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Effective: December 1, 2006 |
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03.35ar1 - Medicare Savings Programs (MSP) (Archive) |
Archived: August 1, 2007 |
Some people who are eligible for Medicare may qualify for a Medicare Savings Program with or instead of Medical Assistance (MA). The Medicare Savings Programs help people keep their Medicare coverage by paying certain Medicare-related expenses, such as premiums.
Relationship to Other Program Eligibility.
The Medicare Savings Programs are:
l The Qualified Medicare Beneficiary (QMB), Service Limited Medicare Beneficiary (SLMB) and Qualified Individuals (QI) programs, which are available to all Medicare eligibles who meet all other Medicare Savings Program requirements.
l The Qualified Working Disabled (QWD) program, which is limited to people with a blind or disabled basis of eligibility.
People who receive Medicare Part A or B simultaneously with any of the Medicare savings programs are known as dual eligibles. This means they have coverage through both Medicare and Medicaid (the federal name for Medical Assistance).
While the majority of people who are eligible for Medicare are age 65 or older, blind, or have disabilities, some people may become Medicare-eligible while a disability certification is pending or be eligible for a Medicare Extension after their eligibility for RSDI ends. These people may be eligible for QMB, SLMB or QI based on their receipt of Medicare. Use Method B and the income deductions that would apply under the applicable blind or disabled status to determine eligibility for the Medicare Savings Programs.
Example:
Don, age 35, has End Stage Renal Disease (ESRD). He is found eligible for Medicare on an expedited basis designed for people with ESRD. He has also applied for RSDI and SSI, but his Medicare is approved before the RSDI/SSI disability certification. He applies for health care. Based on his income, assets and receipt of Medicare, he is eligible for QMB. Use Method B and appropriate deductions for people with disabilities. He is not eligible for MA until he is certified disabled by SSA or SMRT.
Note: Some people may remain disabled but lose RSDI because they earn more than the Substantial Gainful Activity (SGA) level. These people are eligible for a Medicare extension for up to 93 months. They are eligible for the Medicare Savings Programs during the extension if they meet income and asset limits. Because SSA considers them to remain disabled, they continue to meet a disabled basis of eligibility for MA.
Relationship to Other Program Eligibility
Use Method B to determine eligibility for the Medicare Savings Programs. These programs generally have higher income and asset limits than MA.
If people who are eligible for both MA and a Medicare Savings Program meet more than one MA basis, they may choose the most advantageous basis for MA. They must use Method B for the Medicare savings program.
Example:
Duane applies for MA and QMB. He receives RSDI based on disability. He lives with Susan and their two children, so has a Method A basis of eligibility as a parent/caretaker.
Action:
If it is to his advantage, determine Duane's MA eligibility under Method A. He must use Method B for QMB.
People may be eligible for the Medicare Savings Programs and the Alternative Care (AC) program at the same time.
People residing in Institutions for Mental Diseases (IMDs):
l Are not eligible for the Medicare Savings Programs unless they meet one of the conditions that allows MA eligibility in an IMD.
l May be eligible to have their Medicare premiums reimbursed as cost-effective coverage if they would be eligible for the Medicare Savings Programs if they did not reside in an IMD.
People who are Medicare-eligible may receive prescription drug coverage through the federal Medicare Part D program. This coverage takes the place of the former state-funded Prescription Drug Program, which ended December 31, 2005.
See the following sections for a description of each program, the services it covers, and eligibility requirements:
Qualified Medicare Beneficiary (QMB).
Service Limited Medicare Beneficiary (SLMB).