Medicare Is For People With Disabilities Too

Many people think that Medicare is a health program just for "seniors." While it is true that the majority of Medicare beneficiaries are age 65 and older, individuals as young as 20, who get social security benefits based on disability, qualify for Medicare, too. Over four million Americans get Medicare on this basis.

Medicare coverage is extremely valuable, but its beneficiaries can have many problems and questions. Many coverage rules, and even terms used, can be complex and confusing. Beneficiaries must pay premiums, and pick up a portion of the cost of most services ("cost-sharing"); these costs can be substantial and burdensome.

There are many things that are useful for younger Medicare beneficiaries to know about; this article will highlight just two topics-managed care plan enrollments; and Medicaid assistance for low income Medicare beneficiaries.

Managed Care Plans: Medicare beneficiaries can voluntarily choose to enroll in some managed care plans, and, by so doing get all their services through the plan. Such plans were traditionally called "HMOs" (for "health maintenance organizations") but have more recently been referred to by terms like "Medicare Plus Choice" plans. In New Mexico, the managed care plans which can serve Medicare beneficiaries are Lovelace, "Secure Horizons" (run by Presbyterian Health Plan), QualMed, and "Medicare Plus" (run by St. Joseph Healthcare). Enrollment is limited to beneficiaries who live in the greater Albuquerque, Santa Fe, and Las Cruces areas.

These plans often use the word "Senior" in their names. Don't be misled by this-Medicare beneficiaries of all ages are equally able to join. The only requirement is that you have both Part A and B of Medicare coverage. And, with limited exceptions, the plans cannot refuse to enroll you on account of your health status or health care needs.

Managed care plan enrollment can help reduce "cost-sharing," coordinate your health care, and provide some extra services like prescription drugs. On the other hand, enrollees must access most services through the plan, and must comply with the plan's procedures. Medicare beneficiaries considering enrolling with a managed care plan should first learn about how plans operate, and how well the plan will meet their personal health care needs.

Medicaid For Medicare Beneficiaries ("Dual Eligibles") : For Medicare beneficiaries with limited income, paying Medicare's premiums and cost-sharing is difficult. If you have regular Medicaid coverage, Medicaid will cover those costs. However, the financial eligibility test for regular Medicaid is very low.

There are a few types of special Medicaid coverage available which can cover Medicare premiums and/or cost-sharing for beneficiaries with greater income and resources. One of the most important is called Qualified Medicaid Benefits (QMB). If you have 'countable' income of less than $687 per month, and 'countable' resources of less than $4,000, you may qualify for QMB-which will pay your Medicare Part B premium, and Medicare cost-sharing ['countable' means that some income, and some types of assets (like your home) are not counted].

If you meet the QMB resource test, but your 'countable' income is between $687 and $927 per month, you may qualify for Medicaid coverage of your Part B premium. In addition, there is special coverage which pays the Part A premiums of working beneficiaries with 'countable' incomes of up to $1274 per month, who have been dropped from Medicare due to lengthy periods of employment. Applications for these special Medicaid coverages must be made with the state's Income Support Division Offices.

P&A staff can provide you with information, assistance and referrals on the Medicare issues highlighted here. Information and assistance is also available from the state's "HIBAC" program (1-800-432-2080), and, in Bernalillo County, from the Medicare/Health Insurance Counseling Program (764-6400).