Posts Tagged ‘enrolling’

N.J. gets $4.2M for enrolling children in health coverage program

The federal Centers for Medicare & Medicaid Services has awarded New Jersey a $4.2 million performance bonus for increasing NJ FamilyCare health insurance enrollment among eligible, uninsured, children in the state, Gov. Jon Corzine announced Thursday.

Only eight other states – Alabama, Alaska, Illinois, Louisiana, Michigan, New Mexico, Oregon and Washington – qualified for the bonus.

“Access to health insurance for children has been a touchstone of my administration,” Corzine said. “This bonus is a much appreciated honor for our state and a testament to the commitment we’ve exercised in insuring more than 100,000 new children over four years.”
“With our governmental and not-for-profit partners, the Department of Human Services has been working incredibly hard to find and insure eligible children using innovative programs, including presumptive eligibility in hospitals and clinics, and school-based outreach facilitators,” Commissioner Jennifer Velez said. “This award proves that, while there are many children still in need of health care coverage, New Jersey is making great headway.”

In order to receive the bonus, the federal CMS rated states on two areas: Implementing at least five of eight specific programs to promote enrollment and retention for children, and increasing enrollment above a formulaic target set by the Children’s Health Insurance Program Reauthorization Act of 2009.

New Jersey exceeded CMS’ minimum requirements by successfully increasing accessibility to children’s enrollment in six program areas: Continuous 12-month eligibility, eliminating the financial asset test, eliminating in-person interview at application and renewal, instituting single, unified, form for application and renewal, instituting automatic verification at renewal, and instituting presumptive eligibility for coverage.

New Jersey also achieved a 4.2 percent enrollment increase above baseline enrollment for federal fiscal year that ended Sept. 30.

Presently, NJ FamilyCare, the state’s program for low-income families, insures more than 614,197 children and provides a free or low-cost health care coverage for income-eligible families. For example, a family of four earning up to $77,175 – or 350 percent of the federal poverty level – can qualify to insure their children for $133 a month in the state- and federally-funded program.

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Enrolling In Medicare Programs

Enrolling in Medicare Part A or B

Medicare has four parts: Part A, called hospital insurance; Part B, medical insurance; Part C, Medicare Advantage managed care plans; and Part D, prescription drug plans. Most people are eligible for any of these Medicare programs at age 65.

Some people may want to sign up for only one part of Medicare or for several. But each part has a different enrollment procedure, and the processes differ depending on whether she’s already receiving Social Security or other federal pension benefits or is a member of a managed care plan and wants to continue. When and how to enroll can get confusing, so the procedures and timing for each situation and Medicare program are described below.

Automatic enrollment in Medicare Part A if the person is already receiving Social Security or other federal pension benefits

If the person is approaching age 65 and is already receiving Social Security, Railroad Retirement, or federal civil service pension benefits — retirement, disability, or dependents’ or survivors’ benefits — she doesn’t need to do anything to enroll in Medicare Part A. The Social Security Administration will do it for her. About three months before her 65th birthday, she’ll receive an initial enrollment period package in the mail. Included will be notification of her enrollment in Medicare Part A. Because she is eligible for Social Security or other federal pension benefits, she’s also eligible for free Part A coverage. That means she won’t have to pay any monthly premium for Part A. Her coverage will begin on her 65th birthday. If she doesn’t receive these documents by two months before she turns 65, she should contact the Social Security Administration at 800-772-1213.

If she’s under age 65 but has been eligible to receive Social Security disability benefits for at least 24 months, she’s also eligible for free Medicare Part A and will be automatically enrolled. The Social Security Administration will mail Medicare enrollment documents to her when she reaches her 24th month of collecting disability benefits.

How and when to enroll in Medicare Part A if someone isn’t receiving Social Security or other federal pension benefits

If the person isn’t collecting Social Security or other federal pension retirement, disability, or dependents’ or survivors’ benefits, she has to apply for Medicare Part A at a local Social Security office. She should file her application as early as three months before she turns 65, to ensure that the paperwork is completed by her 65th birthday.

If she’s eligible for Social Security or other federal pension benefits but hasn’t yet started collecting them, she will receive free Part A coverage, with no monthly premium. If she is 65 and a citizen or legal resident but doesn’t qualify for Social Security or other federal pension benefits, she can still apply for Medicare Part A. However, she will have to pay a monthly premium for it; the amount is determined by how many Social Security work credits she has accumulated.

If she applies for Medicare Part A within six months after she turns 65, her coverage will date back to her 65th birthday. If she applies more than six months after her birthday, her coverage will date back only to six months before the date she applied.

How and when to enroll in Medicare Part A and Part B if someone wants to continue in a managed care plan

The person may be one of the many people under age 65 enrolled in a managed care health plan. The company that runs that plan may also have a Medicare Part C Medicare Advantage managed care plan that she could switch to when she turns 65. That would let her continue with all the same doctors and other providers from whom she receives care now. If she’s happy with her managed care plan, and the same company offers a Part C Medicare Advantage version, she can simply notify the plan of her intention to switch to this Medicare Part C version. If she does so and isn’t already receiving Social Security or other federal pension benefits, the managed care plan will help her enroll in Medicare Part A and Part B.

Automatic enrollment in Medicare Part B if someone is already receiving Social Security or other federal pension benefits

If the person is already receiving Social Security, Railroad Retirement, or federal civil service pension benefits — retirement, disability, or dependents’ or survivors’ — when she turns 65, Social Security will automatically enroll her in Medicare Part B. About three months before she turns 65, Social Security will mail her an initial enrollment period package, including notification of her enrollment in Medicare Part B. If she doesn’t want to enroll in Medicare Part B, there’s a place on the form where she can decline Part B coverage.

Her Part B coverage will begin on her 65th birthday. If she doesn’t receive the documents by two months before she turns 65, she should contact the Social Security Administration at 800-772-1213.

Everyone who enrolls in Medicare Part B must pay a monthly premium for Part B coverage. In 2008, the basic monthly premium most people pay is $96.40. However, if she has over $82,000 in income (over $164,000 for a married couple), the amount is higher. Part B premiums are automatically deducted from her monthly Social Security check. If she isn’t receiving Social Security benefits, Medicare will send her a bill every three months.

How and when to enroll in Medicare Part B if someone isn’t yet receiving Social Security or other federal pension benefits

If she’s turning 65 but isn’t yet collecting any Social Security or other federal pension benefit, she needs to sign up for Medicare Part B at a local Social Security office. (She can do it at the same time she files for Social Security benefits at age 65, if she’s doing that, too.) In the months immediately before and after her 65th birthday, she has what’s called an initial enrollment period. This allows her to sign up for Medicare Part B as early as three months before the month she turns 65, and anytime within three months after the end of the month she turns 65. If she doesn’t sign up for Part B by the end of this initial enrollment period, she has to wait until the general enrollment period of January 1 through March 31 each year.

The timing of her enrollment in Part B determines when her coverage begins and can affect how much it costs:

If she signs up for Medicare Part B within the three months before the month in which she turns 65, her coverage will begin on her 65th birthday.

If she signs up within three months after the month she turns 65, her coverage will be delayed one to three months; there’s no retroactive Part B coverage back to her 65th birthday.

If she signs up for Part B in the general enrollment period January through March, after her initial enrollment period is over, her coverage won’t begin until July 1 of that year. Also, her monthly premiums for Part B coverage will be higher — 10 percent higher for each year she delayed enrolling.

How and when to enroll in Medicare Part C or Part D

Part C Medicare Advantage

Part C Medicare Advantage managed care plans combine Medicare Part A and Part B coverage within a managed care framework. Medicare doesn’t control the amount a plan charges for this coverage, but it does regulate who may enroll in such a plan and when.

Within six months of enrolling in Medicare Part A and B. Once your friend or relative enrolls in Medicare Part A and B, she has a six-month period in which she may join any Medicare Advantage managed care plan that is operating in the county where she lives. In this period, a plan must accept her enrollment without any medical screening and on the same terms as for anyone else of her age, regardless of her medical history.

During the plan’s open enrollment period. Every Medicare Advantage managed care plan designates at least one month a year for open enrollment, if it’s accepting any new enrollees at all. Some plans have open enrollment for more than one month. During the open enrollment period, she can join the plan regardless of her medical history. Most plans pick November for open enrollment, with coverage beginning the following January 1.

If dropped by another managed care plan. Unfortunately, Medicare Advantage managed care plans regularly drop out of geographic areas that they don’t feel are profitable enough for them. If her plan is dropping out of the area where she lives, it will notify her by October 1, effective the following January 1. She then has two options. She can rejoin traditional Medicare Part A and Medicare Part B; if she does, she is also guaranteed the right to buy a medigap supplemental insurance policy to fill gaps in Medicare coverage. Or she can enroll in any other Plan C Medicare Advantage managed care plan that’s operating in the county where she lives and that isn’t closed to all further enrollment. She can join one of these plans from October 1 through December 31.
If moving out of the plan’s service area. Managed care plans operate within geographic areas. They aren’t required to continue covering someone enrolled in the plan who moves out of the area it serves. If she’s in this situation, she’s guaranteed the right to join any Medicare Advantage managed care plan operating in the new area where she lives, during that plan’s yearly open enrollment period. If there’s a gap between when she moves and the open enrollment period for the new plan she’d like to join, she’ll have to use traditional Medicare Part A and Part B in the meantime.

Medicare Part D prescription drug plan

Anyone eligible for Medicare is guaranteed the right to enroll in any Medicare Plan D prescription drug plan sold in the state where she lives during an initial enrollment period. This period begins three months before the month she turns 65, and continues until three months after the month she turns 65. If she doesn’t sign up for a Part D plan by the end of this period, she has to wait until the Plan D yearly general enrollment period of November 15 through December 31.

There’s a financial penalty if she doesn’t enroll in a plan during her initial enrollment period but later decides to join a plan. For each month she delays enrolling after the close of her initial enrollment period, she must pay a 1 percent penalty on the premium price of any plan she eventually joins.

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State makes headway on enrolling children in Medicaid insurance programs

Kentucky isn’t usually out in front on health issues. But Gov. Steve Beshear said one effort by his administration to improve Kentucky residents’ health is ahead of the game.

Beshear went to Second Street Elementary School in Frankfort on Monday morning to announce the state has enrolled 32,000 qualifying children in the state’s K-CHIP and Medicaid programs for health insurance since last October. Last fall, Beshear set as a goal the enrollment of 35,000 children by June 2010 and he said Monday the state is likely to meet the goal by the end of 2009.

The Kentucky Children’s Insurance Program or K-Chip insures children in families at or below 200 percent of the federal poverty level (about $44,000 for a family of four). Those children are from families, according to Vikki Franklin, spokeswoman for the Cabinet for Health and Family Services, who make too much to qualify for Medicaid but still can’t afford private insurance. Those who do meet Medicaid eligibility guidelines are enrolled in that program. Both programs are largely federally funded.

Janie Miller, secretary of the Cabinet for Health and Family Services, said the total cost of the additional 32,000 kids enrolled in the two programs is about $78,000, about 20 percent of which is paid by the state and the remainder by the federal government. Miller also said the state exploited larger federal Medicaid matches to help absorb the state portion of the added costs. Those funds are scheduled to end in December 2010.

When Beshear last fall called for increased enrollment, about 53,000 Kentucky children were insured by the two programs but an estimated 67,000 were eligible but nor enrolled. The state streamlined the enrollment procedures and recruited schools, local health departments and community agencies to help get the word out to eligible families and help them enroll. The state made it possible to enroll online and eliminated the requirement for face-to-face interviews prior to enrollment.

It worked. About 2,500 enrolled in each month since the program began. But Beshear said that still doesn’t meet the actual need of eligible children and the state will continue to try to enroll as many as it can.

“The state will strive to sign up every eligible family because I believe we have a moral obligation to every child,” Beshear said. He said the numbers of eligible children and the increased enrollment reflect the state of the economy. And “access to quality, affordable health care” is increasingly difficult for Kentucky families who have lost jobs or homes, he added.

“Meeting our goal earlier than anticipated also serves as an indicator of the state of our economy and demonstrates the effect it has on families’ everyday lives,” Beshear said.

The executive director of Kentucky Youth Advocates, a Louisville non-profit organization which advocates on issues affecting children and low-income families, praised Beshear for the program and its success.

Terry Brooks said KYA has lobbied state government for years “to see families as customers rather than as a burden on the state budget. The Beshear administration saw those potential K-CHIP families as customers.”

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