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Medicare

Free Webinar: Improvements to the Qualified Medicare Beneficiary Program (QMB) – Part Two

By | Health Care, Medicare, WEBINAR, Webinar Trainings

Part 2: Tuesday, September 25, 2018 at 11:00 a.m. PT / 2:00 p.m. ET.

The Qualified Medicare Savings Program (QMB) helps low-income Medicare beneficiaries pay for their health insurance by covering Part A and B premiums and cost-sharing. State Medicaid programs, which administer QMB, have a responsibility to screen for eligibility, but many individuals still face challenges enrolling into the QMB program. Another challenge is that even after beneficiaries are enrolled in the program, some Medicare providers, in violation of federal law, bill QMBs for costs covered by Medicare. In the past two years, the Centers for Medicare and Medicaid Services (CMS) has implemented a number of changes to the QMB program, which touch both beneficiaries and providers, and are designed to reduce improper billing.

This two-part webinar, The Qualified Medicare Beneficiary Program: Eligibility, Challenges, and New Developments, provides an overview of the QMB program and eligibility criteria. The webinar also covers challenges to eligibility and under-utilization, and reviews the recent CMS administrative changes intended to curb improper billing.

Part Two of the two-part webinar provides:

  • An overview of the improper billing rules under the QMB program
  • A review of the recent CMS administrative changes

Who Should Participate: 

  • Aging and legal advocates, community-based providers, health plan leadership, and others wanting to learn more about the QMB program and improper billing.

Presenters:
Georgia Burke, Justice in Aging
Denny Chan, Justice in Aging

Part Two took place on Tuesday, September 25, 2018.

WATCH THE RECORDING
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Additional Materials

Free Webinar: Improvements to the Qualified Medicare Beneficiary Program (QMB) – Part One

By | Health Care, Medicaid, Medicare, WEBINAR, Webinar Trainings

Part 1: Monday, September 24, 2018 at 11:00 a.m. PT / 2:00 p.m. ET.

The Qualified Medicare Savings Program (QMB) helps low-income Medicare beneficiaries pay for their health insurance by covering Part A and B premiums and cost-sharing. State Medicaid programs, which administer QMB, have a responsibility to screen for eligibility, but many individuals still face challenges enrolling into the QMB program. Another challenge is that even after beneficiaries are enrolled in the program, some Medicare providers, in violation of federal law, bill QMBs for costs covered by Medicare. In the past two years, the Centers for Medicare and Medicaid Services (CMS) has implemented a number of changes to the QMB program, which touch both beneficiaries and providers, and are designed to reduce improper billing.

This two-part webinar, The Qualified Medicare Beneficiary Program: Eligibility, Challenges, and New Developments, provides an overview of the QMB program and eligibility criteria. The webinar also covers challenges to eligibility and under-utilization, and reviews the recent CMS administrative changes intended to curb improper billing.

Part One of the two-part webinar:

  • Provides an overview of the QMB program, including eligibility and utilization
  • Looks at challenges to enrollment, including state enrollment procedures and data transfer issues
  • Discusses recent improvements in enrollment procedures for individuals who need QMB because they do not have premium-free Medicare Part A.

Who Should Participate: 

  • Aging and legal advocates, community-based providers, health plan leadership, and others wanting to learn more about the QMB program and improper billing.

Presenters:
Georgia Burke, Justice in Aging
Denny Chan, Justice in Aging

Part One took place on Monday, September 24, 2018.

WATCH THE RECORDING
DOWNLOAD THE POWERPOINT

Additional Materials

Fact Sheet: SSA Clarifies Handling of Medicare Part A Conditional Applications

By | FACT SHEET, Health Care, Medicare, Social Security
Many people do not have enough work history to qualify for premium-free Medicare Part A benefits, however there is still an option for low-income individuals to get their Medicare Part A premiums paid.

A new Justice in Aging fact sheet details how they can enroll in the Qualified Medicare Beneficiary (QMB) Program to get their Medicare premiums paid through their state Medicaid program. Enrolling in QMB can be confusing for people without Part A coverage and often requires visits to both the Social Security Administration office and the state’s Medicaid program offices. A further complication is that many Social Security offices have used conflicting and incorrect procedures or provided misinformation to applicants. Read More

Press Release: White Paper Stresses Importance of Oral Health Care Benefit for Older Adults

By | Health Care, Medicare, Oral Health, PRESS RELEASE

Washington, DC 2018 – Justice in Aging, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written and published by leaders in the consumer, healthcare and dental fields, including the American Dental Association, Center for Medicare Advocacy, the Dentaquest Foundation, Families USA, Justice in Aging, Oral Health America and the Santa Fe Group.

With an expected 72.1 million seniors living in the United States by 2030, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care, outlines the need for oral health care coverage for Medicare recipients and the importance of it being integrated with, and elevated to, the same importance as the rest of health care in Medicare. Read More

White Paper: An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care

By | Health Equity, ISSUE BRIEF, Medicare, Oral Health

Oral health is an integral part of overall health. Oral health problems can adversely affect one’s ability to maintain optimal nutrition, self-image, social interactions, and mental and physical health. Oral health problems can lead to chronic pain, tooth loss and serious infections. Poor oral health can even worsen chronic medical conditions such as heart disease and diabetes.

Older adults need timely and affordable access to dental care in order to maintain their health and well-being, yet, there is currently no mechanism for most older adults to access care. Contrary to what many believe, Medicare does not include an oral health benefit. Most older adults cannot afford to purchase private oral health insurance or pay out-of-pocket for the care they need. As a result, 70 percent of Medicare recipients have limited or no dental coverage, and fewer than half see a dentist each year.

A new White Paper, An Oral Health Benefits in Medicare Part B: It’s Time to Include Oral Health in Health Care discusses how a Medicare Part B dental benefit would close disparities in dental use and expense between the uninsured and insured and among older adults with few financial resources and limited oral health education. The paper also details how such a benefit could be structured and the legislative changes that would need to happen before such a benefit could be established.

Supporting Older Americans’ Basic Needs: Health Care, Income, Housing and Food

By | FACT SHEET, Health Care, Health Care Defense, ISSUE BRIEF, Medicaid, Medicare, SENIOR POVERTY, Social Security, Supplemental Security Income

Older adults and their families strive each day to pay for health care and medicine, keep food on the table, have a roof over their heads, and have enough cash on hand to pay the utilities, get where they need to go and meet other basic needs. As families work together to meet these challenges, they are supported by a broad range of federal programs that provide Americans with the means to thrive as they grow older and remain at home and in their communities.

This issue brief discusses how these various programs work, who is eligible for them, and how they support the health and economic well-being of older Americans. For a quick overview, check out the fact sheet.

Advance Beneficiary Notices, Administrative Fees, and Dual Eligibles

By | ISSUE BRIEF, Medicare

Federal law prohibits charging Qualified Medicare Beneficiaries (QMBs) with Medicare cost-sharing for covered services. Depending on state law, other beneficiaries who are fully eligible for both Medicare and Medicaid–full benefit dual eligibles–may also be protected from being billed for co-payments or other forms of cost sharing.

However, QMBs and other dual eligibles may still be responsible for certain charges or fees. A new Justice in Aging Issue Brief: Advance Beneficiary Notices, Administrative Fees, and Dual Eligibles explains for advocates the situations under which these types of beneficiaries may be responsible for charges.

Read the brief to learn what protections QMBs have and what charges they may have to pay.

Additional Justice in Aging resources on improper billing can be found here.

Fact Sheet: Health Care Provisions in the Bipartisan Budget Act of 2018

By | DUAL ELIGIBLES, FACT SHEET, Medicare

On February 9, Congress passed the Bipartisan Budget Act of 2018 (BBA of 2018). In addition to its budget provisions, the BBA extends and makes changes to several Medicare programs and provides funding for other health programs that support low-income older adults, people with disabilities, and their families.

Justice in Aging has prepared a summary of some of the major health provisions in the BBA of 2018, including funding for Community Health Centers and outreach to low-income Medicare beneficiaries, the Medicare therapy cap repeal, Part D “donut hole” closure, and authorization of Special Needs Plans and other Medicare Advantage changes. As these changes are implemented, Justice in Aging will continue to provide updates and analysis and identify advocacy opportunities.

Read the Fact Sheet

Fact Sheet: Improvements in QMB Notices Are Temporarily Suspended

By | FACT SHEET, Health Care, Medicare

On October 2, 2017, the Centers for Medicare and Medicaid Services (CMS) initiated changes in the Provider Remittance Advice and the Medicare Summary Notice (MSN) to show more clearly that Qualified Medicare Beneficiaries (QMBs) may not be charged for Medicare deductibles and co-insurance. Unfortunately, CMS will be temporarily suspending these system changes as of December 8 because of significant unforeseen issues affecting provider payments. CMS is working to address the problem and reinstate the new systems sometime in 2018.

The temporary suspension of the system improvements does not affect the rights of QMBs. QMBs do not owe deductibles and co-insurance for any Medicare Part A or Part B services.

The suspension also does not affect another change, instituted in November, that enables providers to confirm QMB eligibility before serving individuals, using the same systems through which they check other insurance coverage.

To learn more about these developments, read our fact sheet.

For more information on QMB protections, see the CMS QMB Program webpage. For tools that advocates can use to assist QMB clients who have been improperly billed, go to Justice in Aging’s Improper Billing page.