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Elizabeth M. Whitehorn, Director

Provider Notice issued 01/22/15

Medicare Coinsurance Policies Not Allowed for Dual-Eligible Individuals

To:​ All Long Term Care (LTC) and Supportive Living Providers ​
​Date: ​January 22, 2015
​Re: Medicare Coinsurance Policies Not Allowed for Dual-Eligible Individuals​

This notice provides guidance regarding federal restrictions on dual-eligible individuals (eligible for both Medicare and Medicaid) being issued insurance policies for coverage of Medicare Part A or B cost-sharing (Medigap).

The Social Security Act does not allow insurance policies to be sold to dual-eligible individuals.  This prohibition is further described in a recently released federal CMS bulletin containing Frequently Asked Questions (FAQs) titled, FAQs on the Illinois Medicare Medicaid Alignment Initiative (MMAI) and Medigap (pdf).

This bulletin also discusses an exception to this prohibition when a policy was in place prior to Medicaid eligibility.

If you have any questions concerning this notice, contact the Bureau of Long Term Care at

217-782-0545.

    

James M. Parker, Acting Administrator

Division of Medical Programs