Understanding Asbestos Related Medicare Coverage
Medicare Benefits are now available to people who are diagnosed with an asbestos related disease (ARD). If you already have Medicare benefits you may be interested in the pilot program which is explained below.
Who is eligible for Medicare benefits?
You must 1) be diagnosed with ARD by a medical provider, 2) have been “present” in Lincoln County for at least 6 months, 3) the 6 months in Lincoln County must be at least 10 years before you were diagnosed with ARD. You are not considered disabled nor will you receive any cash disability benefits. Social security disability is a completely separate program with a separate application process.
How do I apply for Medicare benefits?
Contact the Social Security Administration, which is the agency responsible for enrolling people for Medicare benefits. They have set up a special phone number just for Libby asbestos claims (1-888-482-3128). What you need to enroll is 1) photo identification, 2) your social security number, 3) information about the time period you were in Lincoln County, and 4) information about your ARD diagnosis.
You do not need to get any “proof” of your diagnosis from CARD. We will verify your diagnosis to Social Security once you have started the enrollment process and signed Social Security’s release of information form.
What are the benefits provide by Medicare benefits?
Medicare benefits you would be eligible for include Part A, Part B, and Part D. This is complete healthcare, NOT just asbestos related healthcare. The benefits are exactly the same regardless of which eligibility criteria you met to get them (ARD, age, disability, etc)
Part A: You will receive these benefits free of charge. This covers “inpatient care” which means healthcare you receive in a hospital or skilled nursing facility and some home health and hospice care.
Part B: This benefit is available for a monthly premium (currently $99.90/month, but there are also financial assistance programs available that are based on your family’s income). This covers “out-patient services” which are doctor’s visits, and other services and supplies not covered by your Part A hospital insurance.
Part C: This benefit, that covers prescription medications, is available and there are many different types of programs that have different premiums and different scopes of coverage.
Cautions: There are a few things you should think through prior to contacting Social Security.
- Asbestos related disease Medicare benefits are exactly the same as the Medicare benefits you would get when turning 65 or being deemed disabled by the Social Security Administration. This means 80% coverage for part A and part B with the individual (you) or a supplemental insurance picking up the 20%.
- If you enroll in Medicare part A but decline to select part B at this time, your monthly premium will increase ten percent for each twelve month period you were eligible for, but did not enroll in, Medicare part B. Your Medicare part D premium will increase by one percent for each full month you were eligible for, but did not enroll in, Medicare part D. These penalties apply except when you have “creditable coverage” (medical coverage that is as good as, or better, than Medicare) or if you wait until you are 65 which is another “initial enrollment period” for Medicare.
- At this time, you must pay monthly premiums for part B ($99.90/month) every 3 months ($299.70), 4 times a year. If you set up automatic deduction, you can pay monthly. The Medicare Savings Plan can provide assistance with premiums, co-pays and deductibles for those that qualify. Contact your local Medicaid office. In Libby Call 293-3791
- If you need help selecting a part D prescription plan, contact Western Montana area VI Agency on Aging, SHIP counselor, Sandy Romey 293-8299.
How long will these asbestos health benefits last?
These benefits are the long-term solution but definitely still a work in progress. There are three components to the legislation that passed granting medical coverage to individuals exposed to an environmental health hazard in a public health emergency site such as Libby. The three parts are 1) Medicare benefits, 2) “a pilot program,” and 3) a screening program.
What is the pilot program?
The pilot program is free and covers costs that are completely denied by Medicare. If you have ARD, Medicare parts A and B, and live in Lincoln or Flathead County, MT you are eligible to apply. The pilot program is not specific to ARD; it covers services beyond what Medicare normally covers for any reasonable healthcare need. Noridian Administrative Services is running this program for Medicare. For more information contact CARD, log onto: www.noridianmedicare.com/ard or call Noridian directly at 1-888-469-9464.
How do these benefits work with the Grace Libby Medical Plan?
You can have both Grace and Medicare benefits. Grace should be billed first, and if denied then Medicare should be billed. The future and timeline of the Grace Libby Medical Plan is unknown.