TennCare Changes Could Leave Elderly, Disabled Without Health Benefits

Mindful doctor securing manometer cuff around upper arm of a senior patient while visiting him in his home (Envato Elements)

By Allison Jones, Legal Aid Society

For elderly and disabled people, doctor and hospital visits can be a regular part of life, causing a seemingly never-ending stream of medical bills.

For those with low incomes, even the portion of those bills not covered by Medicare can be unaffordable. Thankfully, a set of programs known as the Medicare Savings Programs offer additional state-administered financial assistance to help cover this shortfall.

Tennessee has three primary Medicare Savings Program tiers, each with different benefits and eligibility rules. Two of them, Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI), are similar in many respects and both cover the Medicare Part B premium of $164.90 a month for outpatient services and doctor visits. A third, Qualified Medicare Beneficiary (QMB), is the most generous and is intended for residents with the lowest incomes. It pays Medicare Parts A and B premiums, the annual deductible ($260), as well as any other coinsurance and copayments.

Some may lose coverage accidentally

A recent change could put some recipients’ Medicare Savings Program benefits at risk. Starting in March 2020, in order to keep as many people as possible insured during the COVID pandemic, the federal government ordered state agencies like TennCare to maintain coverage for anyone receiving assistance, even if they were no longer eligible. As of March 2023, that period of continuous coverage has ended, and TennCare is now in the process of going through its rolls — a total of 1.7 million people — to check every enrollee’s eligibilty.

The last time TennCare went through a full redetermination of its rolls after a long pause was roughly seven years ago. TennCare renewals stopped in 2014 to facilitate implementation of the Affordable Care Act, and resumed in 2016. During that process, we at Legal Aid Society discovered that a lot of older folks on Medicare Savings Programs were losing benefits they should have received. Often, the reasons they lost benefits were procedural — such as missed paperwork, due to changing addresses, or confusion about what they needed to do.

Losing Medicare Savings Program benefits can be bad enough, but it can also cause a domino effect with other benefits a person might be receiving. If a Medicare recipient’s monthly premium isn’t paid by TennCare, it automatically comes out of their Social Security check. To make things even more confusing, there’s typically a lag of a couple of months before that money starts to be taken out — so, for example, if a person loses their Medicare Savings Program benefits in June, they might not even realize anything’s wrong until their August Social Security check is suddenly much lower than expected. Any financial shortfall that large can throw a person’s life into upheaval, putting them at risk of not making rent or being unable to afford food or other essentials.

Get answers about your benefits

While we at Legal Aid Society can assist with fixing this kind of situation, it’s far better for the person involved if it never happens in the first place. That’s why we’re asking Medicare Savings Program recipients to stay alert for any mailed communications from TennCare over the coming year.

If you’re among the Medicare Savings Program recipients who receives a large packet in the mail this year from TennCare, please don’t disregard it. Even if it looks irrelevant or confusing, it could be essential that you fill it out in order to continue receiving benefits. If you have any doubt over whether something you’ve received in the mail is legitimate or not, don’t throw it off to the side — please call us at Legal Aid Society and we’ll help you determine what to do.

To be clear, not everyone is going to receive a packet, so just because you haven’t received one isn’t cause for concern. Some people will be receiving their packets later in the year, and others will have their eligibility automatically renewed without having to fill out a packet at all.

The best way to find out for sure is to call TennCare at 855-259-0701 and ask when you’re going to be up for renewal. TennCare should be able to share your target month for renewal (though these are estimates). If necessary, TennCare can also update your address in its system to ensure any communications get to the right place. If your month of renewal has come and gone without receiving anything, it’s also good to call and check if you’ve been reapproved or if there’s an issue that needs to be sorted out. If you miss your renewal, you still have 90 days to reestablish eligibility in order to avoid a gap in coverage.

How Legal Aid Society can help

If you’ve lost Medicare Savings Program benefits that you should have received, or you’re having trouble determining where you stand, Legal Aid Society offers free legal services for low-income residents across Middle Tennessee. If you think you may qualify, please call us at 800-238-1443 and we’ll do all we can to help.

About Allison Jones

Allison Jones is a staff attorney in the Nashville office of Legal Aid Society of Middle Tennessee and the Cumberlands (LASMTC) practicing in the areas of health, public benefits and special education. LASMTC is Tennessee’s largest nonprofit law firm, offering free civil legal representation and educational programs to help people in its region receive justice, protect their well-being and support opportunities to overcome poverty.

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