be solved on a one-to-one basis Including: |
- Multiple Part D plans in place
- Paying premiums for plans they should not be
- Paying higher Co-pays than they should be
- Billing problems with pharmacies, doctors, hospitals, durable
medical equipment providers, labs, health care agencies, etc... - Dealing with case workers, service coordinators, billing
departments, doctors, hospitals and pharmacies to solve specific
problems - many other related issues
Our Benefits Advisors are licensed and trained to not just help evaluate and
educate, but also assist with navigating the paperwork for the programs and
benefits described above.
 |  |  |  |  |  |  |  |  |
| ©2006 Medicare Solutions, Inc. & MRD Productions All rights reserved |
Not approved, endorsed, or authorized by the
Centers for Medicare & Medicaid Services or the
Department of Health & Human Services.
Centers for Medicare & Medicaid Services or the
Department of Health & Human Services.