Benefits 101Webinar

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Benefits 101Webinar

• Ann Seguin - Benefits Counselor
• [phone]
• January 2006

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Agenda

• Review programs
• - GAMC Hospital-Only GAMC
• - MNCare
• - MA MA-EPD
• - Program HH (DHS HIV Programs)
• - Private insurance
• - Medicare related programs

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GAMC General Assistance Medical Care

• WHO IS ELIGIBLE?
• Low-income adults w/o children who arent
  eligible for MA (not disabled, not elderly, etc.)
• Not for undocumented or non-immigrants
• Coverage
• Date of application
• No spend-down
• Split into 2 coverage tiers Full GHO

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GAMC Full Benefits

• BENEFITS
• Pays for care if below 75 of FPG
• Co-pays
• - glasses
• - non-preventive office visits
• - non-emergency visit to the ER
• - px
• - dental

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GAMC Hospital Only (GHO)

• BENEFITS
• GHO if between 75 - 175 of FPG
• Inpatient hospital coverage ONLY
• Coverage stops when stay ends
• Co-pay
• - 1,000 for each hospital stay

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MNCare

• WHO IS ELIGIBLE?
• Adults w/o children and families
• Not for non-immigrants or undocumented
• COVERAGE
• 4 month rule
• Monthly premiums based on income
• Split into 2 coverage tiers Full Limited

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MN Care Full Benefits

• BENEFITS
• Pays for all care if below 75 of FPG (adults w/o
  children)
• Co-pays
• - glasses
• - hospital stays
• - px
• - dental

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MN Care Limited Benefits

• BENEFITS
• Somewhat limited care if between 75 - 175 of FPG
  (adults w/o children)
• 10,000 year limit on inpatient hospitalization
  services
• No other limits on health services
• Co-pays
• No dental coverage

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MA Medical Assistance

• WHO IS ELIGIBLE?
• Those with a basis for eligibility
• - children, parents, pregnant women, 65,
  certified blind or disabled
• Non-citizens with qualifying status
• Income limit depends on basis of eligibility
• - spend-down available
• COVERAGE
• Up to 3 months retroactive

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MA - Continued

• BENEFITS
• Most comprehensive level of coverage
• Co-pays
• - glasses
• - non-emergency visits to ER
• - many non-preventive visits
• - px
• - dental
• EMA only covers emergency services

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MA-EPD MA for Employed Persons With Disabilities

• WHO IS ELIGIBLE?
• Must be MA-eligible due to disability work
• No income limits
• Must earn at least 65/mth from work
• Must have taxes withheld by employer or file
  taxes as self-employed

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MA-EPD - Continued

• COVERAGE
• Same coverage as regular MA
• Combination of earned non-earned income
  determines premium (at least 35/mth)
• Medicare B premiums reimbursed if income FPG

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Program HH DHS HIV/AIDS Programs

• WHO IS ELIGIBLE?
• Under 300 of FPG
• Available for undocumented, non-immigrants or
  non-citizens
• Funded by Ryan White
• - must be the payer of last resort

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Program HH - Continued

• COVERAGE
• Monthly premium (cost-share) for insurance
  and/or drug program if between 100 - 300 of FPG
• PROGRAMS
• Insurance
• - will pay premium for private insurance policy
  (i.e. COBRA)

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Program HH - Continued

• Drug (ADAP)
• - pays co-pays/co-insurance for meds on the
  formulary
• - client pays co-pay of 1/3 for meds on the
  formulary
• Dental
• - contracted MN Healthcare Provider
• - prior authorization
• - no caps or co-pays

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Program HH - Continued

• Nutrition
• - 60/month for liquid nutrition or a generic
  multi-vitamin
• - px from doctor fill through pharmacy
• Mental Health
• - prior authorization
• - for those without other mental health coverage
  or if other coverage is exhausted

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Private Insurance

• Individual policy
• - subject to underwriting
• - premium paid by insured individual
• Group policy
• - usually provided by employer
• - premium may be partially paid by employer
• Pre-existing condition limitations
• - continuous coverage

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MCHA an example of an individual insurance
policy

• Created in 1976 to assure availability of private
  health insurance for Minnesotans with preexisting
  health conditions
• Administrated by Medica
• Rates based on age, level of coverage, tobacco
  use
• Annual deductible, then 80 coverage
• Out of pocket maximum
• Pre-existing condition limitation

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Medicare

• COVERAGE
• You must be 65 or disabled (SSDI) for 24 months
• BENEFITS
• Medicare A Hospital Insurance
• Medicare B Medical Insurance
• - 88.50 month premium
• Medicare D Px Drug Insurance

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Medicare Related Programs

• Administered through county social services
• QMB
• - Medicare premiums, deductibles co-pays
• SLMB
• - Medicare Part B premium

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Where to Get More Information

• DHS website www.dhs.state.mn.us
• www.mnevs.state.mn.us
• AIDSLine (800) 248-AIDS
• HIV Resource Guide
• Ann Seguin, Benefits Counselor
• (612) 373 - 2468