Includes an interesting story about SSDI and Health Insurance.
Could work incentives helped their situation???????????
Wednesday, August 27, 2008
2008 Democratic National Convention: Remarks as Prepared for Delivery by Pamela Cash-Roper, Unemployed Nurse and Lifelong Republican From North Caroli
Includes an interesting story about SSDI and Health Insurance.
Could work incentives helped their situation???????????
WWD and Private Health Insurance—Scenario
John is a gainfully-employed individual with a disability, and he has healthcare coverage under Worker with Disabilities (WWD), North Dakota’s Medicaid buy-in program. He pays a premium of $80 per month for the WWD coverage. John’s employer recently told John that John has worked for the business long enough, and is working enough hours, to qualify for coverage under the employer’s health insurance plan. John’s share of the premium for this coverage would be just $40.00 per month.
Should John have both WWD coverage and the private health insurance? The answer depends on a number of factors, including what items and services the private insurance plan covers, whether John will lose the private insurance if his work hours decrease, and whether John has to pay the premiums for both WWD and the private plan.
The private insurer would be required to be the primary, or first, payer of the medical expenses covered under the plan. After that, WWD, as a Medicaid-type program, would fill in the gaps as the secondary payer.
Medicaid might pay John’s share of the premium for the private health insurance if it is "cost effective" for Medicaid to do so. If this is cost effective, Medicaid could even require John to apply for and take the private insurance so that the private insurer would pay first. However, if Medicaid required John to enroll in the private plan, Medicaid would pay the premium for the private insurance in order to save money for the WWD program. Medicaid would not require John to enroll in the private plan if Medicaid would not pay the premium for it.
John should bring this matter to the attention of his eligibility worker at the county Medicaid office for a "cost effectiveness" determination.
Source: Medicaid Program Policy Manual sections 510-05-20-05 and 510-05-20-15.
Any questions may be directed to: rsi5@srt.com
Should John have both WWD coverage and the private health insurance? The answer depends on a number of factors, including what items and services the private insurance plan covers, whether John will lose the private insurance if his work hours decrease, and whether John has to pay the premiums for both WWD and the private plan.
The private insurer would be required to be the primary, or first, payer of the medical expenses covered under the plan. After that, WWD, as a Medicaid-type program, would fill in the gaps as the secondary payer.
Medicaid might pay John’s share of the premium for the private health insurance if it is "cost effective" for Medicaid to do so. If this is cost effective, Medicaid could even require John to apply for and take the private insurance so that the private insurer would pay first. However, if Medicaid required John to enroll in the private plan, Medicaid would pay the premium for the private insurance in order to save money for the WWD program. Medicaid would not require John to enroll in the private plan if Medicaid would not pay the premium for it.
John should bring this matter to the attention of his eligibility worker at the county Medicaid office for a "cost effectiveness" determination.
Source: Medicaid Program Policy Manual sections 510-05-20-05 and 510-05-20-15.
Any questions may be directed to: rsi5@srt.com
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