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Medicare Savings Programs and Extra Help
Medicare Savings Programs and Extra Help Low Income Subsidy Trelisha M. Brown Texas Legal Services Center 815 Brazos, Suite 1100 Austin, Texas 78701 Ph.: (512) 477-6000 Table of Contents General Information: 3 - 6 Medicare Savings Program: 7 - 23 Extra Help – Low Income Subsidy: 24 - 32 Contact information: 33 General Information Medicare Savings Programs (“MSP”) • Provides financial assistance to persons who have limited income • Helps pay for Medicare premiums (Part A and/or B), deductibles and coinsurance costs. General Information Extra Help – Low Income Subsidy (“LIS”) • Provides financial assistance to persons who have limited income and resources • Helps defray prescription drug plan costs under Medicare Part D General Information Who provides funding for the Medicare Savings Program? • The Texas Health and Human Services Commission pays for Medicare premiums (Part A and/or B), deductibles and coinsurance costs with Medicaid monies. Please see - Medicaid Eligibility for the Elderly and People with Disabilities Handbook: Chapter Q • See further 42 U.S.C. §1396a(a)(10)(E)(i) and 42 U.S.C. §1396a(a)(1)(E)(iii) General Information Who provides funding for the Extra Help – Low Income Subsidy? • The Social Security Administration provides the funding to help defray prescription drug plan costs under Medicare Part D. Please see 42 USCS § 1395w-114. Medicare Savings Program (“MSP”) General Eligibility Requirements • Citizen Must be a U.S. Citizen or a qualified legal alien • Resident Must live in Texas • Medicare Must be entitled to Part A MSP Qualified Medicare Beneficiary (“QMB”) • Program Specific Eligibility Income • $903 Individual • $1,215 Couple Gross income limit does not include the $20 general income disregard What counts as income • • • • Social Security Benefits Railroad Retirement Benefits Interest or Dividends, Royalty and Rental payments Earnings or wages MSP QMB cont… • Program Specific Eligibility Resources • $6,600 Individual • $9,910 Couple What is a resource? • • • • • Bank accounts Real Property Life Insurance Policies Stocks and bonds Vehicles MSP QMB cont… • Exclusions Homestead where the individual or spouse lives or intends to live Life insurance policy with a face value of $1,500 or less Burial funds $1,500 or less Car Burial spaces MSP QMB cont… • Benefits The state pays both Medicare parts A and B, deductibles and coinsurance fees for Medicare covered services. QMB recipients do not receive regular Medicaid benefits. They do receive a special card from Medicaid that identifies them as QMB eligible which they can then show their medical providers. MSP Specified Low-Income Medicare Beneficiaries (“SLMB”) • Program Specific Eligibility Income • $1,083 Individual • $1,457 Couple Gross income limit does not include the $20 general income disregard What counts as income • • • • Social Security Benefits Railroad Retirement Benefits Interest or Dividends, Royalty and Rental payments Earnings or wages MSP SLMB cont… • Program Specific Eligibility Resources • $6,600 Individual • $9,910 Couple What is a resource? • • • • • Bank accounts Real Property Life Insurance Policies Stocks and bonds Vehicles MSP SLMB cont… • Exclusions Homestead where the individual or spouse lives or intends to live Life insurance policy with a face value of $1,500 or less Burial funds $1,500 or less Car Burial spaces MSP SLMB cont… • Benefits The state pays Medicare part B premiums only. SLMB recipients do not receive regular Medicaid benefits nor do they receive a special identification card from the state. MSP Qualifying Individuals Program (“QI-1”) • Program Specific Eligibility Income • $1,083 - < $1,219 Individual • $1,457 - < $1,640 Couple Gross income limit does not include the $20 general income disregard What counts as income • • • • Social Security Benefits Railroad Retirement Benefits Interest or Dividends, Royalty and Rental payments Earnings or wages MSP QI-1 cont… • Program Specific Eligibility Resources • $6,600 Individual • $9,910 Couple What is a resource? • • • • • Bank accounts Real Property Life Insurance Policies Stocks and bonds Vehicles MSP QI-1 cont… • Exclusions Homestead where the individual or spouse lives or intends to live Life insurance policy with a face value of $1,500 or less Burial funds $1,500 or less Car Burial spaces MSP QI-1 cont… • Benefits The state pays Medicare part B premiums only. QI-1 recipients do not receive regular Medicaid benefits nor do they receive a special identification card from the state. QI-1 recipients cannot receive any other Title XIX Medicaid –funded benefits MSP Qualified Disabled and Working Individuals Program (“QDWI”) • Program Specific Eligibility Income • $1,805 Individual • $2,429 Couple Gross income limit does not include the $20 general income disregard What counts as income • • • • Social Security Benefits Railroad Retirement Benefits Interest or Dividends, Royalty and Rental payments Earnings or wages MSP QDWI cont… • Program Specific Eligibility Resources • $4,000 Individual • $6,000 Couple What is a resource? • • • • • Bank accounts Real Property Life Insurance Policies Stocks and bonds Vehicles MSP QWDI cont… • Exclusions Homestead where the individual or spouse lives or intends to live Life insurance policy with a face value of $1,500 or less Burial funds $1,500 or less Car Burial spaces MSP QDWI cont… • Benefits The state pays Medicare part A premiums only. QDWI recipients do not receive regular Medicaid benefits nor do they receive a special identification card from the state. Extra Help – Low Income Subsidy General Eligibility Requirements • Citizen Must be a U.S. Citizen or a qualified legal alien • Resident Must live in the United States • Medicare Must be enrolled in Medicare part -D LIS Eligibility Changes In-kind support and maintenance (ISM) will no longer be counted as income for LIS eligibility • Texas still counts ISM in deciding entitlement for MSPs Effective January 1, 2010 Change to the LIS application New question added (question 15) regarding the transmittal of data from SSA to state Medicaid agency to start an MSP application • Your clients should only check the box if they wish to OPT OUT of this process All changes effective January 1, 2010 LIS Eligibility Changes Cash surrender value of life insurance will no longer be counted as an asset for LIS eligibility Effective January 1, 2010 Extra Help – Low Income Subsidy Low Income Subsidy (“LIS”) • Program Specific Eligibility Income • $ 16,245 • $21,855 Individual Couple What counts as income • Social Security Benefits • Railroad Retirement Benefits • Interest or Dividends, Royalty and Rental payments • Earnings or wages Extra Help – Low Income Subsidy LIS cont… • Program Specific Eligibility Resources • $12,510 Individual • $25,010 Couple What is a resource? • • • • • Bank accounts Real Property Life Insurance Policies Stocks and bonds Vehicles Extra Help – Low Income Subsidy LIS cont… • Exclusions Homestead where the individual or spouse lives or intends to live Car Any life insurance policy Help you receive from others for food and shelter, household bills i.e. electric, gas and water; rent, mortgage, and property taxes Extra Help – Low Income Subsidy LIS cont… • Benefit SSA pays up to $3,900 for help with Medicare part -D Prescription Drug Plan Costs. Applying for LIS and MSPs 1) You can help clients to complete an MSP application to submit to the Texas Medicaid eligibility office at the same time that you help them submit their LIS application, OR 2) You can urge them to allow their LIS application information to be transmitted by SSA to your state to start an MSP application. Contact Information In providing services relating to extra help or other Healthcare issues, you have unrestricted access to the back-up and support of Texas Legal Services Center (TLSC). The toll-free numbers for clients to call to reach the Health Law Project are 1-800622-2520 or 1-866-979-4343.
