The Omnibus Budget Reconciliation Act of 1990 requires insurance companies to provide Medicare recipients with certain information regarding any medical coverage which they may have that supplements their Medicare benefits.

More specifically, insurance companies must advise individuals that:

• They do not need more than one Medicare supplement policy;

• If they are age 65 or older, they may be eligible for Medicaid benefits;

• If they begin receiving Medicaid and request a suspension of their Medicare supplement policy within 90 days of becoming Medicaid eligible, the benefits and premiums under their Medicare supplement policy will be suspended during the Medicaid entitlement for up to 24 months (the 24 month count begins on the first day of Medicaid eligibility

• If they lose Medicaid eligibility, the Medicare supplement policy will be reinstated if requested within 90 days after loss of Medicaid eligibility; and

• If they lose Medicaid benefits after 24 months from their certification, the Medicare supplement policy will no longer be in suspense status and they will have to reapply for Medicare supplementary benefits.

Service Representatives in DHS County Offices are asked to share this information with individuals age 65 or older who are Medicare eligible and whose Medicaid applications or reevaluations are being processed by giving them or mailing to them a copy of PUB-319. A copy of the PUB-319 is attached. It may be machine copies for ounty use until the form is available from Central Supply (by mid-September).

If questions arise, the individuals should be informed that, usually, a combination of Medicare and Medicaid coverage will pay one’s medical bills, provided Medicare and Medicaid providers are utilized. However, QMB applicants /recipients should be informed that a QMB Medicaid card will not pay for prescription drugs, because Medicare does not pay for drugs. If they have a supplemental policy that pays for prescription drugs, they may not wish to have it suspended.

County workers should not advise anyone to drop their insurance, but should simply give them the above information, which is the information insurance companies are required to give them. It should be the decision of the applicant/recipient whether or not to drop a Medicare supplement policy.

County offices will also provide verification of Medicaid eligibility when requested from a client or insurance company. The verification needed may be current eligibility status. or begin or end date of eligibility. The verification may be given by telephone, by copy of EMS-700, copy of client’s Medicaid card, or a statement written on DHS letterhead.

Inquiries to: Carol McKnight, 682-8259

Terri Wright, 682-8258

Loyal Crawford, 682-8254

Federal law requires insurance companies that sell Medicare supplemental insurance to allow Medicare recipients to suspend their Medicare supplemental policy for up to two years if they are approved for Medicaid.

With Medicare and Medicaid benefits, you may not need to continue your Medicare supplement policy, because your Medicare and Medicaid benefits will usually cover all your medical expenses if you use providers (doctors, hospitals, etc.) who accept Medicare and Medicaid.

However, if you are approved for Medicaid benefits as a Qualified Medicare Beneficiary (QMB), your Medicaid card will not cover prescr8ption medicine, because Medicare does not cover prescription medicine. If your Medicare supplement does cover prescription medicine, you may not wish to drop the supplemental coverage.

If you are approved for Medicaid, decide to drop your Medicare supplement policy, but want to reserve the right to reinstate your Medicare supplemental policy, then you must:

• Contact the insurance company that carries your supplemental policy within 90 days of the date you are informed of your Medicaid eligibility and request the company to suspend your supplement policy benefits and premiums.

• If you lose Medicaid benefits within 2 years from the time you were approved for Medicaid and contact the insurance company within 90 days from the time of Medicaid loss, the insurance company will reinstate your Medicare supplement policy.

• If you lose Medicaid benefits after 2 years have passed since you were first approved for Medicaid, the Medicare supplement policy will not longer be in suspense status and you will have to reapply with the insurance company if you want to resume the supplemental benefits.

If you have any questions regarding the above procedures, contact the insurance company which carries your insurance