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The new Medicare prescription drug benefitprovides drug coverage
for Medicare benefi-ciaries, including those who also
receivecoverage from Medicaid. In addition,individuals eligible for
both Medicare andMedicaid also receive the low-incomesubsidy for
both the Medicare drug planpremium and assistance with cost sharing
forprescriptions. Medicaid will no longer pro-vide drug benefits
for Medicare beneficiaries.
Since the Medicare drug benefit and low-income subsidy will
replace a portion ofState Medicaid expenditures for drugs,States
will see a reduction in Medicaidexpenditures. To offset this
reduction, theMedicare Prescription Drug, Improvement,and
Modernization Act of 2003 (Public Law108-173) requires each State
to make amonthly payment to Medicare representinga percentage of
the projected reduction. For2006 this payment is 90 percent of
theprojected 2006 reduction in State spending.After 2006 the
percentage decreases by 12/3 percent per year to 75 percent for
2014 and later.
For More InformationFor more information about Medicare
andMedicaid, please visit www.cms.hhs.gov/home/medicaid.asp on the
CMS website.
The Medicare Learning Network (MLN)The Medicare Learning Network
(MLN) is thebrand name for official CMS educationalproducts and
information for Medicare fee-for-service providers. For additional
informationvisit the Medicare Learning Network’s webpage at
www.cms.hhs.gov/MLNGenInfo on theCMS website.
This brochure was prepared as a service to the public and is
notintended to grant rights or impose obligations. This brochuremay
contain references or links to statutes, regulations, or
otherpolicy materials. The information provided is only intended
tobe a general summary. It is not intended to take the place
ofeither the written law or regulations. We encourage readers
toreview the specific statutes, regulations and other
interpretivematerials for a full and accurate statement of their
contents.
ICN#006378 September 2006
Medicare Learning Network
http://www.cms.hhs.gov/home/medicaid.asphttp://www.cms.hhs.gov/MLNGenInfo
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Overview of MedicaidTitle XIX of the Social Security Act is a
Federal/State entitlement program that pays for medicalassistance
for certain individuals and families with lowincomes and resources.
This program, known asMedicaid, became law in 1965 as a
cooperativeventure jointly funded by the Federal and
Stategovernments (including the District of Columbia andthe
Territories) to assist States in furnishing medicalassistance to
eligible needy persons. Medicaid is thelargest source of funding
for medical and health-related services for America’s poorest
people.
Within broad national guidelines established byFederal statutes,
regulations, and policies, each State:
• Establishes its own eligibility standards;
• Determines the type, amount, duration, and scope of
services;
• Sets the rate of payment for services; and
• Administers its own program.
Medicaid policies for eligibility, services, and paymentare
complex and vary considerably, even among Statesof similar size or
geographic proximity. Thus, a personwho is eligible for Medicaid in
one State may not beeligible in another State, and the services
provided byone State may differ considerably in amount, duration,or
scope from services provided in a similar or neigh-boring State. In
addition, State legislatures may changeMedicaid eligibility,
services,and/or reimbursementduring the year.
The Medicare-MedicaidRelationshipThe Medicare Program(title
XVIII of the SocialSecurity Act) provideshospital insurance,
alsoknown as Part A coverage,and supplementary medical
insurance, also known as Part B coverage. Coverage forPart A is
automatic for peopleage 65 or older (and for certaindisabled
persons) who haveinsured status under SocialSecurity or Railroad
Retire-ment. Most people don’t pay amonthly premium for Part
A.Coverage for Part A may bepurchased by individuals whodo not have
insured statusthrough the payment ofmonthly Part A
premiums.Coverage for Part B requirespayment of monthly
premiums. People with Medicare who have limited income
andresources may get help paying for their out-of-pocket
medicalexpenses from their State Medicaid program. There are
variousbenefits available to “dual eligibles” who are entitled to
Medicareand are eligible for some type of Medicaid benefit. These
benefitsare sometimes also called “Medicare Savings Programs”.
For people who are eligible for full Medicaid coverage,
theMedicaid program supplements Medicare coverage byproviding
services and supplies that are available under theirState’s
Medicaid program. Services that are covered by bothprograms will be
paid first by Medicare and the difference byMedicaid, up to the
State’s payment limit. Medicaid may alsocover additional services
(e.g., nursing facility care beyond the100 day limit covered by
Medicare, prescription drugs, eye-glasses, and hearing aids).
Limited Medicaid benefits are also available to pay for
out-of-pocket Medicare cost-sharing expenses for certain
otherMedicare beneficiaries. The Medicaid program will assumetheir
Medicare payment liability if they qualify. QualifiedMedicare
Beneficiaries (QMB), with resources at or belowtwice the standard
allowed under the Supplemental SecurityIncome (SSI) program and
income at or below 100 percent ofthe Federal poverty level (FPL),
do not have to pay theirmonthly Medicare premiums, deductibles, and
coinsurance.
Specified Low-Income Medicare Beneficiaries(SLMB), with
resources at or below twice thestandard allowed under the SSI
program and incomeexceeding the QMB level, but less than 120
percentof the FPL do not have to pay the monthly MedicarePart B
premiums. Qualifying Individuals, who arenot otherwise eligible for
full Medicaid benefits andwith resources at or below twice the
standardallowed under the SSI program, will get help withtheir
monthly Medicare Part B premiums if theirincome exceeds the SLMB
level but is less than 135 percent of the FPL.
Individuals who were receiving Medicare due todisability, but
have lost entitlement to Medicarebenefits because they returned to
work may buyMedicare Part A. If the individual has income below200
percent of the FPL and resources at or belowtwice the standard
allowed under the SSI programand they are not otherwise eligible
for Medicaidbenefits, he or she may qualify to have Medicaid paythe
monthly Medicare Part A premiums as QualifiedDisabled and Working
Individuals.
The Centers for Medicare & Medicaid Services(CMS) estimates
that Medicaid currently providessome level of supplemental health
coverage for about6.5 million Medicare beneficiaries.
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Multi-Language Insert
Multi-Language Interpreter Services
English: ATTENTION: If you speak English, language assistance
services, free of charge, are available to you. Call 1-888-850-8526
(TTY: 711).
Spanish: ATENCIÓN: si habla español, tiene a su disposición
servicios gratuitos de asistencia lingüística. Llame al
1-888-850-8526 (TTY: 711).
Chinese: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電
1-888-850-8526（TTY：711）。
Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ
ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-850-8526 (TTY:
711).
Korean: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.
1-888-850-8526 (TTY: 711)번으로 전화해 주십시오.
Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам
доступны бесплатные услуги перевода. Звоните 1-888-850-8526
(телетайп: 711).
Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang
gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.
Tumawag sa 1-888-850-8526 (TTY: 711).
Ukrainian: УВАГА! Якщо ви розмовляєте українською мовою, ви
можете звернутися до безкоштовної служби мовної підтримки.
Телефонуйте за номером 1-888-850-8526 (телетайп: 711).
Mon-Khmer, Cambodian: ្របយ័� េរើសិន�អកនិ�ប ��ែខ�រ, េស�ជំនបែផក��
េ�បមិនគ័ឈល គ�ច�នសំ�ររំេរអក។ ចរ ទរសព� 1-888-850-8526 (TTY: 711)។
Japanese:
注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-888-850-8526（TTY:711）まで、お電話にてご連絡ください。
Amharic: ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት
ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-888-850-8526 (መስማት ለተሳናቸው: 711).
Cushite (Oromo): XIYYEEFFANNAA: Afaan dubbattu Oroomiffa,
tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama.
Bilbilaa 1-888-850-8526 (TTY: 711).
Arabic: ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة
اللغوية تتوافر لك بالمجان. اتصل برقم 711 (رقم هاتف الصم والبكم:
8526-850-888-1).
Punjabi: ਿਧਆਨ ਿਦਓ: ਜੇ ਤੁਸ� ਪਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤ� ਭਾਸ਼ਾ ਿਵਚ ਸਹਾਇਤਾ
ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 1-888-850-8526 (TTY: 711) 'ਤੇ ਕਾਲ ਕਰ।
German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos
sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer:
1-888-850-8526 (TTY: 711).
Laotian: ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ,
ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ
1-888-850-8526 (TTY: 711).
ត ត ួ តិ � � ឺ ់ � ត ូ ូ យ
ੰ ੱੋ
Premera Blue Cross is an HMO plan with a with a Medicare
contract. Enrollment in Premera Blue Cross depends on renewal.
H7245_PBC0977_Accepted 028023 (11-2016)
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!!!!!!!!!!!!!!!!!!!!!!!!
!
Non-Discrimination Notice
Discrimination is Against the Law Premera Blue Cross Medicare
Advantage complies with applicable Federal civil rights laws and
does not discriminate on the basis of race, ethnicity, national
origin, color, religion, sex, gender, age, mental or physical
disability, health status, claims experience, medical history,
genetic information, evidence of insurability, or geographic
location.
Premera: • Provides free aids and services to people with
disabilities to communicate effectively with us, such as: o
Qualified sign language interpreters o Written information in other
formats (large
print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary
language is not English, such as: o Qualified interpreters o
Information written in other languages
If you need these services, contact the Civil Rights
Coordinator.
If you believe that Premera has failed to provide these services
or discriminated in another way on the basis of race, color,
national origin, age, disability, or sex, you can file a grievance
with: Premera Blue Cross Medicare Advantage Plans, Attn: Civil
Rights Coordinator, P.O. Box 4158, Portland, OR 97208-4158
!
Fax Number: 1-855-339-8129 Expedited appeal requests can be made
by phone at 1-888-850-8526 (TTY: 711). Email:
[email protected]. You can file a grievance in
person or by mail, fax, or email. If you need help filing a
grievance, the Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department
of Health and Human Services, Office for Civil Rights,
electronically through the Office for Civil Rights Complaint
Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone
at: U.S. Department of Health and Human Services, 200 Independence
Ave SW, Room 509F, HHH Building, Washington, D.C. 20201,
1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available
at http://www.hhs.gov/ocr/office/file/index.html. Getting Help in
Other Languages This Notice has important information. This notice
may have important information about your application or coverage
through Premera Blue Cross Medicare Advantage. There may be key
dates in this notice. You may need to take action by certain
deadlines to keep your health coverage or help with costs. You have
the right to get this information and help in your language at no
cost. Call 888-850-8526 (TTY: 711).
Premera Blue Cross is an HMO plan with a with a Medicare
contract. Enrollment in Premera Blue Cross depends on renewal.
H7245_PBC0979
028023.pdfMulti-Language Insert
