What You Should Do If You’ve Been Asked To Recertify For Health Insurance Coverage

Question: I just received a document from Chautauqua County Department of Health & Human Services, telling me I have Medicaid and need to recertify within two weeks. I do NOT have Medicaid and I don’t think I should fill out this form/application. What do you think?

Answer: There are many programs under the umbrella of Department of Health & Human Services (DHHS); just one of them being Medicaid. There are also many types and levels of Medicaid. Without looking at the letter, and because it is June/July, I would guess that you get your Medicare Part B Premium paid by either New York state or the Federal government. This Medicare Part B Premium is the $134 for most Medicare enrollees or it may be a lesser amount, like $121 if you have had Medicare for a long time. That Medicare Part B premium is usually taken out of your Social Security check each month before you get it. This benefit comes under the heading of Department of Health & Human Services and Medicaid, so it says Medicaid in the letter. Some letters actually say “During the previous year, you or a member of your household was eligible to have the Medicaid Program pay the Medicare Part B Premium.” Some letters say “During the Previous year, you or a member of your household were eligible for Medicaid.”

This letter is saying that at sometime in the last year, or prior to that time, you applied for a benefit that would have that premium added back into your Social Security check. Your Social Security check would have increased and you would have gotten a letter from Social Security explaining the new payment level and why. This benefit is called the Slimb/QI-1 benefit, or the Medicare Savings Program (MSP). This benefit, like many others, needs to be recertified (or re-applied for) each year. The DHHS office sends out the annual re-certifications in the month of June/July. We have heard from many individuals with this same question.

Anyone who has applied for, or had a continuing benefit during the year for this program, is required to recertify in June and July. The form is usually mailed to them in June and due back within two to three weeks. Some of the individuals we have talked with are frustrated; “I just completed this form in April, why do I have to do it again?” ALL individuals with this benefit have to re-certify in June/July. So from now on your paperwork will be due in June/July.

If you choose not to complete the form or don’t return it back to them, your benefit will stop. That means your Social Security will go down by $134, (or whatever amount is withheld), because you will be paying the Medicare Part B premium again. I would therefore recommend that you complete this form and send it back with the requested documents. You can also call DHHS, at the number on the letter and ask for help in determining what program you are in. If it is the benefit I have been talking about, complete the form and send it in. You will continue to get the higher Social Security amount.

I consider this benefit a “gateway” benefit. Once approved, there are many other benefits that you are automatically approved for, such as the Low Income Subsidy (LIS) from Social Security to help with Medicare Part D costs.

This Slimb/QI-1 benefit allows an individual to have monthly income up to $1386 and two persons up to $1,872 per month. This benefit does not consider the money you have as assets (like in the bank, or investments), only the income you receive. This benefit also allows for a reduction to your income by the amount you pay in insurance premiums. Not all insurance premiums, but premiums for health insurance, prescription drug coverage insurance, dental insurance, and long term care insurance. So if you have Dental insurance for $33 per month and Health Insurance for $129.50 per month, your income could be up to $1,548.50 per month and you would still be eligible for this benefit. The same is true for couples. If you both have dental, and that same health insurance premium, your income could be closer to $2,197 per month and still be eligible. So there are many individuals and couples who may be eligible for this benefit in our community.

There are many programs that require an annual recertification. This simply means you have to inform them of your financial situation again, including your income, your expenses and for some, your assets. Some of these programs are: Slimb/QI-1 (the one we talked about above), EPIC, Food Stamps, HEAP, and Low Income Subsidy (LIS), to just name a few. For the time it takes to complete the annual form, you get a year’s worth of benefits. For most this is a very good deal.

If you look back to your approval letter when you were approved for this program, you will see the letterhead in Department of Health & Human Services letterhead. Most individuals don’t remember that or notice the name until they get the recertification forms.

I am always cautious in advising completing forms and mailing them back to someone without understanding what it is and why, so I am glad you asked. Always call for more information if you are unsure about the requests. If you are not comfortable with this answer or are still unsure, review it with family, the Office For the Aging or a professional in the field.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.

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