Medicare is a valuable benefit for Medicaid members and states. It is a source of expanded benefits and coverage for qualifying Medicaid beneficiaries and the largest single source of Third Party Liability (TPL) savings for states.
Medicaid members may not understand the difference between Medicaid and Medicare, or how the programs can work together. The Medicare enrollment process with the Social Security Administration (SSA) can also be confusing and daunting.
As a result, some Medicaid members lose out on a wider range of benefits, and state Medicaid programs continue to pay for healthcare services that could and should be covered by Medicare.
Our Approach:
Since 2011, ForHealth Consulting has partnered with states to implement the Medicare Enrollment Support Initiative, educating Medicaid members about potential Medicare eligibility and assisting them through the enrollment process. Medicaid members can often enroll in Medicare with no added costs with Medicare Savings Programs (MSP) benefits.
The ForHealth Consulting team uses specialized data analyses to identify members who appear highly likely to qualify for Medicare benefits. As these recipients already receive Medicaid benefits, they may also qualify for state payment of Medicare Part A and Part B premiums and cost-sharing as Qualified Medicare Beneficiaries through the MSP. When Medicare provides primary coverage for Medicaid recipients, the state Medicaid program can realize both cost avoidance savings and recovery opportunities from the new Medicare coverage.
What Makes Us Different?
Making enrollment easier:
ForHealth Consulting’s Medicare Enrollment Support team contacts Medicaid members over the age of 65—who appear to qualify for Medicare—to help with the enrollment process and address any barriers that may have prevented past enrollment, including effectively communicating the benefits of Medicare coverage.
We explain how the MSP can help pay Medicare premiums and assist members with scheduling SSA appointments to complete Medicare enrollment. Our team is always available to support Medicaid members through the process.
Working with state partners, our team has fostered and maintained cooperative relationships with SSA Regional Offices, focusing on the shared goal of members obtaining all benefits for which they may be entitled.
We go the extra mile:
- ForHealth Consulting provides live customer service support, available in members’ primary languages, through a toll-free hotline to answer questions, provide information, and assist with SSA appointments.
- We also help states monitor federal and state eligibility files to ensure the Medicare coverage is granted and successfully posted to state systems.
Supporting Members and Clients
ForHealth Consulting provides Medicaid members with education and support and takes the time to answer their questions and address their concerns. When we can speak with members, nearly all choose to pursue Medicare enrollment with our support.
Our approach and comprehensive customer service allows us to build trust with those members who may otherwise have been missed by regular member communications.
We are thorough, comprehensive, empathetic, and educational. We understand the challenges and barriers that these members face, and we collaborate with them to ensure that they are fully informed of the process. Our team resolves barriers—including data disconnects—that may have prevented successful Medicare enrollment in the past.
Learn more about how our Medicare Enrollment Support team can help you identify Medicaid members who are potentially eligible for Medicare, expanding their healthcare coverage and creating cost savings for your Medicaid program.
Attending MESC 2024? Learn more about we can help you and your members with our Medicare Enrollment Support team.