By Sara Jackson, MiCAFE Network Specialist
Medicare is a federal health insurance program available to individuals who are 65 years or older, persons with disabilities under the age of 65, and individuals with end-stage renal disease.
Medicare has two parts —Part A and Part B
Medicare Part A is hospital insurance and helps pay for inpatient hospital care, some skilled nursing facility care, hospice care, and home health care. Medicare Part B is the medical insurance and helps to pay for doctors’ services, outpatient hospital care, medical supplies, and various other medically necessary health care services. Enrollment in Medicare Part A is available to most senior citizens at no charge. Enrollment in Medicare Part B is available by paying a monthly premium. In certain circumstances, some individuals may have to pay more than the premium rate amount and in other cases, the cost may be covered for certain recipients with Medicaid eligibility.
Imagine being told one day that you were going to start to have money come out of your Social Security check each month to pay for your Medicare Part B premium and the amount taken out would be $121.80. To some, that amount may not seem like a big deal, but to others it is everything. An individual that needs help paying for their Medicare expenses and is elderly or disabled with a low income and limited assets, may qualify for the Medicare Savings Program (MSP).
Types of Medicare Savings Programs:
Qualified Medicare Beneficiaries (QMB) is a program for people who are eligible for Medicare Part A and/or Part B and have income up to 100% of the Federal Poverty Level (FPL). Individuals must answer an asset eligibility questionnaire. If eligible for this program, the cost for the Medicare Part B premium, Medicare co-insurances, and deductibles will be paid by the program for the eligible individual.
Specified Low-Income Medicare Beneficiaries (SLMB) is a program that is available for individuals who have income between 100% and 120% of the Federal Poverty Level. Individuals must answer an asset eligibility questionnaire. If eligible for this program, the Medicare Part B premium only is paid by the program for the eligible individual.
Additional Low-Income Medicare Beneficiaries (ALMB) is a program that is available for individuals who have income between 120% and 135% of the Federal Poverty Level. If eligible for this program, the Medicare Part B premium is paid by the program for the eligible individual. Individuals must answer an asset eligibility questionnaire and enrollment is limited to funds available for the calendar year.
If you are working with a client who needs help paying for their Medicare expenses and is elderly or disabled with a low income and limited assets, they may qualify for the Medicare Savings Program (MSP). To find out if a client is potentially eligible for MSP, please complete a Key Benefits Screening on MiSOAP.
How much can an individual save?
Depending on the individual’s income, assets, and other factors, the client could save:
- Over $1,000 a year on the premium for their Medicare Part B medical insurance because MSP pays for the part B premium each month;
- On the annual Part B deductible;
- 20% of the approved costs that they would usually have to pay after they reached the Medicare Part B deductible;
- They may be eligible for additional help for prescription drug expenses (this determination is made separately through Social Security and is referred to as Medicare Part D Extra Help or The Low-Income Subsidy for Prescription Drugs).
How to Apply
Once you have completed a Key Benefits Screening on MiSOAP and it informs you that the client is potentially eligible for MSP, you will want to help them apply for MSP by completing the ‘Apply for Benefits’ section on MiSOAP. Once that section is completed, you will want to click on the MI Bridges box and complete the Healthcare Application. Make sure to mention that this application is to be processed for MSP in the “Notes for the Caseworker”.
What happens if an individual qualifies for benefits?
If a client does qualify for the benefits, they will receive a letter from their local MDHHS office explaining what benefits they qualify for. The client may start to see an increase in their monthly Social Security payments if Medicaid starts paying the Medicare premiums. If the client qualifies for Medicaid to pay for the Medicare premiums, co-insurance, or deductibles, they will receive a mihealth card in the mail. That card should be used when they have co-insurance charges or deductibles to pay. It can usually take about four months from the approval date before Medicaid starts paying the Medicare premiums, causing the monthly Social Security payment to increase. If this is the case, a client will receive a refund for the premiums that they paid during that time.