Most Commonly Asked Questions - Medicare Pilot Program for Asbestos Related Disease

Enrollment

Q1. Is there a certain timeframe I need to enroll in MPPARD?
A1. No, you may enroll in the Medicare Pilot Program for Asbestos Related Disease (MPPARD) at any time during the year if you meet the requirements, such as having Medicare Part A and Medicare Part B. You may contact Noridian to enroll after you have received notification from the Social Security office with your Environmental Health Hazard provision (EHH) designation. The effective date for MPPARD will be the first of the month following which you call to enroll. For example, if you call us to enroll June 15th, your effective date for MPPARD will be July 1st.

Q2. Will I receive an insurance card for MPPARD?
A2. No, you will not receive an additional insurance card; beneficiaries will receive an enrollment letter from MPPARD. The letter should be kept as proof of enrollment and can be shown to your medical providers/suppliers and pharmacies.

Coverage

Q1. What services are covered under MPPARD?
A1. Services are based on the individual needs of the beneficiary along with medical necessity. It is difficult to give a listing of all services covered as the individual needs of beneficiaries vary greatly. If you have questions regarding coverage, please call 1-888-469-9464 for additional information.

Q2. What are the requirements to get reimbursed for travel costs to doctor appointments?
A2. MPPARD reimburses for mileage to medically necessary appointments, such as doctor appointments, having lab work or other testing done, and hospitalization if there is no other state/government agency that provides the same coverage, as that coverage would be primary and cannot be duplicated.

To be reimbursed for mileage, the following must be provided:

• Proof of attendance of the appointment
• Name, address and phone number of the physician, facility or hospital
• Number of round-trip miles
• Mileage is reimbursed to the closest appropriate facility outside of the city you live in

Q3. What is an acceptable form of proof of attendance for a medical appointment?
A3. A visit summary note, explanation of benefits from insurance company, and/or a signed and dated letter from the doctor that explains the purpose of the visit. The proof of attendance must show the appointment date, facility/provider, and reason for the appointment. Please note that appointment reminder cards and co-pay receipts are not acceptable forms of proof of attendance as they do not support the medical necessity of the appointment.

Q4. Does MPPARD reimburse for Medicare deductibles, coinsurances, or copays?
A4. No, MPPARD does not reimburse Medicare or other insurance deductibles, coinsurance, or copay amounts.

Q5. Am I still eligible for services if I am not at my permanent residence during the winter months?
A5. Services at your permanent residence are not reimbursable when you are not there. You may contact a nurse care coordinator to assess for services at your other location. Example, snow removal would not be covered at your permanent residence in the winter if you are "down south" for those winter months.

Q6. What types of nutritional supplements are reimbursable?
A6. Nutritional supplements must be prescribed by your physician to be considered for coverage under MPPARD. Examples of nutritional supplements are liquid nutrition, such as Ensure, Boost, Glucerna, or other similar brands.

Q7. Are medications covered under MPPARD?
A7. There may be reimbursement coverage if a medication was fully denied by your Part D plan or other creditable coverage. As a reminder, co-payments or deductibles are not reimbursable through MPPARD.

Q8. What is creditable coverage?
A8. Creditable coverage is drug coverage that is expected to pay, on average, at least as much as standard Medicare prescription drug coverage. It could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, or Medicare Advantage drug plans. Your plan must tell you each year if your drug coverage is creditable coverage. You may get this information in a letter or in a newsletter from the plan.

Note: If your MPPARD enrollment letter indicates you do not have creditable coverage, you may fax or mail your creditable coverage letter/certificate to us.

Q9. How can I obtain Medicare Part D coverage?
A9. If you did not enroll in a Medicare Part D plan when you enrolled in Medicare, you will have to wait until the yearly General Enrollment Period to enroll in a Part D plan. A late enrollment penalty would apply, depending on how long you went without creditable prescription drug coverage.

Q10. Is there any coverage for medications while I am in the coverage gap or "donut hole" in my Medicare Part D plan?
A10. There is a potential for reimbursement for medications while in the coverage gap. Please contact the MPPARD at 1-888-469-9464 for further information.

Q11. Who will pay for my medications if I do not have Medicare Part D or other creditable coverage?
A11. If there is no Part D or other creditable coverage, the beneficiary is responsible for payment.

Q12. Is dental work, hearing services, or vision care covered under MPPARD?
A12. No, routine dental, hearing services or vision care are not covered under MPPARD. Subsequently, MPPARD is unable to reimburse for mileage for travel for these types of appointments.

Claims

Q1. When should I submit my claims for reimbursement?
A1. Claims may be sent in any time after the service has been completed but must be submitted within one year from the date of service. Please note that reimbursement cannot be made prior to a service being received.

Q2. How long will it take to receive reimbursement from Noridian once I have submitted my claim?
A2. Once the claim is received by Noridian, it can take 6-8 weeks to process for reimbursement.

Q3.I received a check from Noridian and do not know what it is for. How can I find out?
A3. Payments made by MPPARD have a corresponding Explanation of Benefits (EOB). Typically, you will receive your reimbursement check first and your EOB will arrive shortly after. If you have questions regarding a check received for MPPARD services after you receive your EOB, please call 1-888-469-9464.

Q4. What is the timeline to file an appeal for a denied claim?
A4. The appeal must be submitted within 120 calendar days from the date on the MPPARD Explanation of Benefits (EOB).

Other

Q1. Will payments from MPPARD affect any settlement we receive from the lawsuit against the mine?
A1. If Medicare records show the beneficiary has received a settlement, Medicare has the right to recover any payments which were made for services that are related to the settlement.

Q2. If the Affordable Care Act is changed or discontinued, will this eliminate MPPARD?
A2. At this time the Affordable Care Act is in place so it is premature to discuss what possible changes to the Act will mean to MPPARD.