Help For Medicare Beneficiaries With Special Needs

By Marc Manor

Many of our seniors and other Medicare beneficiaries are living on fixed incomes with very little wiggle room for unexpected medical expenses. Fortunately, there are a number of state and federal programs available that can bring much needed relief to those who need “extra help” with paying for medical expenses. One of the most prevalent sources of assistance for medical expenses is Medicaid.

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Those Medicare Beneficiaries who get their assistance via Medicaid are referred to as “Dual Eligible” because they qualify for both Medicare and Medicaid. There are a number of Medicare Part C (or Medicare Advantage) Plans that are specifically designed with Dual Eligible beneficiaries in mind. These types of plans are known as “Dual Special Needs Plans” or D-SNP. If you are getting Medicaid and qualify for Medicare, I highly recommend speaking to an agent about what plan choices are available in your area. The agent can assist you with sifting through the D-SNP options in your area to be sure any specific requirements you may have are met with the plan you choose.

Not sure if you qualify for Medicaid?

I recommend visiting https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicaid 

or seek out other resources at your local library to see if you qualify for Medicaid. From there you can access information and several tools to help you determine your eligibility and how to apply for benefits. You may also contact your county Medicaid office to assess your situation and answer any questions you may have. Different states have different rules and the process for qualification can be quite challenging; however, I would encourage anyone who thinks they qualify to remain diligent in their pursuit.

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Who can help and advocate for me when applying for Medicaid?

There are a number of agencies and attorneys that can assist, but those usually come with a fee. Elder Law attorneys are one source of assistance. You may want to consider this option if you have had any property or monetary considerations in the recent past. Most state Medicaid agencies have a look-back period of 60 months (five years). Attorneys can be expensive. Find out up front what the charges will be. You will have to decide based on your situation if the fees involved will be a good value for you in the long run.

Your county Medicaid office may be able to direct you to organizations who can assist with applying for Medicaid at no cost. Waiting and process times may be lengthy and your ability to have your questions answered along the way may be more difficult using free assistance. However, if you know this going in, you can manage your expectations. There is rarely a “fast pass” method of going through the Medicaid application process regardless of whether you use a paid or free service anyway.

Whether you use a paid service or a non-profit “free” assistance program, I highly recommend knowing what you will be charged (if anything). You also need to thoroughly verify the credibility of the person or organization providing the help. Personal and private information will likely be disclosed, so you will want to be 100% sure who you are dealing with especially if you are paying a fee.

What happens once Medicaid is approved?

Once approved, you will receive a card and information in the mail. Social Security will become involved as well, depending on the level of benefits awarded. Benefits are on a sliding scale based on a number of factors, including the state's rules on Medicaid. Full Medicaid is when the benefit is approved at 100% and Medicaid will pay most of the out-of-pocket co-pays and deductibles associated with most D-SNP Medicare Advantage Plans (refer to your plan for specifics).

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Full Dual Eligible Beneficiaries on Medicare Advantage Plans are currently able to change their plans throughout the year. Starting in 2019, they may only allow changes once per quarter. When it comes to this option, I don't recommend making too many changes. Altering your plan may cause errors or confusion on the part of the providers when they submit claims. Whenever a change is made, be sure to provide your updated insurance information to your providers as soon as possible after the new plan takes effect.

An experienced independent agent can assist you making your choices, so you get the best plan for your needs. This also means frequent changes shouldn’t be required throughout the year. If you are on a fixed income and think you may qualify, ask your agent to help point you in the right direction. It may give you just the help you need to stay ahead of your medical bills.

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits.  As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions.  There is no charge for a consultation so call 904-222-0698 or email marc@marcmanor.com today!