Enrolling in a Medicare Savings Program (MSP) is Helpful for Consumers

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Justin Young

The Medicare Savings Program is a state established program to assist eligible consumers with paying for Medicare premiums, co-insurance, and deductibles.  For many of the consumers served by the Center for Disability Rights Community Supplemental Needs Pooled Trust, it is to the consumer’s better interest to be enrolled in a version of the Medicare Savings Program.  If they are not enrolled in a Medicare Savings Program, then they are charged a $104.90 Medicare premium.

The 2013 income and resource requirements for individuals wishing to enroll in this program must be below $800 and $14,400 respectively.  For married couples they are $1,175 and $21,150 respectively.   There are at least three types of Medicare Savings Programs which are the Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLIMB), and Qualified Individual (QI) programs.

These programs also differ in what they can help provide for as well.  The QMB program can pay for the Medicare Part A and/or Part B premium.  An individual can be eligible for QMB only or for QMB and Medicaid.  This program also pays for the Medicare Parts A and B co-insurance and deductibles.  To be eligible for this program, it is required consumers have income below 100% of the Federal Poverty Level (FPL) + $20 equaling $978 per month for single individuals and $1,313 per month for married couples.  The SLIMB program pays for the Medicare Part B premium only.  Individuals can be eligible for SLIMB only or for SLIMB and Medicaid (with a monthly spend down). The applicant must have Medicare Part A in order to be eligible for the program.  To be eligible for this program, it is required to have income below 120% FPL + $20 equaling $1,169 per month for single individuals and $1,571 per month for married couples.  The QI program pays for the Medicare Part B premium only.  Individuals cannot be eligible for QI and Medicaid.  The applicant must have Medicare Part A. States are allotted money for this program on a yearly basis.  To be eligible for this program, it is required to have income below 135% FPL +20 equaling $1,313 per month for single individuals and $1,765 per month for married couples.
http://www.health.ny.gov/health_care/medicaid/program/update/savingsprogram/medicaresavingsprogram.htm

After describing this program in length, it is shown how each category differ in both services and the amount of monthly income required by both single individuals and married couples to participate in the program.  The best type of Medicare Savings Program to have is the Qualified Medicare Beneficiary program because as indicated above it provides for the most service.  The other two only do either Medicare part A or part B only.  Overall it is beneficial for our consumers to enroll in one of the above mentioned programs because it helps in paying for any medical expenses incurred.  Also, the consumer would benefit by having a gain to their gross income of the $104.90 which they would have lost that could be applied to cover approved items out of their funds in the Pooled Trust.