MA App Trivia Question

[Winter_123]

When MA apps ask whether the client is working or not, why is that question being asked. I mean what difference does it make?

On long term care, life insurance, and disability it is used as one of many indicators of whether the person is currently functioning but unless a person has renal disease they are good to go with an MA. So what are they trying to get at there. If a person says "I work one afternoon a week at the senior citizen center, then what? You check yes and it tells them what?

Where are they headed with that question?

Yeh, I know. It's trivia.

 

[Josh]

I LOVE MA TRIVIA! To answer your question it's more obvious than you might think. It's asked along with a bunch of other questions referring to other coverage (other insurance, VA benefits, medicaid, etc). They're looking to see if there is the possibility the beneficiary has employer coverage. I've never noticed them do anything with it and would be interested to hear if anyone has, but there are some random rules about employer coverage that could factor into things. For example, if the beneficiary is working for an employer with over 100 employees then Medicare pays secondary (which should also mean Med Adv pay secondary). Again, I've never seen or heard of them acting on this because it's such a random situation, but that's why the question is on there. Make more sense now?

 

[Winter_123]

I LOVE MA TRIVIA! To answer your question it's more obvious than you might think. It's asked along with a bunch of other questions referring to other coverage (other insurance, VA benefits, medicaid, etc). They're looking to see if there is the possibility the beneficiary has employer coverage. I've never noticed them do anything with it and would be interested to hear if anyone has, but there are some random rules about employer coverage that could factor into things. For example, if the beneficiary is working for an employer with over 100 employees then Medicare pays secondary (which should also mean Med Adv pay secondary). Again, I've never seen or heard of them acting on this because it's such a random situation, but that's why the question is on there. Make more sense now?

Yup. It makes sense. They are asking a question that no one knows how it is used or heard of them acting on it but knows what it could be used for in theory if it were to be used. On med supp apps they just ask what they have for other plans. Maybe they should replace that question on med supp apps with the one on ma's which just asks they or their spouse work to make it more unclear. Nevermind.

 

[retread]

When MA apps ask whether the client is working or not, why is that question being asked. I mean what difference does it make?

On long term care, life insurance, and disability it is used as one of many indicators of whether the person is currently functioning but unless a person has renal disease they are good to go with an MA. So what are they trying to get at there. If a person says "I work one afternoon a week at the senior citizen center, then what? You check yes and it tells them what?

Where are they headed with that question?

Yeh, I know. It's trivia.

When I go over the question, I translate it to "Are you employed?" The next question is about whether or not they have group insurance for either them or their spouse. To ask if they "work" is degrading. A farmer works his tail off, but does not have group insurance, and neither does a housewife.... These people WORK. They do not qualify for group insurance, which is what the questions should be directed to.

Argh...

 

[stormtracker]

It's a question intended to determine ACORN eligibility. If the answer is YES, a representative will be calling them shortly to discuss the merits of contributing a tax-deductible gift. If the answer is NO, a recruiter will be calling shortly.

 

[Josh]

When I go over the question, I translate it to "Are you employed?" The next question is about whether or not they have group insurance for either them or their spouse. To ask if they "work" is degrading. A farmer works his tail off, but does not have group insurance, and neither does a housewife.... These people WORK. They do not qualify for group insurance, which is what the questions should be directed to.

Argh...

Even all potential humiliation aside, it's not very direct. It is so convoluted that thousands of reasonably intelligent agents have seen it and helped beneficiaries answer it, but couldn't understand the relevance. This is really the type of organization Al thinks should be running the entire healthcare system, right?

 

[DS4]

. For example, if the beneficiary is working for an employer with over 100 employees then Medicare pays secondary

Medicare is secondary with 20 or more full- or part-time employees.

 

[Josh]

Medicare is secondary with 20 or more full- or part-time employees.

Let me preface this with I can't WAIT to see what the public option looks like and how it runs. It would appear we're both right, depending on the situation. The question of who pays primary can be found by using this easy to read reference sheet: http://www.cms.hhs.gov/mlnproducts/downloads/msp_fact_sheet.pdf.

 

[DS4]

The100 ee threshhold applies only to employees disabled on Medicare.

 

[Frank Stastny]

I LOVE MA TRIVIA! To answer your question it's more obvious than you might think. It's asked along with a bunch of other questions referring to other coverage (other insurance, VA benefits, medicaid, etc). They're looking to see if there is the possibility the beneficiary has employer coverage. I've never noticed them do anything with it and would be interested to hear if anyone has, but there are some random rules about employer coverage that could factor into things. For example, if the beneficiary is working for an employer with over 100 employees then Medicare pays secondary (which should also mean Med Adv pay secondary). Again, I've never seen or heard of them acting on this because it's such a random situation, but that's why the question is on there. Make more sense now?

If I'm not mistaken I believe the employer only has to have twenty employees for Medicare to be secondary.

When Medicare is secondary, obviously the group pays first. If the group company pays an amount equal to or greater than what Medicare would have paid if Medicare was primary then Medicare will pay nothing. Medicare will only pay up to the amount that they would have approved.

This means that if there is still a balance owed by the patient and the group has paid what Medicare would have paid the patient will be responsible for 100% of the remaining amount.

I have talked to prospects who have experienced this.