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Coordination of Health Coverage for Medicare Enrollees: A Case Study of HIV/AIDS

By: June Eichner
Published: July 2001
Medciare Brief No. 7 ~ July 2001

Summary: When people with HIV/AIDS become eligible for Medicare, they find that it does not pay for a significant share of their health care needs. As enrollees seek supplemental health coverage (e.g., Medicaid, employer-sponsored and individually-purchased insurance, and premium payment programs), they find that though there are numerous potential benefit and insurance options, the rules are complex and often conflicting. The search for comprehensive health coverage is further complicated by the fact that each program is separately administered, with different eligibility requirements and application processes. Because each program and agency's staff knows little about other programs, they are often unable to help coordinate coverage.

Respondents to the study believe that people with a serious chronic condition would benefit from reforms that make Medicare's benefits more comprehensive and its eligibility, coverage, and payment rules less complicated. They also said that enrollees need better access to Medicare information and enhanced mechanisms to coordinate Medicare with supplemental health coverage. Some HIV/AIDS organizations have developed benefits counseling programs that help their clients piece together a synthetic health coverage “system.” These and other issues discussed in this Medicare Brief illustrate possi-ble policy reforms that could help enrollees with HIV/AIDS and other serious chronic conditions.