Medicare A & BMedicare supplementPart D Precription DrugPrescription Drug Plan

What is the “Medicare Savings Program?”

If you have a limited income you may be able to get assistance with your health care costs through a Medicare Savings Program (MSP) also known as Medicare Buy-In programs or Medicare Premium Payment Programs.

Individuals enrolled in Medicare Parts A and B may apply for the Medicare Savings Program. If eligible you will receive help paying the Medicare Part B premium, currently $135.50. In some instances, (QMB) the program will pay your Part A and Part B deductible and co-insurance amounts. (And possibly a percentage of your Part C Medicare Advantage plan premium.)

Eligibility is based on your income after subtracting for eligible health insurance premium deductions such as i) Medicare Supplement / Medigap premium, ii) vision, iii) dental and iv) long term care premiums.

New York excludes the cost of certain health insurance premiums from
your income. For example, if you are over the income limit for an MSP but pay a premium
for a Medigap or other secondary health insurance, you may deduct that premium from your
gross monthly income to qualify.
Example: If you are single with a monthly income of $1588 and you subtract $182 ($20 standard) and $162 for a Medicare Supplement Plan N) the net $1406 meets the QI category.

QMB: Individuals with net income at or below $1,041 [100% of Federal Poverty Level] receive help with the $135.50 Medicare Part B monthly premium and the Medicare Parts A and B deductible and cost sharing. No retroactive Part B reimbursements are available to QMB enrollees.

SLMB: Individuals with net income at or below $1,249 [100-120 % of Federal Poverty Level] receive help with the $135.50 Medicare Part B monthly premium. Some retroactive Part B reimbursements are available to SLMB enrollees.

QI: Individuals with net income at or below $1,406 [120-135 % of Federal Poverty Level] receive help with the $135.50 Medicare Part B monthly premium. Some retroactive Part B reimbursements are available to QI enrollees however not retroactive from prior to any month in the prior year.

Strategy: Many of my clients with monthly income above the $1,406 QI level were previously enrolled in a Medicare Advantage plan with a low monthly premium but higher medical copay and prescription drug costs. These clients understood that by increasing their premium expense (they enrolled in Medicare Supplement and Part D drug plans) their “net” income would be at or below the $1,406 qualifying level. The higher Medicare Supplement premium payment is then offset by the $135.50 Part B premium subsidy, the reduction or elimination of those medical copays and the elimination of the Part D deductible. As one client said in her email, “The savings are a godsend…”

When you enroll in an MSP, you will also automatically get Extra Help, the federal program that helps pay most of your Medicare prescription drug (Part D) plan costs like the monthly premium, plan deductible and prescription copays.

Sources:

New York State Department of Health link

New York Health Access link

Medicare Rights link

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