Health benefits go unclaimed, study finds Medicaid repayment often misunderstood


WASHINGTON -- More than 2 million poor elderly in the United States may be paying $1,000 or more a year in Medicare premiums and deductibles because no one has told them that the government will cover these out-of-pocket expenses, according to a study released yesterday.

"If this were a benefit for the 2 million richest people in the United States, the president and Congress would make sure that the job was done and that everyone received the benefit," said Ron Pollack, head of Families USA, a national advocacy group for senior health-care issues.

Under a law updated last fall, the federal and state governments must pay Medicare premiums of $29.90 per month, as much as $728 in deductibles and 20 percent of all doctors' bills for elderly people living at or below the poverty line.

The payments are supposed to be made under Medicaid, a health insurance program for the poor that is jointly funded by federal and state governments.

Single people with incomes below $6,620 and assets of less than $4,000, excluding their house and cars, and couples who earn less than $8,800 and have assets of less than $6,000 are eligible for this "buy-in" program but must apply at local welfare offices.

But Mr. Pollack said that more than 2 million potential beneficiaries have never applied because they don't know about it.

What's worse is that the Social Security Administration continues to deduct the $29.90 monthly Medicare premium from their Social Security checks, he said.

Mr. Pollack accused the federal government and the states of failing to notify impoverished seniors of the benefit because they don't want to pay their share of the estimated $1.6 billion annual cost.

In most states, Medicaid costs are split between the federal government, which pays 55 percent, and the state. Medicaid costs have risen sharply in the past decade.

Officials in the Health Care Finance Administration, the agency that administers the Medicare and Medicaid programs, say that they have no way of identifying who would be eligible for the "buy-in" program.

"We don't know the incomes of each Medicare beneficiary to make a determination of eligibility," said Dr. Gail Wilensky, administrator of the agency.

He added that state welfare agencies are best equipped to make that determination.

The states, meanwhile, say signing up eligible beneficiaries is job for the federal government.

"It's time for everyone to stop passing the buck on this," Mr. Pollack said.

"If no one in Health and Human Services wants to take the lead, we may have to act legislatively to push them to do it," said Representative Henry A. Waxman, D-Calif., chairman of the House subcommittee on health and environment.

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