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Effective: January 1, 2011 | |
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03.35ar5 - Medicare Savings Programs (MSP) (Archive) |
Archived: January 1, 2012 |
Medicare Savings Programs are federal and state-funded programs and follow Medical Assistance (MA) policy unless otherwise noted.
Some people who are eligible for Medicare A federal health insurance program for people who are age 65 or older, disabled, blind, or have permanent kidney failure. 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.
Clients who apply for Extra Help A Medicare Part D cost-sharing subsidy program. Full-benefit, dual eligible enrollees are automatically eligible for the full Extra Help subsidy. Others may apply to the Social Security Administration for full or partial Extra Help subsidies. with Medicare Part D costs through the Social Security Administration (SSA) may choose to have their application data transmitted to initiate an application for MSP or MA. See Applications for Health Care Programs - SSA Data as a Request for MHCP for more information.
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 who are eligible for Medicare and 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.
Relationship to Other Program Eligibility.
People who receive Medicare Part A or B may be eligible for Medicare savings programs. See Medicare for information about eligibility criteria for Medicare.
Some people may become Medicare-eligible while a Social Security Administration (SSA) disability certification is pending or may be eligible for a Medicare extension A period of extended Medicare eligibility for some disabled people who lost their RSDI benefit because they earn more than the Substantial Gainful Activity (SGA) level. after their eligibility for RSDI Retirement, Survivors, and Disability Insurance. A program operated by the Social Security Administration that provides a monthly income to retired people, survivors or dependents of insured people, and people with disabilities. ends. These people may be eligible for a Medicare Savings Program based on their receipt of Medicare.
Use Method B and the income deductions that apply under the applicable blind or disabled basis to determine eligibility for the Medicare Savings Programs.
Example:
Don, age 35, has End Stage Renal Disease (ESRD). He is 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.
Note: Some people stop receiving RSDI payments because they earn more than the Substantial Gainful Activity (SGA) A level of work activity and earnings, defined by the Social Security Administration. level but are still certified disabled by SSA. These people are eligible for a Medicare extension for up to 93 months. During the extension they may be eligible for the Medicare Savings Programs if they meet income and asset limits.
See Relationship to Other Program Eligibility below for information about when people may or may not be enrolled in Medicare Savings Programs and other programs at the same time.
Relationship to Other Program Eligibility
People may choose the most advantageous basis for MA when they are eligible for a Medicare Savings Program and meet more than one MA basis. 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 (except QWD) and the Alternative Care (AC) A state-funded program, administered by county social services agencies, which provides home and community-based services for clients age 65 or older in an effort to keep the client in the community and avoid a nursing facility placement. 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 eligible for Medicare may receive prescription drug coverage through the federal Medicare Part D program.
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).