The Affordable Care Act includes a pilot program to provide additional services for certain Medicare beneficiaries who are entitled to free Medicare Part A (Hospital Insurance, HI) based on exposure to Environmental Health Hazards (EHH), see HI 00803.001. The Medicare Pilot Program for Asbestos Related Disease (Pilot Program) began July 1, 2011, with voluntary participation by EHH Medicare beneficiaries living in certain ZIP codes in Lincoln and Flathead counties, Montana.

The Pilot Program was expanded on March 1, 2014, to include EHH individuals who currently reside in the following Idaho, Montana, and Washington counties as well as a limited group of other individuals, who previously resided in these counties.

The Pilot Program covers items and services beyond what Medicare normally covers such as:

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  special home care service,

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  special medical equipment,

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  help with travel to get care,

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  special counseling, like help quitting smoking,

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  nutritional supplements, and

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  prescription drugs not covered by Medicare (for those enrolled in a Medicare drug plan).

Beneficiaries will also be able to work with a nurse case manager who will help them get the care they need. There is no cost to participate in the Pilot Program.

To participate in the pilot, EHH Medicare beneficiaries must be entitled to Medicare Part A (HI) and Part B (Supplementary Medical Insurance, SMI) and currently reside within one of the following ZIP codes in the states of Idaho, Montana or Washington.

Idaho ZIP codes:

Montana ZIP codes:

Washington ZIP codes:

 

EHH Medicare beneficiaries who do not live in the ZIP codes listed above are eligible to participate in the Pilot Program if they:

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  are entitled to EHH Part A (HI) and Part B (SMI),

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  previously resided in one of the ZIP codes listed on or after July 1, 2011,

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  have since moved out of the Pilot Program area, and

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  apply to participate in the Pilot Program by March 30, 2015.

As part of the enrollment application to participate in the pilot, the beneficiary will need documentation to show proof of current or previous residency in one of the listed ZIP codes.

EHH beneficiaries with HI and SMI, living in the expanded service area, can sign up for the pilot starting March 1, 2014.

EHH beneficiaries with HI only, living in the expanded service area must enroll in SMI prior to signing up for the pilot. Beneficiaries may enroll in SMI during their initial enrollment period, the general enrollment period, or the special enrollment period, as described in HI 00803.220.

NOTE: EHH beneficiaries residing in these ZIP codes will be eligible for the SMI special enrollment period (SEP) described HI 00803.220.

NOTE: Individuals not already enrolled in SMI and not currently residing in the listed ZIP codes are not eligible for the EHH SEP described in HI 00803.220.

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  HI 00803.001 Hospital Insurance (HI) Entitlement for Individuals Exposed to Environmental Health Hazards (EHH)

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  HI 00803.030 EHH Medicare Application

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  HI 00803.210 Special Enrollment Period for Medicare Pilot Program for Asbestos Related Disease (July 1, 2011 to June 30, 2012)

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  HI 00803.220 Special Enrollment Period for Expanded Medicare Pilot Program for Asbestos Related Disease (April 1, 2014 to March 31, 2015)