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MEDICARE SECTION
THOSE WITH MEDICAID (MUST READ) - Need To Requalify For Medicaid! ASAP
Some of my clients have heard me discuss how they qualified for Medicaid when they were enrolled in the Affordable Care Act (ACA) health insurance through the New York State of Health. Medicaid helped those eligible and paid for premium reductions and the tax credits when they were under the age of 65 and enrolled in the Affordable Care Act insurance. Once someone became eligible for Medicare (and had to get off of the ACA health insurance) you are/were supposed to reapply for State Medicaid. The income limits for State Medicaid are lower (than the Medicaid with the ACA …. that helped enrollees pay for their under the age 65 health insurance).
But then there was a HOLD on Medicaid status because of COVID …. Read on.
At the beginning of the pandemic, Medicaid agencies paused eligibility reviews so those with benefits could keep them. Soon all states will return to their Medicaid eligibility reviews. This review process is also called Medicaid “renewal,” “redetermination” or “recertification.”
Medicaid Redeterminations
Medicaid redetermination, also called renewal or recertification, is the process where states redetermine an individual’s eligibility for Medicaid. Medicaid redeterminations were paused in early 2020 due to the COVID-19 public health emergency (PHE). However, with the passage of recent legislation, states will resume the redetermination process and can end Medicaid coverage for individuals who are no longer eligible.
Starting April 1, 2023, states will be starting the recertification process at different times and have until May 2024 to recertify their members. Now may be time for you to renew Medicaid coverage so you don’t risk losing it. Each state determines when their redetermination process will begin.
Impacted beneficiaries will be notified by the state approximately 60 calendar days prior to their disenrollment effective date from State Medicaid.
Renewal Of Eligibility & Reporting Responsibility
If you are found eligible for ongoing Medicaid or another Public Health Insurance Program you will be required to re-establish your eligibility at regular intervals as determined by the New York State Social Welfare law. This is called a “Renewal”. You will receive notification of your renewal and a renewal form by mail. It must be returned by the date in the notice for your benefits to continue.
Social Services law requires that you report any changes in your income, resources, third party health insurance, family composition and residence to the Medicaid office. You may also be contacted by the department if a computer income match indicates a change in your circumstances.
If you have any questions, you may contact the Medicaid Community Unit at (315) 435-2928
D-SNP members (on a Medicare Advantage plan who qualify for Medicare and have Medicaid also) who lose their Medicaid coverage will be placed in a
6-month grace period. D-SNP members who do not regain their Medicaid coverage will need help to obtain new Medicare coverage.
If you are disenrolled from your Medicare Advantage plan AND need to find another plan, please reach out to me by email, phone, or text, so I can stay your Agent of Record. Do NOT go through the insurance company. You will lose me as your Agent.
What does this mean for those with Medicaid?
Some members may be automatically renewed by their Medicaid agency based on information the state uses to confirm eligibility (e.g., tax returns, bank accounts, unemployment, SNAP eligibility).
Others may need to take action and provide documentation to verify their Medicaid eligibility. Beneficiaries (you) will be notified by your state Medicaid agency via postal mail or email when you are having your coverage redetermined. It’s important that members have their current contact information on file with their state agency. When notified, beneficiaries (you) may need assistance understanding what you need to do, and in most states, most insurance companies, will be sending a letter with an offer to help members through the redetermination process.
- Ten states are currently excluded from this outreach: Arizona (H0321-002 is excluded and H0321-004 is in scope), Florida, Iowa, Massachusetts, Minnesota, Missouri, Tennessee, Virginia, Washington DC, and Wisconsin.
- This may be subject to change.
What Can You Do?
If a member receives notice from their Medicaid agency that they need to recertify their Medicaid eligibility, please complete the requested information as soon as possible so you don’t risk losing your Medicaid benefits.
If you are deemed ineligible, that is considered a qualifying life event and you will have the opportunity to enroll in a different plan. Please reach out to me by email, phone, or text if you need to find another Medicare plan, so I can stay your Agent of Record. Do NOT go through the insurance company. You will lose me as your Agent.
Medicare Savings Program
This is a government program, if you qualify based on income, that will help you with Medicare costs. This program will help pay your Part B premium. In 2023, the Part B premium is $164.90 that is taken out of your Social Security income check.
APPLICATIONS FOR THE MEDICARE SAVINGS PROGRAM MAY BE OBTAINED BY CALLING Medicaid at (315) 435-2928
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