Medicaid And Medicare Savings Program

Date:

Who Is Eligible For Qi

Is Financial Assistance Available for Medicare?

· Those with Part A coverage and those eligible for Part A

· Singles with a monthly income of $1,456 and couples $1,933

· Singles whose annual asset limit is $7,730 and couples with an $11,600 asset limit.

QI medical benefits

· Automatic extra help

How to apply for QI in Florida

The application process is like the process in QMB above. Or for the easiest way, call us at 888-997-5204 and we will help you.

Contact Your Local State Health Insurance Assistance Program

Based on the information you provided, you do not appear to be eligible for Medicare cost-saving programs.

Each state offers a State Health Insurance Assistance Program , partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.

Visit www.shiptacenter.org to find your local SHIP office.

Helpful Tips For Members

  • Use your formal, legal name. No nicknames or initials. Be consistent.
  • If you change your name, make sure Social Security updates all three of their databases:
  • Numident
  • Title 2
  • Title 16
  • Make sure Social Security has your correct date of birth before you apply for Social Security benefits. Sometimes, Social Security will not correct a person’s date of birth after a person has started receiving benefits.
  • State data must match federal data before buy-in can take place. Make sure your name and date of birth you put on your application matches the name and date of birth that Medicare has.
  • Also see our Medicare/Medicaid Frequently Asked Questions for more helpful information.
  • If you have more questions about this program please contact our Customer Contact Center.

    Program Contact: , 303-866-5402

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    You Must Meet The Following Qualifications Before Applying For Medicare Savings Programs

    You can reach out to apply for a Medicare Savings Program with your states Medicaid office if all the following are true for you.

    • You have or are eligible for Medicare Part A
    • You do not exceed the maximum income requirements
    • You do not exceed the maximum limited resources requirements

    Now, lets look at the four types of Medicare Savings Programs and what each pays for and then the specific financial eligibility conditions for each.

    What Is The Medicare Savings Program

    Medicare and Medicaid

    Not all Medicare beneficiaries can afford to pay their premiums, copayments, and coinsurance. If you have a lower income, its possible that youll qualify for a Medicare Savings Program to help with your out-of-pocket expenses.

    Are you asking, Do I qualify for a Medicare Savings Program? If so, this article will help. This page is designed to help you understand the Medicare Savings Program income limits and other requirements.

    Read on to find out if you qualify.

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    Types Of Medicare Savings Programs And What They Cover

    Medicare Savings Programs are programs that help pay Medicare premiums and, in some cases, some of your out-of-pocket expenses like your Part A and Part B deductibles, coinsurance, copayments, and prescription drugs. These programs are also sometimes known as Medicare Buy-In Programs or Medicare Premium Payment Programs.

    There are four types of Medicare Savings Programs. Depending on your individual circumstances, you may qualify for one or more of the following programs. But before we go any further, lets quickly look at the three overall questions you must answer Yes to before even being eligible to explore a Medicare Savings Program.

    Medicare Savings Program Vs Medicaid

    The Medicare Savings Program is administered by each state, often through the Medicaid office. However, it is not the same as Medicaid.

    Medicaid is specifically designed for low-income families and individuals and covers medical care with little to no out-of-pocket expenses. There is no monthly premium to be on Medicaid, you qualify based on your income and assets.

    The Medicare Savings Program is designed to help Medicare beneficiaries, who are disabled or over 65, pay for their out-of-pocket costs with Medicare. This may include your Part B premium, your Part A premium , and other costs.

    It is possible to be eligible for both Medicare and Medicaid at the same time. These folks are known as Dual Eligible, and generally qualify for a Medicare Savings Program automatically, along with Extra Help for prescription drugs.

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    Quick Review: Whats Medicaid

    Medicaid is a federal assistance program that provides health insurance for low-income and vulnerable Americans. The program is partially funded by the states and each state can set its own eligibility requirements. Qualifying for Medicaid benefits depends largely on your income, but also on your age, disability status, pregnancy, household size, and your household role.

    See if you qualify with our state-by-state guide to Medicaid.

    Medicaid is a separate program from Medicare. Both programs provide health insurance, but Medicare coverage is primarily for seniors while Medicaid eligibility depends largely on your income. Itâs possible to take part in both programs at the same time. Learn more about the difference between Medicaid and Medicare.

    You do not need to have Medicaid to apply for MSPs. In fact, you donât qualify for the QI program if you have Medicaid.

    Who Is Eligible For A Medicare Savings Program

    Medicare & You: Ways to Save Money

    Eligibility for a Medicare Savings Program depends primarily on your income and resources. Your resources are loosely defined as all the savings and investments you have. The income limits and resource limits vary by MSP and state. They are based on the federal poverty guidelines , so they may be adjusted each year and you may not qualify even if you qualified in the past.

    Three of the four MSPs are only for Medicare beneficiaries. They all require you to have, or be eligible for, Medicare Part A. You also need to live in one of the 50 states or the District of Columbia.

    You may also qualify for an MSP if you receive Social Security Disability benefits, you have certain disabilities, or if you have permanent kidney failure .

    The chart below provides the general Medicare Savings Program monthly income limits for 2021. Requirements in some states may vary slightly. These income limits are set to change in 2022, but until the new figures are released you may still qualify using the 2021 limits.

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    Who Is Eligible For Qmb

    · A person who qualifies for Medicare Part A

    · A Florida resident

    · A US citizen or immigrant with residency status

    · 2021 – An individual whose monthly income is less than $1,094, or $1,472 for couples

    · 2021 – Assets of USD $7970 or less for an individual or USD $11,960 for a couple

    How to apply for QMB Program in Florida

    · The easiest way is to call us at 888-997-5204 and have us do it for you.

    · You can otherwise visit the local Department of Child and Family Services DCF office. Most offices are currently closed due to covid.

    What to do if you have QMB benefits, and the hospital charges you.

    · Make sure your doctor knows you are in the program.

    · Find out if your doctor accepts Medicare.

    · Contact the Customer Relations Department if the billing persists.

    · If you are not getting help, call your local Legal Aid to see if he/she can help.

    How To Apply For A Medicare Savings Program

    MSPs are administered by state Medicaid programs, so you must call your stateâs Medicaid office to apply. Medicare.gov lists contact information for all state Medicaid offices.

    If you think your income or total resources are too high to qualify, you should still fill out a Medicare Savings Program application. Individual states may have different requirements, so you could still qualify for assistance depending on where you live. Alaska and Hawaii have slightly higher income limits, for instance.

    Also Check: Yearly Income To Qualify For Medicaid

    Medicaid For The Elderly And People With Disabilities Handbook

    • Chapter Q, Medicare Savings ProgramMenu button for Chapter Q, Medicare Savings Program”>
    • Q-1000, Medicare Savings Programs OverviewMenu button for Q-1000, Medicare Savings Programs Overview”>

    Revision 21-1 Effective March 1, 2021

    This chapter describes the Medicare Savings Programs. The Medicare Savings Programs use Medicaid funds to help eligible persons pay for all or some of their out-of-pocket Medicare expenses, such as premiums, deductibles or coinsurance.

    HHSC manages the Medicare Savings Programs, which consists of the following:

    • Qualified Medicare Beneficiary Program
    • Specified Low-Income Medicare Beneficiary Program
    • Qualifying Individual Program
    • Qualified Disabled and Working Individual Program

    Countable resource limits for Medicare Savings Programs are updated annually based on the Consumer Price Index. QDWI requires a person to have countable resources equal to or less than twice the limits for the SSI program to be eligible based on resources. The treatment of income and resources is based on policy in Chapter E, General Income, and Chapter F, Resources. Application and redetermination policies for Medicare Savings Programs adhere to policy and procedure in Chapter B, Applications and Redeterminations. Transfer of assets, spousal impoverishment and co-payment policy and procedures are not used in the Medicare Savings Programs.

    All Medicare Savings Programs require a person to meet non-financial eligibility requirements described in Chapter D, Non-Financial.

    What Is The Medicare Extra Help Program

    Medicare Savings Programs

    MSPs can help pay the out-of-pocket expenses associated with Medicare Part A and Medicare Part B. They do not cover prescription drug costs. However, Medicare recipients who qualify for an MSP are also automatically eligible for Medicare Extra Help, which helps pay for a Medicare Part D prescription drug plan. Extra Help eliminates your premiums and deductibles. It also reduces your copays for generic and brand-name medications.

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    Income And Resource Limits

    Your eligibility for each program will depend on your income and available resources. Here are the resources that count toward your limits.

    · Current checking account and savings account

    · Bonds

    Some resources don’t count when determining income and resource levels. They include:

    · The main house and car

    · Funeral plot and costs up to $1,500

    · Furniture and household items

    · Personal items

    · Money held in your hand is not counted for nine months. Examples of holding money are tax advances and housing allowances.

    Qualified Disabled Working Individual

    If you qualified for Medicare due to a disability but recently returned to work, you may no longer be able to get Medicare Part A premium-free. You can qualify for this assistance if you make as much as 400% of the Federal Poverty Limit if your income is from working.

    The Qualified Disabled Working Individual program may help you if the following apply:

    • Youre a disabled working person under 65
    • You lost Social Security benefits and premium-free Medicare Part A due to returning to work
    • Youre not getting medical assistance from your state through Medicaid
    • You meet the income and resource requirements set by the state

    QDWI will help pay your Medicare Part A premiums.

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    What Counts As Income For Medicare Savings Program

    When looking at your income, how do you know what counts? The good news is that if you are working, around half of your working income is excluded. Workers compensation and disability benefits are also excluded.

    If your income, after these adjustments, is close to the limit, its worth applying for the program. If approved, you could save a considerable amount of money on out-of-pocket expenses. Contact your states Medicaid office if you have questions about your eligibility.

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    If a Medicare beneficiary also qualifies for full Medicaid benefits, they may enroll in SLMB+ . SLMB+ pays for both the Medicare Part B premium and all Medicaid covered services.

    Qualifying for SLMB also makes you eligible for the Medicare Part D Extra Help program, which helps pay for Medicare Part D drug costs such as premiums, copayments and coverage gaps.

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    How Do You Qualify For Slmb

    Each state Medicaid program has its own rules concerning qualification.

    One standard model used for SLMB eligibility is if you have countable assets at or below two times the standard allowed by the Supplemental Social Security program and an annual income of no more than 120% of the Federal Poverty Level.

    For 2022, that breaks down to:

    • Individuals = $1,308 per month in income $7,970 in assets
    • = $1,762 in monthly income $11,960 in assets

    The income and asset limits may change each year. According to Medicare.gov, you should still apply for SLMB benefits if your income and resources are slightly higher than whats listed above.

    Assets include:

    • Money in checking or savings accounts
    • Stocks

    What Is The Income Limit For The Medicare Savings Program

    The Medicare Savings Program income limit varies by location most states base it on a percentage of the Federal Poverty Limit, which shifts slightly each year.

    In 2021, here are the monthly income limits for each program. Limits for Hawaii and Alaska are slightly higher.

    • Qualified Medicare Beneficiary: Individual $1,094 and Married Couple $1,472
    • Specified Low-Income Medicare Beneficiary: Individual $1,308 and Married Couple $1,762
    • Qualified Individual: Individual $1,469 and Married Couple $1,980
    • Qualified Disabled Working Individual: Individual $4,379 and Married Couple $5,892

    There are also resource limits for each program. Counted resources include stocks, bonds, and money in your checking or savings account. The resource limit for the QMB, SLMB, and QI programs is $7,970 for an individual and $11,960 for a married couple.

    For the QDWI program, the resource limit is $4,000 for an individual and $6,000 for a married couple.

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    What Counts Toward Your Resource Limit

    Your resource limit includes money you have in all types of savings accounts, checking accounts, and retirement accounts. It also includes all of your investments in stocks or bonds. If you own multiple properties, the value of everything except your primary residence may count toward your resource limit.

    The resource limit does not consider your primary home, a car, a burial plot, furniture, or any other personal items. You can also exclude $1,500 per person to account for burial expenses. A life insurance policy doesnât count, and neither do any advance tax credits or money you received for housing assistance.

    Effective Date Of Coverage

    Simply Explained: Medicare Savings Programs

    Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

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    What Are The Medicare Savings Programs

    There are four types of Medicare Savings Programs. Three of them are available only if you have Medicare and are at least 65 years old:

    • The Qualified Medicare Beneficiary Program helps pay for Medicare Part A premiums and Medicare Part B premiums, deductibles, coinsurance, and copays. Itâs possible to qualify for the QMB program and other Medicaid programs.

    • The Specified Low-Income Medicare Beneficiary Program helps pay for Medicare Part B premiums only. You must already have Medicare Part A to qualify. You can take part in the SLMB program and other Medicaid programs at the same time. Some states may refer to this as the SLIMB program.

    • The Qualifying Individual Program helps pay for Medicare Part B premiums only. Itâs granted on a first-come, first-served basis, with priority given to people who qualified the previous year. If you qualify for the QI program, you cannot qualify for other Medicaid programs.

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    The fourth MSP is available to workers who have a disability and are under age 65:

    • The Qualified Disabled and Working Individuals Program helps workers who have a disability to pay Medicare Part A premiums. Itâs only available to those who lost Part A coverage because they returned to work.

    Qualified Disabled And Working Individuals Program5

    The QDWI program helps pay the Part A premium.

    To qualify, 1 of these must apply:

    • Youre a working disabled person under 65
    • You lost your premium-free Part A when you went back to work
    • You arent getting medical assistance from your state
    • You meet the income and resource limits required by your state

    Income and resources limits for 2021 include:

    • Individual monthly income limit $4,379*
    • $5,892*
    • Individual resource limit $4,000
    • $6,000

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    Specified Low Income Medicare Beneficiary

    The SLMB program has higher limits than QMB. Once you qualify, SLMB pays:

    • Medicare Part B premium: $170.10/month for most people in 2022.
    • Retroactive Part B premium amounts for each of the past three months.

    Medicaid, QMB and SLMB are guaranteed for those who qualify, but QI benefits are limited.

    • QI pays the Medicare Part B premium: $170.10/month for most people in 2022.
    $12,600

    Qualified Disabled And Working Individuals Program:

    Medicare Help in Charleston, South Carolina from a Local UnitedHealthcare Agent
    • Covers Medicare Part A premiums only.
    • Apply to this program if you meet the income and resource limits and if any of the following apply to you:
    • Youre a working disabled person under 65
    • You lost your premium-free Part A when you went back to work
    • You arent getting medical assistance from your state
    • You are within the income and resource limit amounts

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    Qualified Medicare Beneficiary Program

    This program pays for the monthly premiums for Part A and Part B as well as cost-sharing expenses including deductibles, coinsurance and copayments.

    Part A is premium-free for most people due to paying a sufficient amount of Medicare taxes while working . But some people do not meet this qualification and must pay a monthly premium for Part A. Part B carries a monthly premium based on income.

    Eligibility for the QMB program is determined by the low-income subsidy asset test and the qualifying amount is subject to change every year. In addition, you must also be eligible for Part A of Medicare.

    Specified Low-Income Medicare Beneficiary Program

    If you earn too much money to qualify for the QMB program, you may still qualify for the SLMB. This savings program pays for the Part B premium but unlike the QMB, it does not pay for Part A premiums or for any cost-sharing expenses.

    The SLMB program uses the same income and asset qualifying criteria as the QMB, with qualifying numbers that may change from year to year.

    Qualifying Individual Program

    Those who dont qualify for either the QMB or the SLMB may still qualify for the QI savings program. This program pays for Part B premiums .

    Qualified Disabled and Working Individuals Program

    This Medicare Savings Program is a little different from the other three in that it only pays for the Part A premiums. This program is for people who:

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