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SHINE Program

SHINE Program. Certification Resource Tool 2018. Medicare. Part A* – Hospital Insurance Part B** – Medical Insurance Part C – Medicare Advantage Plans HMO, PPO, SNP (SCOs) Part D** – Prescription Drug Coverage

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SHINE Program

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  1. SHINE Program Certification Resource Tool 2018

  2. Medicare • Part A* – Hospital Insurance • Part B** – Medical Insurance • Part C – Medicare Advantage Plans • HMO, PPO, SNP (SCOs) • Part D** – Prescription Drug Coverage *Premium cost for Part A based on quarters worked/credits earned. Premium-free if earned 40 credits under Social Security/Medicare. Premium charged for beneficiaries with less than 40 credits (0-29 credits) full cost – for Part A in 2018 $422 ($232 if 30-39 credits) See 2018 Medicare Part A Benefits and Gaps **Premium for Part B & Part D indexed per income (IRMAA-Income Related Monthly Adjustment Amount) – See 2018 Medicare Premiums chart

  3. Medicare Eligibility • Medicare at age 65 • If earned 40 credits under Social Security and/or paid into Medicare Tax • Or married (or divorced and marriage lasted 10 years) can enroll into Medicare at age 65 as long as: • Spouse* (or ex spouse) is at least age 62 with sufficient credits to qualify for Medicare • Medicare under age 65 • If meet Social Security disability for 24 months or diagnosed with ESRD or ALS *Including same-sex marriage spouse

  4. Medicare Enrollment Periods • Initial Enrollment Period (IEP) – age 65 • Special Enrollment Period (SEP)* – up to 8 months after current coverage under the EGHP ends (can get Part B – no penalty – can be effective on 1stof month beneficiary enrolls or first of following month) • General Enrollment Period (GEP) – late/voluntary enrollees – Jan 1-March 31 – coverage effective on July 1 *Exception: The IEPsupersedes the eight-month SEP if a client is still within his/her seven-month window when enrolling

  5. Enrolling in Medicare • Initial EnrollmentPeriod – seven-month window • Must contact Social Security to enroll if not already collecting Social Security – not automatically enrolled at 65 • If collect Social Security prior to age 65, will be automatically enrolled first day of month turn 65 • Date coverage begins determined by date of enrollment • Enrollment delayed if wait till after birthday month • If continue employment • Client/spouse with Employer Group Health Plan (EGHP) coverage beyond 65 may take Part A, delay Part Band remain on EGHP – can pick up B at any time (if beyond 7-month IEP) as long as have been covered by EGHP – (Special Enrollment Period)

  6. Enrolling in Medicare (cont.) • Special Enrollment Period (SEP) • Must enroll in Part Bwithin 8 months of end of current employment or end of current EGHP* coverage to avoid penalty Note: Can drop Part B later if return to work with EGHP coverage • Penalty of 10% of current premium for every full 12-month period of delayed Part B enrollment Note: Coverage under COBRA does not provide a SEP or protect one from Part B penalty Living outside the US does not provide a SEP or protect from B penalty *See Current Employment Status handout

  7. Initial Enrollment Period (IEP)

  8. Enrolling in Medicare and Health Savings Account (HSA) • Enrollment Exception with HSA • People with Medicare are not allowed to contribute money into an HSA • If continue to contribute, will receive a penalty from the IRS • Medicare Part A will be retroactive for up to 6 months (as long as person was eligible during the 6 months), so contributions to the HSA must stop 6 months prior to when the person signs up for Medicare* *See Medicare and HSA Handout Note: Individuals contributing to an HSA should speak with their Human Resource department and tax consultant

  9. Delaying Medicare Enrollment • Can delay Medicare enrollment without a penalty if covered under EGHP* because of current employment (client or spouse). If client wants to delay should: • Check with employer to see if coverage will change at 65 • Review employer outline of coverage with Medicare options to compare costs and coverage Note: If entitled to Medicare and employer has less than 20 employees (less than 100 if on Medicare due to disability), Medicare would be primary *Note: Individual may be offered a severance package that can include continued coverage under the EGHP which would provide an 8-month SEP when coverage ends

  10. Medicare and the Health Connector (HC) • How the Health Connector works with Medicare: • A Health Connector member can remain on the HC plan when become eligible for premium-free Medicare Part A* – will not be required to take A and/or B – however: • Will lose premium subsidy or tax credits and may have to pay back for tax credits • Will be subject to Part B late enrollment penalty** if delay enrolling in Part B • If delay Part B, would only be able to enroll during the General Enrollment Period – January 1-March 31 – with coverage effective July 1** *If required to pay for Part A, would not be required to enroll, could remain on the Health Connector plan and continue to receive premium subsidy **See Slide #11 Health Connector and Equitable Relief

  11. Health Connector and Equitable Relief • CMS has allowed a SEP scheduled to end Sept. 30, 2018 for Market Place (Health Connector is Mass. Market Place plan) members who did not enroll in Part B when initially eligible either at age 65 or on becoming eligible due to disability* • This SEP provides Part B coverage which can begin the month the individual enrolls with no penalty • Documentation of Market Place/Connector coverage can include: • IRS Form 1095-A • Health Connector premium notices • Receipts of premium payments • Other documentation that clearly shows individual was enrolled in a Health Connector plan *See Equitable Relief Handout – Title: Limited Equitable Relief for Individuals with Medicare and Marketplace Coverage– EM-16033 REV 2

  12. Options for Medicare Coverage • Original/Traditional Medicare • Part A (Hospital) Part B (Medical) • Freedom of choice, gaps in coverage • Coverage from Medicare provider anywhere in US • Medicare Advantage Plan (MA)* • May have network restrictions • Co-pays, may be higher costs for out-of-network service *(Note: MA is the managed care option for Medicare It is not Medicare Supplement/Medigap)

  13. Medicare Part A Coverage and Out-of-Pocket Costs - 2018 • Inpatient Hospital Care • $1,340 deductible per benefit period • Benefit Periods are renewable – must be out of a hospital/facility for 60 consecutive days – unlimited # in lifetime • Skilled Nursing Facility (SNF) • Medicare pays in full days 1-20, (must enter SNF within 30 days of 3-day/overnight inpatient hospital stay*-not observation) beneficiary pays $167.50/day co-pay for days 21-100 • SNF benefit period also renewable – must be out of SNF for 60 days, have 3-day/overnight inpatient hospital stay • Medicare does not provide coverage for long-term custodial care *May not be required for Medicare Advantage (MA) members or some ACO members

  14. Medicare Part A Coverage and Out-of-Pocket Costs (cont.) • Home Health Care • Physician ordered • Patient homebound & • Requires intermittent/part-time skilled care • No co-pay for home health • Hospice Care • Have life expectancy of six months or less • Blood See 2018 Medicare Part A Benefits and Gaps

  15. Medicare Part B Coverage and Out-of-Pocket Costs – 2018 • Doctor, lab and X-ray services • Ambulance • Durable Medical equipment • Home Health Care, Blood • Other outpatient services • Some medications covered under Part B (See Slide #29) • Standard Pt B premium $134.00* • Annual deductible $183.00 • 20% co-insurance for most Part B services See 2018 Medicare Part B Benefits and Gaps *Note: See 2018 Medicare Premiums chart for premium cost for higher income beneficiaries (IRMAA)

  16. Medicare Fraud & Abuse • Fraud • Intentional deception or misrepresentation an individual makes that results in unauthorized benefit/payment • Abuse • Unintentional practice or procedure which may result in provider receiving payment for services

  17. Medicare Appeals • Livanta (Beneficiary and Family Centered Care Quality Improvement Organization) handles Part A hospital appeals • MAP (Medicare Advocacy Project) can help with most other appeals–Part B, Part C, Part D • Medicare Summary Notice includes info on: • Why Medicare did not pay • How to appeal • Timeline for appeal

  18. Services Not Covered by Medicare • Routine Care (Note: Welcome to Medicare and Annual Wellness Visit are covered) • Eye exams/glasses, foot care, hearing exams/hearing aids • Note: Beneficiary may be asked to sign an ABN (Advance Beneficiary Notice) which would make him/her liable for bill • Medical care outside the USA in most cases • Dental care/dentures

  19. Medicare Supplemental Coverage (Medigap) • Designed to supplement/fill the gaps of original Medicare • Pays second to Medicare for Medicare covered services (may have added services offered by plan – foreign travel under some Core plans for instance) • Some insurance companies offer riders which may provide coverage for additional services such as dental, hearing, vision • Must have A & B to join a Medigap • Under 65 – cannot have ESRD • Medicare supplement can be offered through employer retiree group coverage or non-group plan Note: Medicare Supplement/Medigap is NotMedicare. Medigapis private insurance a beneficiary can purchase to fill the gaps in their coverage under original Medicare.

  20. Medicare Supplement/Medigap Insurance (cont.) • Seven companies, all have continuous open enrollment – all offer Core & Supplement 1 • Core – less costly, doesn’t cover all gaps including Part A hospital deductible and SNF co-pay (some have “add on” of foreign travel) • Supplement 1 – covers all gaps and provides coverage for foreign travel • Note: Both plans cover Medicare co-insurance for any medications covered by Part B (after meet annual deductible in Core) – alldoctors/providers accept both Core and Supplement 1 Note: Enrolling in Medigap with new company does not automatically disenroll member from first company

  21. Medicare Supplement/Medicare Select Insurance • Medex Choice – offered by BCBS of Mass • Similar* to Bronze only if use BC HMO Blue, Inc. “Blue Choice” network PCP • Similar* to Core if use BC HMO Blue network PCP • No Coverage (Medicare only) if PCP is out of BC HMO Blue network • Need referrals from PCP for specialist *Cannot purchase BC Hearing/Vision Rider – no foreign travel

  22. Employer Retiree Options • Employer Retiree Options • Beneficiaries who have employer retiree benefits such as: • GIC (state/municipal retirees) • Federal Blue Cross/Blue Shield • Usually have very comprehensive coverage provided by the plan Clients should be referred back to their plan administrator or Human Resource department with questions

  23. Employer Retiree Options (cont.) • Benefits May Also Be Offered: • Through licensed benefits management company contracted by former employer such as VIA (formerly One Exchange) or AON • Retiree is offered a dollar benefit* • Must work with and usually enroll through benefits management company • SHINE counselors should refer clients back to the benefit advisor and not enroll clients on the Medicare Plan Finder *The dollar benefit is usually only available if client works/enrolls with the benefits management company

  24. Medicare Advantage (MA) (Part C) • Medicare Advantage Plans • Contract with CMS to provide members their Medicare benefits • Must have A & B to join Part C and live in plan’s service area (MA members still required to pay Part B premium) • Can join an MA during the Initial Coverage Election Period – 3 months before, month of, 3 months after eligibility for both A & B. (Late enrollee into Part B who is enrolling during General Enrollment Period [January 1 – March 31] can enroll in MA plan April 1 – June 30 with coverage effective on July 1.) • Coverage for urgent/emergency care only out of service area • Not required to sell to beneficiaries with ESRD

  25. Medicare Advantage (cont.) • If beneficiary enrolling in an MA plan wants Part D coverage, must take it with the MA HMO/PPO (MA-PD) plan. If joins stand-alone Part D plan, will be dropped from MA. (Exception – beneficiaries enrolled in a PFFS plan may be able to join a stand-alone PDP.) • Enrolling in different MA-PD plan will automatically disenroll beneficiary from their current plan (During annual Open Enrollment Period or due to a SEP, for instance)

  26. Types of Medicare Advantage Plans • HMO– Health Maintenance Organization – most restrictive require member to receive care in network (exception – urgent/emergency care) • HMO/POS – Health Maintenance Organization with Point of Service option – allows member to go out of network • PPO – Preferred Provider Organization – allow member to go out of network usually at higher cost • SNP – Special Needs Plan – Includes: • Senior Care Options (SCO) plan – for dual eligible 65 and over who have Medicare and MassHealth Standard or only MassHealth Standard • One Care (for dual eligible age 19-64 who have MassHealth Standard or CommonHealth • PFFS* – Private Fee For Service – allow member to go to any provider that agrees to terms of plan *Not available in Mass

  27. Enrollment Periods for Medicare Advantage • Initial Coordinated Election Period (ICEP) – Age 65: seven-month period – coincides with Initial Enrollment Period (IEP) • Open Enrollment Period – 10/15 - 12/7 • Special Enrollment Period • PA members eligible to make one change anytime through year • Extra Help and MassHealth members have continuous SEP • Five-star SEP – can enroll in 5-star plan (or switch within 5-star plan) • SEP65–individuals who join an MA plan during the ICEP at their 65th birthday can disenroll any time during the first 12 months of their enrollment into an MA plan (Trial), return to original Medicare and join a Pt. D

  28. Enrollment Periods for Medicare Advantage (cont.) • Special Enrollment Period • Residents of long-term care facilities, including recently discharged • Move into or out of plan service area • Leave employer coverage • Medicare Advantage Disenrollment Period (MADP) – 1/1-2/14 – May disenroll from MA and return to original Medicare and pick up Part D plan even if beneficiary was in an MA plan without drug coverage (would still have penalty if applicable) – cannot use the MADP to switch to another MA plan Note: A late enrollee into Part B (enroll during General Open Enrollment Period [January 1-March 31]) can enroll in an MA plan from April 1-June 30 with coverage effective on July 1 See SEP Chart (PDP and MA-PD Special Enrollment Periods) for more details

  29. Medicare Prescription Drug Program (Part D) • Provides outpatient prescription drug coverage to Medicare beneficiaries • Note: Some drugs/supplies covered under Part B – diabetic supplies, injections (e.g. antigens) administered in doctor’s office, some chemo Rx, immuno-suppressant Rx after Medicare-covered transplant • CMS contracts with private companies to provide coverage including: • Prescription Drug Plans (PDPs) • Medicare Advantage Prescription Drug Plans (MA-PDs) • Beneficiary pays monthly premium* whether enrolled in a PDP or MA-PD *Note: Higher income categories pay a monthly Part D “Adjustment” (IRMAA) which is deducted from the Social Security check whether enrolled in a stand-alone Part D or in a Medicare Advantage with Part D. IRMAA also pertains to beneficiaries covered by group Part D or group MA-PD plans such as GIC See 2018 Medicare Premiums Chart

  30. Enrollment Periods for Part D • Initial Enrollment Period for Part D • Enrollment period for initially eligible mirrors the seven-month window for A & B • Can enroll in stand-alone Part D (PDP) if have either Medicare Part A or Part B • Can enroll in Medicare Advantage with Part D (MA-PD) only if haveboth A & B • Can also enroll during: • Open Enrollment Periodof October 15 – December 7 (If member is switching plans, simply enrolls in new plan) • Special Enrollment Period– if meet eligibility requirements (involuntary loss of creditable coverage [such as EGHP for instance], creditable Rx coverage ending [even if under COBRA], move out of or into plan service area [2 months to enroll], PA member, 5-star, Extra Help, MassHealth) Note: A MassHealth member who becomes eligible for Medicare will be auto-enrolled into a “Basic”(Pink plans on Part D chart) Part D plan by Medicare unless self-selects Part D plan

  31. Enrollment Periods for Part D (cont.) • Special Enrollment Period • Nursing home residents (private pay and Medicaid) entitled to monthly SEP • Medicare Advantage Disenrollment Period (1/1-2/14) • Can return to original Medicare and join a stand-alone PDP • Note: • Enrolling in different PDP or MA-PD would automatically disenroll member from current plan • Change in plan’s formulary does not provide a SEP • Dropping from Medex Gold (Sup 2)* to Bronze (Sup 1) does not provide a SEP • Having creditable coverage under the VA* does not provide a SEP *Note: Would not have penalty because of creditable coverage, but no SEP

  32. Enrollment Periods for Part D (cont.) • SEP provided to members of a PDP that will end its contract with CMS effective January 1 – SEP begins December 8 and ends on the last day of February • Penalty for late enrollment: • 1% of National Base Premium for each month did not enroll and did not have creditable coverage • Penalty is lifetime Note: A beneficiary who returns to the US after living permanently outside the US would get 2-month SEP for Part D – (Different requirements for Part B) See SEP Chart (PDP and MA-PD Special Enrollment Periods) for details

  33. 2018 Part D Standard Benefit • $405 Deductible • Provides coverage for drugs on plan’s formulary • Co-pays/co-insurance during initial coverage period until hit coverage gap • Coverage Gap/Donut Hole when retail costs(includes what plan and member pay) hit $3,750 • Under Affordable Care Act will pay 35% for brands and 44% for generics in 2018 (other costs covered by plan and pharmaceutical company • Catastrophic Coverage begins when total costs (includes amount plan and member pay and 50% manufacturer’s discount) hit $5,000 • Note: Plan premium, cost of medication not on plan’s formulary and 5% paid by plan in gap do not count toward out-of-pocket costs See 2018 Part D Standard Benefit Chart

  34. Part D Coverage Issues • Drugs must be on plan’s formulary* to be covered • Plans can drop drugs from the formulary* • Formulary change would not provide a SEP to change plans • Cost of drugs can change • Member’s costs can be impacted by pharmacy network • Tier category can be different from plan to plan *Note: Member can always ask for an exception if medication is not on formulary or speak with doctor about possible medication change

  35. Part D Appeals • Conditions that would warrant an appeal: • Member would face serious physical harm without drug • Member disagrees with plan’s decision not to cover or pay for a drug • Member or prescriber believes that a coverage rule (like prior authorization) should be waived • Member believes should pay less for a higher tier drug because member and prescriber believe can’t take any of the lower tier drugs for same condition Note: Client can contact the Medicare Advocacy Project for help with an appeal

  36. Creditable Coverage • Coverage as good as Medicare Part D • Many retiree plans and COBRA provide creditable prescription coverage • Important to be aware that beneficiary has only 2 months from end of creditable coverage to enroll in Part D or MA-PD • Coverage with the VA Health Plan is creditable but does not provide a SEP to join outside of the annual OEP • All Medicare beneficiaries (including those still working) must have creditable coverage to avoid the late enrollment penalty • Beneficiaries must keep letter from employer/retiree plan stating creditable coverage

  37. LIS (Limited/Low Income Subsidy) AKA Extra Help • Helps with costs of Part D plan whether beneficiary is in PDP or MA-PD* • Provides SEP to join/switch Part D plan monthly whether in stand-alone Part D (PDP) or Medicare Advantage with Part D (MA-PD) • Eliminates late-enrollment penalty • Must meet income/asset eligibility: • Income no higher than: • 150% FPL = $1,538**/mo. Individual $2,078**/mo. Couple • Assets: $14,100 Individual - $28,150 Couple *Note: LIS (Not MassHealth) will subsidize the premium in stand-alone Part D basic plan or the portion of the MA-PD plan that covers Part D premium for beneficiary enrolled in MassHealth **Amounts include $20 disregard See Eligibility Guidelines for Public Benefit Programs

  38. LIS (cont.) • Full Extra Help: • $0 premium (basic plan), no deductible, co-pays: • With Gross Monthly Income/Assets of: • 100% FPL – $1,032-Ind./$1,392*-Cpl. – Assets: $9,060 Ind./$14,340 Cpl. • Co-pays – $1.25 generics, $3.70 brands • 135% FPL – $1,386-Ind./$1,872*-Cpl. – Assets: $9,060 Ind./$14,340 Cpl. • Co-pays – $3.35 generics, $8.35 brands • Partial Extra Help: • Sliding scale premium, $83 deductible & 15% co-insurance: • With Gross Monthly Income/Assets of: • 150% FPL – $1,538-Ind./$2,078*-Cpl. – Assets: $14,100 Ind./$28,150 Cpl. • Assets not counted include: • Home, one car • $1,500/person for funeral expenses • Life insurance policies *Amounts include $20 disregard

  39. Automatic Eligibility for LIS/Enrollment SEP/Loss of LIS • Automatic Eligibility for LIS • Beneficiaries are “deemed” (automatically) eligible if: • Enrolled in MassHealth Buy-In Program (QMB, SLMB, QI – AKA MSP) • On SSI • Have Medicare and MassHealthStandard or CommonHealth – AKA “Dual Eligible” • Enrollment SEP • LIS members can change* plans monthly • *Note: Institutionalized beneficiary can also change plans monthly whether private pay (non-LIS) or on LTC Medicaid • Loss of LIS • If lose LIS at end of year, have three-month SEP that ends March 31 Note: If on MassHealth (Standard, CommonHealth, Buy-In) with LIS and lose MH before July, will have LIS until end of the current calendar year (12/31) If lose MH after July, will remain on LIS until 12/31 of the following year See Slide #42 for detail

  40. MassHealth Standard 65 and Over • People 65 and over (applying for MassHealth while living in community) eligible if: • Income: 100% FPL or less=$1,032*/mo. Ind. – $1,392*/mo. Cpl.** • Assets $2,000 Individual – $3,000 Couple and include: • Savings/checking, IRA, stocks/bonds, cash value of whole life insurance • Coverage: • Wraps around Medicare – covers premiums, deductibles, co-insurance, deemed eligible for LIS, and additional benefits such as adult day health, medical transportation, dental, eyeglasses, hearing, some OTC (over-the-counter) prescription generic drugs and eligible to join a Special Needs Plan such as a Senior Care Options (SCO) plan *Amounts include $20 disregard **MH counts combined income/assets of married couple – does not count as combined for married not living together or if living with adult family member

  41. MassHealth Standard Under 65 on Medicare • People under 65on Medicare due to a disabilityeligible if: • Income: 138% FPL (133% + MAGI 5% disregard) or less = $1,397/month Individual, $1,894/month Couple • No asset test for under 65 • Coverage: • Comprehensive coverage – Medicare primary, MassHealth secondary Note: When first become eligible for Medicare, will be automatically enrolled by Medicare into “Basic” Part D plan and deemed eligible for LIS – MassHealthmay cover some OTC (Over-the-Counter) prescription generic RX

  42. Medicare, MassHealth and LIS • Medicare beneficiaries on MassHealth Standard, CommonHealth, or a Buy-In program are deemed eligible for LIS • Note: Medicare reviews MassHealth enrollment data in July of each year. If a member of one of the MH benefit programs listed above loses the MH benefit program before July, he/she will have LIS for the remainder of the year (until 12/31). If a member loses the MH benefit program after July, he/she will remain on LIS until December 31 of following year.

  43. MassHealth Senior Buy-In (AKAMedicare Savings Program [MSP] Qualified Medicare Beneficiary [QMB]) • MassHealth Senior Buy-In Eligibility: • Income: 100% FPL = $1,032*/mo. Individual $1,392*/mo. Couple • Assets: $7,560 Individual – $11,340 Couple • Covers Medicare A & B premiums, deductibles & co-insurance • Not required to see MassHealth providers • Deemed eligible for LIS • Need to complete MassHealthSACA application *Amounts include $20 disregard

  44. MassHealth Buy-In Programs (AKA Medicare Savings Program [MSP]) • MassHealth Buy-In (AKA Qualified Individual 1 – QI 1) • Income: 135% FPL = $1,386*/mo. Individual $1,872*/mo. Couple • Assets: $7,560 Individual - $11,340 Couple • MassHealth Buy-In (AKA Specified Low-Income Medicare Beneficiary – SLMB) • Income: 120% FPL = $1,234*/mo. Individual $1,666*/mo. Couple • Assets: $7,560 Individual – $11,340 Couple Note: Buy-In programs pay the late enrollment penalty and enrollment into Part B is effective immediately with Buy-In eligibility. *Amounts include $20 disregard

  45. MassHealth Buy-In Programs Medicare Savings Program (MSP) (cont.) • Both Buy-In programs (QI 1 & SLMB) cover Part B premium only • Members deemed eligible for full LIS • Can complete MassHealth Buy-In (MHBI) application, however, • Should complete SACA application so client will be screened by MassHealth for other programs such as Health Safety Net

  46. MassHealth Frail Elder Waiver/AKA Home and Community-Based Waiver/AKA Spousal Waiver Program • People 60 and over eligible if: • Income no higher than $2,250/month (300% SSI) • Assets in applicant’s name $2,000 or less • Note: Will waive income of spouse and waive assets up to $123,600* • Meet clinical eligibility (screening done by ASAP Coordination of Care Unit) • Receiving homecare (ASAP) service *Note: Asset allowance for spouse under FEW same as long-term care Medicaid

  47. MassHealth Frail Elder Waiver/AKA Home and Community-Based Waiver/AKA Spousal Waiver Program (cont.) • Coverage: • MassHealth Standard • Deemed eligible for full LIS • No co-pay for drugs • Increased homecare services • Frail Elder can join a Special Needs Plan such as a SCO (Senior Care Options) plan because have MH Standard Note: May not pay Medicare Part B premium if applicant does not meet income eligibility for Buy-In Need to Complete SACA application including Resource Transfers section of Long-Term Care Supplement A

  48. MassHealth Health Safety Net • Medicare beneficiaries 65 and over are eligible if: • Income no higher than 150% FPL for full HSN benefit: • $1,518 –Individual • $2,058 – Couple • Between 151% - 300% for partial HSN benefit would have to meet a deductible – amount of deductible determined by MassHealth • Assets not counted Need to complete SACA application

  49. MassHealth Health Safety Net (cont.) • Full HSN Covers Part A deductible or hospital co-pays in MA plan – does not cover care in a SNF • Partial* HSN members would need to meet a MassHealthdeductible (amount of deductible determined by MassHealth) • Covers some services at hospital-based/affiliated (satellite) clinic/center • Can receive care and Rx* coverage at Community Health Centers (CHC) and hospitals *Partial HSN members do not need to meet MassHealth deductible before receiving co-pay assistance for Rx at CHC

  50. Long-Term Care MassHealth/Medicaid • No income eligibility – member pays all but $72.80/month (PNA – Personal Needs Allowance) of income to nursing home (NH) • Must meet clinical eligibility • Countable assets no higher than $2,000 • Includes: • Savings/checking accounts • IRA • Stocks/bonds • Cash value of a whole life* insurance policy • Cannot have a disqualifying transfer of assets *Note: Term life policy has no cash surrender and not a countable asset by MH

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