Medicare Saving Programs in New York – All You Need to Know

The Medicare Saving program or MSP is a Government-funded program that helps the people that are enrolled in it to pay for the Part B monthly premiums. This program is designed specifically to help low-income people who are a part of the medicare program. The Medicare Saving Program NY also helps its enrollees to get subsidized prescription drugs that are listed under Part D. The Medicare savings programs NY have three separate programs that fall under it. These are as follows:

  • Specified Low Income Medicare Beneficiary (SLIMB) Program
  • Qualified Individual (QI) Program
  • Qualified Medicare Beneficiary (QMB) Program

Specified Low Income Medicare Beneficiary Program

The Specified Low-income beneficiary program is designed such that this will only help you pay for the Medicare premiums under part B. The one caveat is that you need to have Medicare part A for eligibility. The Specified Low Income Medicare Beneficiary program goes into effect usually from the month when you filed your application, however, in some cases this may be retroactive for up to three months before the filing of the application. There may also be cases where you might be eligible for not only SLIMB but also for other Medicare programs.

Qualified Individual Program

The Qualified Individual Program comes under the Medicare saving program NY and will only help you in the payment of the Medicare premiums falling under part B. An individual is only eligible for this program if they are eligible for Medicare under Part A. The Qualified Individual program is active throughout the year and the applicants are vetted on a first come first serve basis. There is no retroactivity in this program and the program goes in effect the month when the application was filed. The Qualified Individual Program does not allow its beneficiaries to be eligible for other programs if they receive this benefit. 

Qualified Medicare Beneficiary Program

The Qualified Medicare Beneficiary program allows for the beneficiary to have their Premiums for the Medicare falling under Part A and Part B, co-insurance and other deductibles to be paid. The Qualified Medicare Beneficiary program goes into effect once the eligibility is determined. An individual can also be eligible for other Medicare programs if they are receiving the benefits from the Qualified Medicare beneficiary program.

The Benefits of becoming a part of a Medicare Saving Program

Benefits of a Medicare Saving Program

The Part A Medicare that helps people pay for the treatment they receive in the Hospital is mostly at no cost to them once they hit the age of 65 years, however, the individual still needs to endure and pay for the part B which covers the cost of treatments and medicine has premiums that need to be covered. The Part B Medicare premiums are usually deducted out of the social security check an individual receives, however, once someone becomes a part of the Medicare saving program, they no longer are on the hook for paying those part B premiums. Another benefit that awaits the eligible people is that once they become a part of the Low-income subsidy programs, the prescription costs that fall under part D may also be covered. Other out-of-pocket costs may also be covered under the Medicare saving program NY which may consist of the annual deductibles and insurance.

The Asset Limit

Programs that fall under Medicaid usually have some sort of Asset limits that limit them from being eligible for it, however, there are no asset limits for the people who want to become a part of any of the three Medicare Saving Programs.

Income Limits and Rules

There might not be any asset levels that need to be adhered to, however, there are several income limits that have to be applicable to you if one wants to become a party of any of the three Medicare saving programs. These Income limits are then used to place individuals in the program they are eligible for, which has different benefits tied. The Income limits are in accordance with the federal poverty limits.

The Federal Poverty levels get updated each year. There, however, is some downtime where the Federal Poverty level for the new year is being determined. This downtime can usually take days, weeks, and sometimes even a few months. During this time, the Medicaid offices normally use the Federal poverty level that was determined the previous year.

The income that is then run against the income limit index is determined using the exact methodology it is determined so that they can claim social security benefits. This, however, does have an exception where the size of oneness household is also taken into consideration when a married couple is applying.

There are incomes which are disregarded and not considered when running them against the income limit.

  • The first 20 dollars for a couple’s monthly income is not counted towards the income limits. An individual cannot claim this benefit.
  • The income that is earned by the Supplemental security income is not taken into consideration.
  • The first 65 dollars of a couple’s monthly income.
  • Half of that monthly income once the 65 dollars are deducted.
  • Any income that is used towards any disability easement. This can be the blind work expense and the impairment-related work.
  • The income goes toward spying your life insurance monthly premium. This, however, does not include the Part B outPatient premiums which will now be paid under the Medicare saving program NY. These premiums may be for a myriad of policies that may be vision, dental, Medigap supplemental policies.
  • Food stamps will not be counted towards the income limit.

One of the conditions that the individuals applying for medicare saving program should adhere to is that if they are eligible to receive social security benefits and are not receiving it then they are supposed to apply for it as that is one of the conditions they have to follow to qualify fully for a medicare saving program.

There are also income trusts that are exempt from being considered in the income limit called Medicaid exception trusts.

Household Size

There is a significantly higher advantage to be a part of a household that is large. This allows for the income limit to go a lot higher than one would have in case they were a single individual. The Income limit for a household having two people is larger than it has with one individual.

There may be times where a married individual is considered as one in a household and the income limit for one is applied. This is usually true for cases where the spouse even though they have no income and is supported by the individual that is applying for the medicare saving program. This household will be adhered to the income limit of one person.

There have been times where a household income is significantly lower than a couples monthly limit, however, the client is not deemed eligible because their income is above the single income limit. However, in 2010 the Department of Health in the State of New York changed their rules which allowed married couples to be counted as two and fall in the income limit for the couples.

There, however, also have been times where the income of a spouse is significantly higher than the spouse that is applying for the Medicare saving program. When cases like this happen, a spouse can use the “Spousal Refusal” form which is an affidavit that testifies that your significant other is not taking care of your healthcare needs which you desperately need.

Four Special Benefits of the Medicare Saving Program

1 . The Low Income Subsidy or Part D “Extra Help” for prescriptions

The people who receive the benefits allotted to them by the Medicare Saving Program are also then given direct access to the Low-Income Subsidy for Medicare Part D which subsidizes the prescriptions and makes them a lot more affordable. The Part D medicare subsidy is active for an entire calendar year regardless of whether they become ineligible for the Medicare Saving plan.

The Income Limit for the Extra Help Medicare Part D is 135 percent of the Federal Poverty Limit. However, there may be times an individual holding assets that exceed the asset limits may make them ineligible for the Extra Help even though they are still eligible for the Medicare saving programs.

There have also been changes in Federal law in where The New York Department of Health requires that the social security administration share the eligibility data with them for those who are applying for the Extra Help Part D medicare. The date where their Medicare Saving program goes into effect must be the same as the date they filed for the extra help subsidy

2 . Enrolling in a Medicare Saving Programs will automatically waive any late enrollment penalties for Part B medicare

There are strict guidelines regarding the time frame one has to enroll in the Part B medicare. These timelines consist of either tuning 65 after which you have to enroll immediately or after receiving social security disability for 24 months. An exception to that may be when an individual or a couple is still working or has a kidney disease that is at its end age. If one fails to get themselves enrolled and registered during these times, their premiums will go up for life as a late enrollment penalty. Now enrolling in a medicare saving program gets rid of any penalties that may come from as a result of late enrollment. This waiver also continues even if one later becomes ineligible for a medicare saving program later on life.

3 . No Liens on the estate of the deceased to recover the cost of the receive benefits under Medicare saving programs

There have been states in the federation that have placed Liens on the Estates of the deceased so that they can recover the cost of benefits received by the deceased recipients of medicaid. Congress then ruled such that protections were expanded to the receivers of the medicare saving programs and no individual that died after the January 1st, 2010 may have liens placed on their estate to recover the cost of the benefits they received under medicaid.

4. Food Stamp benefits will not be reduced or affected in any way despite the income increase due to Medicare Saving Program

The Food stamp benefits are manipulated usually by the amount of income earned. However, once the income goes up thanks to enrolling in the Medicare saving program, the Food stamp income may go down, however, there are some protections in place to circumvent that.

They ask the question whether individuals who receive a Medicare saving program have to report to their SNAP or Food stamp worker about their economic condition and that their income has increased thanks to becoming a part of a medicare saving program since they no longer pay for the premiums that they once had to for Part B Medicare.

The protection an individual or a family that relies on food stamps and Medicare saving programs to meet their end is that they do not have to report the added income which is procured after becoming a part of the medicare saving program until the next time they have to be certified for SNAP or Food stamps. This certification period usually is 24 months till which they can have the Food stamps or Snap according to their old certification.

Now that once the certification happens and a decrease in the food stamp or SNAP payment occurs, the decrease is not dollar for dollar which means that a decrease of a 100 dollars in your medical expenses will generally result in the decrease of about 30 dollar in SNAP or food stamp benefits.

The Enrollment process is automated for the people who have Free Medicare part A

The people who are enrolled for medicaid after attaining the age of 65 years are sometimes automatically enrolled in Medicare saving programs by the New York state Department of Health. The remaining people, however, do need to apply for it themselves.

These are the people who are automatically enrolled in any Medicare Savings program NY belonging to the following categories.

  1. People who are entitled to receive even One dollar of the supplemental security income will be enrolled into the medicare saving program directly without their active involvement. These people are more often than not registered in the Qualified Medical Beneficiary program. This comes into effect once they are eligible for medicare and then start to receive both Part A and Part B.
  2. The People or individuals that have applied for medicaid once they are eligible for medicare are automatically put into the medicare saving program.
  3. Individuals that apply for part D extra help in the social security administration and are then rejected because they do not adhere to the asset limits. These people have then contacted thanks to the data sharing among the institutions and are enrolled directly into the medicare saving programs.

Here is how you apply for the Medicare saving program with Local medicaid program

Individuals or couples who do not have Medicaid and want to apply for medicare saving programs can do so using their social services district that is based in their locality.

Individuals or couples who do not wish to apply for medicaid and are in need of just a medicare savings program should apply using the simplified Medicare saving program application. The application form can be sent via mail and there are no requirements for you to show up and get interviewed.

Individuals who are applying will need the following documents:

  • Copy of Medicare Card with front and back
  • Proof of income
  • Proof of residency

Getting a Medicare Saving Program if you were already covered by Medicaid and just became eligible for Medicare

Individuals who were already covered by medicaid through the affordable care act before being eligible for medicare, however, already were eligible for their part B premiums to be paid using medicaid. Any out of pocket expense was also supposed to be reimbursed.

The procedure with which the premiums for part B outpatient treatments are to be paid for is different for each variant of the medicaid. These differ by whom they were administered and when they were obtained.

The individuals who are receiving medicaid and then change their plan to medicare should automatically be vetted for their medicare saving program eligibility when they are being recertified for medicaid.

If the recipient had Medicaid from the New York State of Health Exchange before getting Medicare

If the Individual had obtained Medicare before they reached the age of 65, they will receive a letter asking them to renew their medicaid using their local district. Their income limit will go down and they may also have an asset limit. There may be individuals who may lose their medicare. That is when they will be enrolled into the Medicare saving program even if they lose their medicaid.

Becoming Eligible for Medicare based on disability and being underage

There may be instances where continued eligibility kicks in. You may have Medicaid, however, you may also have medicare because of your disability. This lasts for about twelve months from authorization.

Seniors without any Medicare

Seniors without any Medicare

There may be seniors who do not have any medicare, be it Part A or Part B can then enroll in the Part A buy in program where medicaid will then pay for their part A premiums.

How are the Part B premiums paid when a Medicare Saving program gets approved

In all the three Medicare saving programs, the medicare administration is entitled to pay all the part B premiums for the recipient of the program. Their premiums are paid even if they are not directly a part of the Medicare. Here is how the entire process happens once a person gets approved for the Medicare saving program.

The Medicare Office that works locally first sends the New York State Department of health the Medicare saving program approval. This information is then shared with the social security administration and the centres for medicare services because of the data sharing guidelines.

The Social security administration which used to deduct the medicare part B outpatient treatments premiums from the social security checks which the recipient used to receive, They stop deducting that amount. They also refund and reimburse any amount that was deducted if the medicare saving program was retroactive and dated back from the month of the application. This process does take a while so you may have to be patient.

The Centre for medicare services also deem the beneficiary of the Medicare saving program eligible for the Part D prescription or Low income subsidy.

Retroactivity in the Medicare Saving Programs

There is a chance for your application to be retroactive and for the benefits to come into effect before you even filed the application.This, however, changes according to the type of the Medicare saving program you get.

For the Qualified Medical beneficiary program, your application will not be retroactive and the benefits only start from the date you have filed in your application.

For The Specified Low Income Medicare beneficiary program, There is a chance that your application may be retroactive for at least three months. If the applicant is deemed eligible, the Social security administration may even reimburse them for any out of pocket expense or the social security deducted.

For the Qualified Individual-1 program there may be retroactive applications for three months for some people. However, this must be within the same calendar year, meaning an application filed in january will not be retroactive to october or november.

Special Rules on Cost sharing in the Qualified Medical Beneficiary

The Qualified Medical Beneficiary is the only category in the Medicare saving plans that can pay for the Co-insurance and your part B premiums. However, there are some limits that apply to it. The Provider of medicare insurance must accept Medicaid. This Drawback is the only thing that limits the Qualified Medical beneficiary program as not all Medicare providers accept Medicaid.

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