How We Help
How We Help Medicare Beneficiaries

How we help individuals in our communities has evolved out of the recent changes
in the Medicare program. Medicare Solutions began conducting public forums in
early 2006 to help those in the community with the questions and concerns they
had about the government's new Medicare Plan D prescription drug plan. Early on
the settings were in a townhouse meeting format, but it became apparent to
effectively assist everyone that one-on-one evaluations were necessary as
everyone's individual situation determined how the new changes applied to them.

Out of the public forums we discovered that many individuals were ill informed,
confused and were not aware of the programs they were eligible for. The subsidies
designed to assist the lower income had, and still have, a low percentage of
participation (averaging 30%). It became obvious the lower income group were the
ones choosing between food and prescriptions (or going to the doctors) and were
not receiving the help they were eligible for.

Medicare Solutions, Inc. began focusing on assisting this segment of our
population. Statistics show 61% of dual eligible (Medicare/Medicaid) beneficiaries
have less than a high school education. 27% of individuals with lower income
responded to letters and applications sent out by Social Security in 2005 to apply
for lower income subsidy (extra help) to help pay for part D prescription drug
premiums and co-pays. Less than one third (about 30%) of individuals that qualify
for Medicare Savings Program (subsidizes Medicare Part B premium and/or
Medicare co-insurance and deductibles) are participating.

To address these needs we designed a Medicare "check up". During a "check up"
our Benefits R
epresentatives are able to help evaluate, one-on-one, a Medicare
Beneficiaries individual status in relationship to what programs are available in
their county and state. In the process we provide a whole cafeteria of related

Assist with informational needs. Many individuals simply have questions
related to our field due to the complexity of the Medicare System. This
segment of our population is overwhelmed by systems Federal (Medicare),
State (Medicaid), and Health care (doctors, hospitals, labs, pharmacies,
etc...). Being a knowledgeable source that covers such a broad spectrum
and provides the service in a personalized manner is what our Medicare
Solutions Benefits Consultants are trained to do. Questions we cover
  • All facets of Medicare (Parts A, B, C & D)
  • All facets of Medicaid (QMB, SLMB & QI-1)
  • All facets of Social Security (SSDI, RSDI & SSI)
  • All facets of Private Health Insurance (group health insurance,
    Medicare supplements, retirement benefits,etc...)   
  • All facets of heath care in general
  • Many other related issues

Understanding how these systems all inter-relate and work together is valuable in
helping us to assist each individual with how these systems apply to them on a
personal level.

Assist in Evaluating if the individual is Eligible for any Subsidized Programs
they are not Currently Receiving.

  • Low Income Subsidy - (aka Extra Help) From Social Security to
    subsidize prescription co-pays and premiums.
  • Medicare Savings Programs - (AKA QMB, SLMB or QL-1) From the
    department of Job and Family Services in individual's county, funded
    by the state (subsidizes Medicare Part B premium, deductible and/or

Assist In Evaluating if the Current Medicare Part D Prescription Plan is
working properly for the Individual. Statistics show individuals that are dual
eligible are higher Rx users than the rest of the population. 4% of
subsidized drug plans are chosen. The rest (96%) were auto enrolled by
the states (Department of Jobs and Family Services) with no regard to
matching up of current drugs taken by individuals to the formulary of the
company they were enrolled with. 60% were enrolled in plans that did not
cover all of their drugs.

Assist in Evaluating Part D Excluded Drug Issues That Need to be
Addressed. Medicare determined that two classifications of drugs would
not be covered by the New Prescription Drug Plan. These include
Barbiturates and Benzodiaziapines. MEDICAID will pay for these excluded
drugs in many cases. Also some Part D enhanced plans will cover some
excluded drugs as a part of their formulary. A common issue related to dual
eligible individuals and Part D excluded drugs is out-of-pocket expense
when the excluded drug either should be (Medicaid) or could be (Enhanced
Plan) covered. Pharmacies often simply need appropriate billing
information from Medicaid and individuals are reimbursed for out-of-pocket

Assist in Evaluating Individuals level of Understanding about Medicare Part
C. (AKA Medicare Advantage Plans) The "Medicare and You" handbook sent
to all Medicare beneficiaries has a chapter about this option within the
Medicare system. For dual eligible beneficiaries there are plans called
Special Needs Plans (SNP) within Part C of Medicare. Most dual eligible
beneficiaries have limited if any knowledge about them. These can be a
helpful option for certain individuals. Examples include individuals that have
a spend down, those wanting wider range of doctors than Medicaid
participating physicians, Veterans, and those with transportation needs.
Some newer plans designed for Duel Eligible Individuals have enhanced
dental, optical and hearing aid coverage to help pick up where Medicaid
has cut back.

Assist  New Medicare Beneficiaries in Navigating the System. Generally any
individual who is getting ready to turn 65 or has been collecting disability
benefits from Social Security (SSDI) for 24 months is entering what
Medicare calls an Initial Enrollment Period (IEP). During this transition
many individuals need help with being educated about what programs they
are becoming eligible for and how to navigate the system.

Assist with any troubleshooting Needs. The New Medicare System has
privatized the prescription drug coverage that was previously administered
by each state (Medicaid) for dual eligibles. The integration of the New
System with pharmacies, Medicare and numerous insurance companies
who are contracted with the federal government  to administer the Part D
prescription coverage has left many falling through the cracks in the
system. Our Benefits Consultants clear up many issues that can only be
solved on a one-to-one basis Including:

  • Multiple Part D plans in place
  • Paying premiums for plans they should not be
  • Paying higher Co-pays than they should be
  • Billing problems with pharmacies, doctors, hospitals, durable
    medical equipment providers, labs, health care agencies, etc...
  • Dealing with case workers, service coordinators, billing
    departments, doctors, hospitals and pharmacies to solve specific
  • many other related issues

Our Benefits R
epresentatives are licensed and trained to not just help evaluate
and educate, but also assist with navigating the paperwork for the programs and
benefits described above.             
Medicare Solutions, Inc.
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