Medicare

The Medicare program provides healthcare coverage for people 65 or older, people under the age of 65 with certain disabilities, and people of all ages with End-Stage Renal Disease. Medicare has three components: Part A for hospital coverage, Part B for physician services, and Part D for prescription coverage. Individuals may opt out of Medicare and enroll in a Medicare Advantage Plan, referred to as Part C. For more information on Part C visit our Medicare Advantage page.

 


  • New Medicare Beneficiary Cards -  Beginning April 1, 2018, Medicare patients will be assigned new Medicare cards with the new Medicare Beneficiary Identifiers (MBI). The new MBI replaces the social security number-based Health Insurance Claim Number (HICN). Texas Medicare beneficiaries will begin receiving the new replacement cards after June 1, 2018, but beneficiaries new to Medicare will be issued cards with the new MBI beginning April 1, 2018. The old MBIs may continue to be used through the transition period April 1, 2018- December 31, 2019. More information can be found on the CMS MBI web page. The new MBI also requires that a new fax/mail cover sheet be used for submitting unsolicited PWK segments beginning April 2, 2018. A MBI look-up tool is available in Novitasphere (enrollment required). 

  • The Medicare Access and CHIP Reauthorization Act of 2015 repealed the Sustainable Growh Rate (SGR) and replaced it with the Medicare Quality Payment Program (QPP).

 

  • Billing for Dual Eligibles - The Qualified Medicare Beneficiary (QMB) program is a Medicaid program that helps very low-income dual eligible beneficiaries (individuals who are enrolled in both Medicare and Medicaid) with Medicare cost-sharing. Federal law protects QMBs from any cost-sharing liability and prohibits all original Medicare and Medicare Advantage providers, including those who do not accept Medicaid, from billing QMB individuals for Medicare deductibles, coinsurance, or copayments. All Medicare and Medicaid payments that physicians receive for furnishing services to a QMB individual are considered payment in full. For additional information, see the  MLN Matters notice and MLN Booklet.

    QMBs may obtain benefits through Medicare and Medicaid, or they may choose to select a Medicare Advantage plan that is designed for dual eligibles. These plans combine the Medicare and Medicaid benefits into one plan and often offer additional benefits not available with Medicare such as case management and wellness programs. In Harris county, HHSC and CMS have set up a Demonstration Project blending Medicare and Medicaid benefits into a managed care plan, referred to as a Medicare-Medicaid Plan (MMP), for people who have both Medicare and Medicaid coverage, known as dual eligibles. In these plans, Medicare and Medicaid benefits work together to better meet the member’s health-care needs and the MMPs must provide the full array of Medicaid and Medicare services. 
       
        

 


  

  • Novitas Appeals Inquiry Status Tool - This tool allows for you to search redeterminations and appeals online. Go to the Novitas website. Click on Jurisdiction H. On the left-hand side menu, hover over "Appeals", then select "Status of My Appeal".