Are there really changes on the horizon, did the recent legislation upheld by the Supreme  Court affect you. These are questions that I am afraid there are no current answers to at the moment, but I feel any and all changes to Utah Medicare rules and procedures will occur after the elections. As always we recommend you have a competent agent who specializes in Utah Medicare coverage to help answer your questions as they arise. Of course we are biased, but a good agent is always better than no agent.

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Senior Services of Utah

Disguised by the ornate language of a bill that would wrest Medicare from the federal government and put it under Utah’s control is the law of untended consequences.

The bill, SB208, would adopt the interstate Health Care Compact, which backers say would use the money far more efficiently than the feds’ Affordable Care Act. Now, the federal government runs Medicare and the state runs Medicaid.

However, the math doesn’t work out that way, according to the Utah Health Policy Project, which estimates Medicare would lose $217 million by 2014. Add in the loss that yearof about $132 million for Medicaid, and joining the compact makes no sense at all.

Here’s the deal. While Utah still has the nation’s youngest population, there are plenty of us who aren’t getting any younger and probably will need help with medical bills. At present, 280,000 Utahns are enrolled in the program.

Meantime, as Utah cuts spending, the feds will too, says Jason Cooke, the UHPP’s Medicaid researcher and policy director.

SB208, he says, “asks to be hit twice — volunteer for a whipping now and take another one when the fed cuts later. We’ll lose more than $1 billion over 10 years.”

Now, Utah Medicare recipients include people 65 and over, those with kidney failure or long-term kidney disease and those who are permanently disabled and can’t work.

Utah Medicaid, a state-governed program, helps low-income pregnant women, children under 19, people over 65 and older and those who are blind, disabled or need nursing care home.

Who among us doesn’t know someone who needs that help, and how willing are we to deny them? Meantime, Cooke says, Utah now employs 200 people to manage Utah Medicaid. The state likely would need a similar sized staff to run Medicare.

Cooke, who formerly was Medicaid and Children’s Health Insurance Program director for Texas, also believes Utah lawmakers are going to take a whipping from beneficiaries who’ll flood them with calls about reduced benefits, quite likely requiring more permanent staff, too.

Another unintended consequence is that as benefits dwindle, people who are underinsured or uninsured and can’t get medical care could flood emergency rooms, as often happens now. Meantime, the number of caregivers who simply can’t afford to give care under Medicaid and Medicare coverage are simply not taking those patients anymore.

The Health Care Compact, which now includes just four states, is a huge gamble that, like all bets, can go either way.

This is a time of fervent states’ rights activism — witness Utah’s plan to take over most federal lands in our borders to reap some imaginary amount of money to boost education spending and possibly eliminate state income taxes.

But Medicaid and Medicare are all about the elderly, the ill, the disabled and the children. Consider who opposes the compact — the Utah Hospital Association, -Utah, the American Cancer Society and, at street level, county health directors.

Its backers? The deeply conservative Sutherland Institute and the arch-conservative Utah Eagle Forum.

I’ll stand with the pros on this one. SB208 and related bills need to be tossed aside like the pipe dreams they are.

http://www.sltrib.com/sltrib/politics/53600077-90/utah-medicaid-medicare-care.html.csp

Have you wondered if you qualify for extra help from Medicare? The information below may shed some light on Utah Medicare/Medicaid eligibility.

Dual Eligible Programs.

The state has programs that are part of the Medicaid program that will pay some of the costs associated with Medicare. These programs have similar names but offer lots of different benefits. These also have slightly different qualifications. Your client’s income and resources (if any) determine which program they can possibly qualify for.

Here are the options:

Qualified Medicare Beneficiary (QMB)
Specified Low-Income Medicare Beneficiary (SLMB)
Qualifying Individual (QI)
Qualified Disabled and Working Individual (QDWI)

Qualified Medicare Beneficiary (QMB) Program

You May be Eligible for the Qualified Medicare Beneficiary (QMB) Program If:
• You are entitled to Medicare Part A. If you do not have Medicare Part A because you cannot afford it, the QMB program may pay the Medicare Part A premium for you.
• You have an income of 100% of the Federal Poverty Level or even less and your resources do not exceed twice the limit for SSI eligibility.
The expenses covered by the QMB program are:
• Medicare Part A deductible
• Medicare Part B premium ($99.90 for 2012)
• Medicare Part B deductible ($140 for 2012)
• Co-insurance ( typically 20% of approved Part B costs not paid 
to doctors by Medicare—which is usually the beneficiaries responsibility)
• Co-insurance for extended hospital stays and skilled nursing 
( normally an out-of-pocket expense for the beneficiary)
• In some cases, the Medicare Part A premium if applicable
• May also cover the cost of additional health services and prescriptions if you qualify for full Medicaid services as well (QMB Plus)

Specified Low-Income Medicare Beneficiary (SLMB) Program
You May be Eligible for the Specified Low-Income Medicare Beneficiary (SLMB) Program If:
• You are entitled to Medicare Part A. If you are not sure you have Medicare Part A, you can look on their red, white, and blue Medicare insurance card or call Social Security at 1-800-772-1213.
• You have an income above 100% of the Federal Poverty Level, but below 120% of the Federal Poverty Level and your resources do not exceed twice the limit for SSI eligibility
The expenses covered by SLMB are:
• Medicare Part B premium
• The cost of additional health services and prescriptions if they qualify for full Medicaid services (SLMB Plus).

Qualifying Individual (QI) Program
You May be Eligible for the Qualifying Individual (QI) Program If:
• You are entitled to Medicare Part A
• You have an income at least 120% of the Federal Poverty Level, but less than 135% and your resources do not exceed twice the limit for SSI eligibility
• You are not otherwise eligible for Medicaid benefits

The expenses covered by QI are:
• Medicare Part B premium
•
The Qualifying Individual (QI) Program is different from the Specified Low-Income Medicare Beneficiary (SLMB) Program because:
• Each year, the state has only a certain amount of money for allocated toward this program
• Once the funding runs out, no one else will be enrolled.
• Eligible beneficiaries receive assistance on a first come, first served basis.
• Beneficiaries have to re-apply for the program every year in order to determine eligibility

Qualified Disabled and Working Individual (QDWI)
Who qualifies?
• People with disabilities who lost their Medicare Part A because they returned to work and are eligible to purchase Medicare Part A benefits
• You have an income of 200% of the Federal Poverty Level or less and your resources do not exceed twice the limit for SSI eligibility
• An individual must not be otherwise eligible for Medicaid benefits
•
The expenses covered are?
• Medicare Part A premium (if applicable)

If you think you may qualify for one of these programs, here is what you should do:

First of all, make sure you have Medicare Part A.. If you do not have Medicare Part A because you cannot afford it, the QMB program may pay the Medicare Part A premium for you, so you should still apply.
How do you enroll in the dual eligible programs Although anyone can help complete an application for the dual eligible programs, only a state worker can determine if a person is eligible because the programs are part of the state Medicaid program).Call your local Medicaid office and tell them you want information on the dual eligible programs available in Utah.
Documentation varies from state to state. Some of the things you may need:
• Medicare card
• Proof of identity
• Proof of residence
• Proof of income
• Recent bank statements
• Property deeds
• Insurance policies
• Financial statements for bonds or stocks
• Proof of funeral or burial policies
There could be many more depending on what the state asks for.

For More Information: call the state Medicaid office or call Medicare’s 24-hour toll-free helpline at 1-800-Medicare (1-800-633-4227).

Hopefully this answered how the Medicaid program runs and you have some answers as to go about getting qualified. The State of Utah has some great programs to help low income folks.

Once you determine if you are eligible, please feel free to Contact Us as we may direct you toward some great supplemental plans designed to assist folks who qualifiy for the Medicaid programs. There are coverage’s for dental and vision that Medicaid itself typically does not cover.

Jimmy Hobson

801.979.6365

Finding the right Utah Medicare plan can be a daunting task. In order to make the right decision, you will need to have an idea how the parts of Medicare work for you.

Medicare has three main parts

Medicare Part A

Medicare Part A mainly covers hospitalization and inpatient services. Most Utah Medicare beneficiaries get this when they turn 65 or after they have been disabled for 2 years. For 2012, Medicare Part A will include a $1156 deductible for days 1-60, $289 per day for days 61-90 and $578 per day for days 91-150 .There are many Utah Medicare plans that will help to cover most if not all of these deductibles.

Medicare Part B

Medicare part B helps pay for doctor’s services, outpatient, and other medically necessary services that aren’t covered under Part A. There are many preventative services that are also covered. Medicare Part B typically has a monthly premium, and for most Utah Medicare beneficiaries that will be $99.90 per month for 2012. Medicare Part B has a $140.00 annual deductible. After paying your annual deductible Medicare pays 80% and you pay 20% of the costs. As with Part A, there are Utah Medicare plans that can help offset the deductibles and cost sharing.

Medicare Part D

Medicare Part D or prescription drug coverage is offered by private insurance companies and helps to offset a portion of the costs of your medications. These plans include deductibles and coverage is different from every private insurer that offers them. These plans can exist by themselves or can be included within a Medicare Advantage plan (MAPD) There are many intricacies involved with these plans, including possible broad gaps in coverage, so make sure you are careful when choosing your coverage.

You have 2 options when it comes to offsetting your basic Medicare coverage. A Medigap/ Medicare Supplement plan or a Medicare Advantage plan

A Utah Medicare Supplement policy pays after Medicare. Once Medicare pays their portion of the bill, they forward the difference to your Medicare Supplement plan. There are 10 standardized plans(A, B, C, D, F, G, K, L, M and N). A Medigap plan fills in most of the gaps that Medicare does not cover.

Utah Medicare Advantage plans or MA plans are also called Part C. These plans are funded by Medicare and work as your primary Medicare plan. Normally with a Medicare Advantage plan you will have lower premiums than Medicare Supplements but higher co-pays and deductibles. Be assured you are still part of Medicare and you still get all the same rights and protection. These plans work great for many folks because of their lower upfront costs.

There are many great Utah Medicare plans to choose from and finding the right one is important. Hopefully you have a better understanding of how they work.

Jimmy Hobson
Senior Services of Utah
www.Utahseniorservices.com
888.772.4678