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Medicaid and Medicare Savings Programs

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Key Takeaways

  • Low-income individuals can access Medicaid, a sort of health insurance. It differs from Medicare, which offers health insurance to persons 65 and older and some disabled people.
  • People with Medicare may also be qualified for Medicaid if they meet the state’s standards.
 

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What is Medicaid?

Medicaid is a state-run health insurance program that provides coverage for a variety of medical procedures for people with limited financial means. Since Medicaid is a state-run program, eligibility standards and extra benefits may vary from state to state. All of these are regarded as basic services, along with doctor visits, hospital inpatient and outpatient treatment, lab tests, x-rays, medical transportation, family planning services, nursing facility care, home health care, and nurse practitioner services. Medicaid also oversees the Medicare Savings Programs, which are government financed.

Medicaid vs. Medicare

Medicaid and Medicare are not the same. Medicare is a government-run health insurance program for anyone over 65. A few disabled people could also be able to enroll in Medicare. Is it possible to have both Medicaid and Medicare?

People with Medicare may also be qualified for Medicaid if they meet the state’s standards. A common term for them is “dual eligibles” or “duals.” Medicaid can pay for Medicare co-payments and deductibles as well as services like vision, hearing, and dental care that are not covered by Medicare but may be covered by your state’s Medicaid program.

For people with Medicare enrollment, Medicaid is no longer the primary payer for their prescription drugs. Medicare Part D will help those with Medicaid and Medicare pay for their prescription medications. In some areas, Medicaid may offer coverage for particular prescriptions that Medicare does not. Additionally, people who are registered in both Medicaid and Medicare are automatically eligible for the Medicare Part D Low Income Subsidy (LIS/Extra Help).

Medicare Saving Program

What are the 4 Medicare Savings Programs?

Medicare enrollees with limited resources and income have access to Medicaid-managed programs known as Medicare Savings Programs (MSPs). These programs offer assistance to those who can afford Medicare. There are four separate Medicare Savings Programs, and the income and resource requirements for each one vary. The following are the eligibility requirements for the 2022 Medicare Savings Program:

1. Qualified Medicare Beneficiary (QMB): If a person’s income is less than 100% of the federal poverty level and their resources are less than $8,400 for single people and $12,600 for married couples, they may be eligible (FPL). If eligible, QMB will cover all Medicare-related Part A and Part B premiums, deductibles, copayments, and coinsurance. The monthly income limitations include a $20 general income disregard; Alaska and Hawaii have slightly stricter requirements:

  • Residents of 48 states & District of Columbia: $1,153/$1,546 single/married
  • Alaska: $1,436/$1,928 single/married
  • Hawaii: $1,323/$1,775 single/married

2. Specified Low-Income Beneficiary (SLMB): Seniors and people with disabilities may qualify if their income is between 100% and 120% of the federal poverty line and their assets do not exceed $8,400 for single people and $12,600 for married people. If eligible, SLMB will cover the monthly Medicare Part B premium ($170.10 in 2022) The overall monthly income cap is $20; however, residents of Alaska and Hawaii have significantly higher income caps:

  • Residents of 48 states & District of Columbia: $1,379/$1,851 single/married
  • Alaska—$1,719/$2,309 single/married
  • Hawaii—$1,583/$2,126 single/married
 

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3. Qualifying Individual (QI): QI is a block-grant program that only accepts initial applications and has a strict participation cap. Medicare recipients may qualify if their resources are less than $8,400 ($single) or $12,600 ($married) and their income is between 120 and 135% FPL. QI will cover the Medicare Part B deductible if eligible. The monthly income limitations include a $20 general income disregard; Alaska and Hawaii have slightly stricter requirements:

  • Residents of 48 states & District of Columbia: $1,549/$2,080 single/married
  • Alaska: $1,931/$2,595 single/married
  • Hawaii: $1,778/$2,389 single/married

4. Qualified Disabled Working Individual (QDWI): Adults under 65 who are disabled, have just resumed working, and are no longer qualified for premium-free Part A is referred to as QDWI. Their income must be at or below 200% of the federal poverty level, and their resources must total $4,000 for single people and $6,000 for married people. The QDWI income cap is now 400% FPL due to additionally earned income disregards. QDWI will cover the Part A premium if qualified. A $20 general income disregard and a $65 earned income disregard are included in the monthly income limits for Alaska and Hawaii, which are marginally higher:

  • Residents of 48 states & District of Columbia: $4,615/$6,188 single/married
  • Alaska: $5,748/$7,715 single/married
  • Hawaii: $5,295/$7,105 single/married

Note: Federal rules are represented by the higher boundaries. Some states might choose to change the combined resource test or increase these federally recommended amounts. Look up your state’s eligibility requirements.

Medicare Saving Program

What are the advantages of Medicare Savings Programs?

Seniors and younger disabled individuals who do not always satisfy the standards for full Medicaid coverage may nevertheless be eligible for the Medicare Savings Programs. The main advantages of doing this are:

  1. reducing the cost of Medicare. Three of the four MSPs pay the Medicare Part B premium, which in 2022 will be $170.10 per month for individuals who require premium assistance. Seniors and people with disabilities who sign up for MSPs receive nearly $2,000 back annually.
  2. Automatic Extra Assistance Upon participation in MSPs, a person is “deemed” to be eligible for the Medicare Part D Low Income Subsidy (LIS/Extra Help). The worth of this benefit, which helps with the expense of prescription drugs, has been assessed by the Social Security Administration at $5,100 annually. Additionally, if a senior or handicapped adult receives Extra Help and does not enroll in Part D, they will not be charged a late registration fee.

Where can I get help applying for the Medicare Savings Program?

If you believe that you or a loved one could be eligible for these services, you can seek assistance.

  • The NCOA’s network of Benefits Enrollment Centers (BECs). Elderly and disabled individuals can apply for any benefits they may be missing with the help of BECs.
  • BenefitsCheckUp® is a free online tool that determines a person’s eligibility for tens of thousands of programs, including as Medicaid and the MSPs, which can pay for medical care, prescription medicines, and other costs.
  • Your local State Health Insurance Assistance Program (SHIPs). Two federally funded programs that SHIPs can assist you in applying for are the Medicare Savings Programs and the Part D Low-Income Subsidy/Extra Help. Additionally, ships provide Medicare recipients and their families with free, impartial help.
 

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I have additional questions about Medicare and need help. Where can I get more information?

If you require help analyzing your Medicare alternatives, Medicare Advisors is a broker that satisfies the NCOA’s Standards of Excellence. In order to meet your Medicare selection preferences and needs, SHIPs and Medicare Advisors are options that are committed to doing so without charging you any money. To find out more, get in touch with a licensed Medicare enrollment specialist right immediately.

FAQS

What does SLMB mean in Medicare?

Specified Low-Income Medicare Beneficiary

Specified Low-Income Medicare Beneficiary (SLMB): exclusively covers the recurring Medicare Part B premiums. • Qualifying Individual (QI): Only pays the Part B premiums each month. However, the QI program has a restricted budget.

What are Medicare costs for 2023?

Medicare Part B members’ typical monthly premium will be $164.90 in 2023, down from $170.10 in 2022 by $5.20. All Medicare Part B patients will have an annual deductible of $226 in 2023, down from an annual deductible of $233 in 2022.

How long are Social Security disability benefits?

If we determine that you were disabled during that period and you meet all other requirements, we may award Social Security disability benefits for up to 12 months before you applied. Benefits often persist until you can resume regular employment.

What prescriptions are covered by Medicare?

Part D

Everyone with Medicare has access to prescription drug coverage. The name of this insurance is “Part D.” Medicare prescription drug coverage.

Medicare Saving Program

What are the 4 types of Medicare Advantage plans?

The most typical Medicare Advantage Plan kinds are listed below.

  • Plans for health maintenance organizations (HMOs).
  • Plans from PPOs (Preferred Provider Organizations).
  • Plans for private fee-for-service (PFFS).
  • Plans for Special Needs (SNPs)

How much are Medicare premiums per month?

Depending on how long you or your spouse worked and paid Medicare taxes, the premium in 2023 will either be $278 or $506 per month. To purchase Part A, you must also enroll in Part B. You may incur penalties if you choose not to buy Part A when you first become eligible for Medicare, which is typically at age 65.

 

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What are Medicare deductibles for 2023?

Medicare Part A‘s benefit period deductible is $1,600 in 2023, and Part B’s yearly deductible is $226. Every fall, the Centers for Medicare & Medicaid Services (CMS) publishes new Part A, Part B, and Medicare Part D income-related monthly adjustment amounts for premiums, deductibles, and coinsurance.

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