MEDICARE SAVINGS PROGRAM MSP Health Insurance Training Center

MEDICARE SAVINGS PROGRAM (MSP) Health Insurance Training Center (HITC) New York State Public Health Insurance Programs Sponsored by the New York State Department of Health through a training and administrative services agreement with CAI Global

2 Medicare Savings Program (MSP) • Explanation of Medicare • MSP Categories o Qualified Medicare Beneficiaries (QMB) o Specified Low Income Medicare Beneficiaries (SLMB) o Qualified Individuals (QI) o Qualified Disabled and Working Individuals (QDWI) • Program Benefits

3 What Is Medicare • A federal health insurance program available to individuals receiving Social Security Benefits • Criteria to participate in Medicare: o o 65 yrs or older On SSD for 24 months Renal Dialysis for 3 months ALS - Amyotrophic Lateral Sclerosis § (AKA Lou Gehrig’s disease)

4 4 Parts to Medicare • Medicare Part A (Inpatient Coverage) o Free for most people • Medicare Part B (Outpatient Coverage) o Has a premium • Medicare Part C (Medicare Advantage Plans) o Cost varies based on the type of plan purchased • Medicare Part D (Prescription Coverage) o Premiums vary by health plan

6 Medicare Savings Program • A program that can assist individuals/couples in paying for their Medicare Premiums

7 Medicare Savings Programs • 4 Medicare Savings Programs o o Qualified Medicare Beneficiaries (QMB) Specified Low Income Medicare Beneficiaries (SLMB) Qualified Individuals (QI) Qualified Disabled and Working Individual (QDWI)

8 MSP Application • MSP applicants may complete DOH-4328 (shortened application) • QMB and SLMB applicants that are also applying for Medicaid must follow Medicaid eligibility rules and: o Complete the “Access New York Application” (DOH-4220) and “Supplement A” (DOH-5178 A) o May complete the “PA, Medicaid, FS, Services” combined application (LDSS-2921)

9 MSP Application, cont’d. • All MSP applications received at the LDSS must first be checked for eligibility on the Marketplace • Eligibility can be check by utilizing the “Client Search” tab in e. Med. NY o Search by SSN • If active on the Marketplace, fax the MSP application to the Third Party Liability unit o (518)473 -0601 • Third Party unit will process for a MIPP payment

10 MSP Eligibility Criteria • New York State Resident • Citizen or have satisfactory Immigration Status • Must apply for available Social Security benefits when applying for Medicare

11 MSP Eligibility Criteria, cont’d. • QMB o Must have Medicare Part A or be eligible for Medicare Part A • SLMB & QI o Must have Medicare Part A

12 MSP Income Levels • QMB o Income must be at or below 100% of FPL • SLMB o Income is greater than 100% FPL but less than 120% FPL • QI o Income is at least 120% of FPL but less than 135% of FPL • QDWI o Less than 200% of FPL

13 MSP Resources • QMB, SLMB and QI o No Resource Test • QDWI A/Rs may attest to resources o Individual Level - $4000 o Couple Level - $6000

14 QMB Benefits • Medicare Part A & B premiums reimbursed • Deemed eligible for the Low Income Subsidy (LIS) Part D benefit • Medicare Co-Insurances and Deductibles paid including: o Chiropractor o Podiatry o Clinical Social Worker • Can be fully eligible for Medicaid or can spend down to the Medically Needy (MN) level

17 SLMB Benefits • Medicare Part B premium is reimbursed • Deemed eligible for the Low Income Subsidy (LIS) Part D benefit • Can spend down to the Medically Needy (MN) level

19 QI Benefits • Medicare Part B premium is reimbursed • Deemed eligible Low Income Subsidy (LIS) Part D benefit • Cannot spend down to be Medicaid eligible o Must choose between QI or Medicaid • Auto renewals based on WMS, e. Med. NY and MABEL

20 QDWI • Reimbursement of their Part A Premium

21 MSP Budgeting • SSI-R Budget (04) • Buy in indicator “A” • Household size 1 or 2 o Based on Buy-In Indicator and LA code: 1 or 2 • Use gross Social Security income • Do not allow Medicare Part B premium as a deduction

24 MSP Eligibility • QMB: o o Eligibility must be prospective Reimbursement begins the month after Medicaid eligibility starts • SLMB: o Eligibility may be determined 3 months retro • QI: o Eligibility may be determined 3 months retro but MUST be within the same calendar year

25 QMB Application Date – 7/5/19 QMB starts – 8/1/19 3209 screens 1 & 5 – 7/1/19 – 6/30/20 e. Med. NY – 8/1/19 Auth “From” date MUST be one month prior to QMB enrollment in e. Med. NY

26 SLMB Application Date – 6/15/19 Requesting 3 months Retro Coverage • March-May 3209 screens 1 & 5 – 3/1/19 to 5/31/20 e. Med. NY – 3/1/19

27 QI Application Date – 3/7/19 Requesting 3 months Retro Coverage • December - February 3209 screens 1 & 5 – 1/1/19 to 12/31/49 e. Med. NY – 1/1/19 Retro must be in the same calendar year

28 QMB Coverage Codes • Income below the MN Level o Coverage Code as appropriate § See Attestation of Resources 04 ADM/06 • Income above the MN Level but less than or equal to 100% FPL o Coverage Code 09 • May spend down to the MN Level for Medicaid eligibility

29 SLMB Coverage Codes • Coverage Code 09 • May spend down to the MN Level for Medicaid eligibility

30 QI Coverage • Coverage Code 09 • Cannot spend down for Medicaid eligibility

31 MSP and MA Eligibility for SSI-R and Non SSI-R Spouses • A two step process must be used o GIS 10 MA/10 o For MSP eligibility, enter the Buy-In Indicator of an “A” in the Buy-In field in MABEL § Print and store the MSP budget in the case record o For Medicaid eligibility, remove the Buy-In Indicator of an “A” § Store the Medicaid budget in MABEL

32 e. Med. NY • e. Med. NY entries must be done before reimbursement will begin o QMB – P o SLMB – L o QI – U o QDWI – X

34 e. Med. NY, cont’d. • Certain closing transactions in WMS will trigger the closing of the Buy-In span in e. Med. NY o GIS 14 MA/20 o Buy-In span closed at the end of the clock down period • Closing codes other than those listed in GIS 14 MA/20, span must be ended manually in e. Med. NY

35 The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)

36 MIPPA • Effective January 1, 2010, an application for the Medicare Part D Low Income Subsidy will be considered an application for the Medicare Savings Program • MSP applications will be transmitted daily via a file transferred from SSA to NYS

37 MIPPA, cont’d. • Currently no automated process • Interim procedures implemented • 10 OHIP/ADM-3

38 MIPPA Interim Procedures • File will be provided to the LDSS o Application date is the date they applied for the LIS o 45 days for processing begins when the State receives the file from SSA • If LIS applicant has an active MSP case there is no further action

39 MIPPA Interim Procedures, cont’d. • If LIS applicant has an active or pending Medicaid Case with no active MSP then the LDSS must make an MSP determination o Send notice

40 MIPPA Interim Procedures, cont’d. • If LIS applicant has an active Medicaid case with a spenddown or is only eligible for Medicaid because they are using the Part B premium as a deduction the LDSS must send a letter giving them the choice of MSP or spenddown o Recipient indicates choice and returns letter

41 MIPPA Interim Procedures, cont’d. • If LIS applicant does not have an active or pending Medicaid case the LDSS must send a cover letter and Request for Information form o If form is returned determine MSP eligibility and send notice o If form is not returned send denial for failure to return information