2 programs will help pay patients' Medicare tabs

March 31, 1993|By Katherine Richards | Katherine Richards,Staff Writer

Some low-income Carroll County Medicare patients may be unnecessarily paying hundreds or even thousands of dollars a year in health care costs.

That's because they may not be taking advantage of two federal programs that could help pay part of their out-of-pocket costs for Medicare coverage.

The programs offer "a great deal of help," said Susan G. Cronin, coordinator of Senior Health Insurance Counseling and Advocacy for the Carroll County Department of Aging.

But people don't sign up for the benefits -- often because they don't know the help is there.

"The word is not really out," said David R. Ensor, assistant director of the Carroll County Department of Social Services, which enrolls eligible county residents for the assistance programs.

Last week, a Washington, D.C., consumers group, Families USA Foundation, released a report saying that nationwide, 2.7 million people are eligible for the programs but have not signed up.

In Carroll County, 1,116 people receive help from the programs, according to John P. Stewart, assistant director of the Medical Care Operations Administration in the Eligibility Services division of the state Department of Health and Mental Hygiene.

The number of county residents eligible for the help but not signed up is not known.

Medicare is a federal health insurance program. Anyone over age 65 may join, as may anyone with permanent kidney failure and some people with disabilities who are under age 65.

People who sign up for Medicare pay a monthly premium of $36.60.

They also have to pay other deductibles and co-payments that can add up to thousands of dollars, depending on their individual health-care needs.

Two federal programs exist to help seniors with those out-of-pocket costs.

One, the Qualified Medicare Beneficiary program, or "QMB," pays Medicare premiums, deductibles and co-payments for low-income people whose incomes and savings meet certain guidelines.

The other program, the Specified Low-income Medicare Beneficiaries program, or "SLMB," helps people whose incomes are low, but not low enough to qualify for QMB.

The SLMB program pays only the monthly Medicare Part B premium of $36.60. It does not cover other out-of-pocket expenses related to Medicare.

Families USA Foundation estimated that 31 percent of Maryland seniors eligible for the QMB benefit do not receive it.

And, of an estimated 2,500 people eligible for the SLMB benefit in Maryland, only 16 people, including two from Carroll County, have signed up, said Mr. Stewart.

One reason for the low participation, he said, is that the SLMB program is new. It began Jan. 1, 1993. The state has not had time to tell people the help is there, he said.

Mr. Stewart said another problem is that people who are eligible to receive SLMB are not the same people who are eligible for other Social Services programs. Their names are not in the department's computers, and they do not frequent Social Services offices, where staff could inform them and enroll them in the SLMB program.

Ms. Cronin said some county seniors don't want to sign up because they are afraid it would alienate their doctors.

Both QMB and SLMB are administered by the state's medical assistance agency. Some doctors do not like to see medical assistance patients.

"We sometimes go up the wall with that," said Ms. Cronin.

"Sometimes we need to go to bat for [seniors] with the doctors," she said. But often, she said, even a hesitant doctor will accept a patient once she explains how the QMB and SLMB programs work.

Mr. Stewart said the QMB and SLMB programs present no more paperwork for doctors than regular Medicare coverage.

Rose Matricciani, chief operating officer with the Medical and Chirurgical Faculty of Maryland, the state physicians' society known as Med-Chi, said Monday that people should not be afraid to sign up for QMB and SLMB because they don't want to offend their doctors.

Mr. Stewart said the state Department of Health and Mental Hygiene notifies doctors of programs such as QMB and SLMB.

But many doctors, as well as patients, don't know the QMB and SLMB programs exist.

Gill Chamblin, public relations director with Carroll County General Hospital, said she had asked three doctors about the QMB and SLMB programs, in response to a reporter's question. One of the doctors, she said, has a practice consisting mostly of Medicare patients. But she said none of the three doctors had heard of the programs.

Mr. Ensor said that whenever anyone applies for any Social Services program, the person is automatically screened to see if he is eligible for all Social Services benefits, including QMB and SLMB.

Ann Ransom, branch manager of the Social Security Administration in Westminster, said she tries to publicize QMB and SLMB benefits.

She also said that when a person comes into the office to sign up for Social Security or Medicare benefits, the applicant is referred to Social Services if it seems the person may be eligible for QMB or SLMB help.

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