409.00 Medicare Savings Program

 

A. General Description

 

The Medicare Savings Program provides help with Medicare expenses for people who are entitled to Medicare Part A.

 

NOTE: There is no categorical element (age 65 years or older, blind, or disabled) requirement for the Medicare Savings Program. Persons with end stage renal disease can be eligible for the Medicare Savings Program, even if DDSA does not determine them disabled, provided that they have Medicare Part A.

 

Medicare Savings Program (MSP) offers the following programs:

 


 

B. Who Determines Eligibility?

 

The Arizona Health Care Cost Containment System Administration (AHCCCSA) determines eligibility for the Medicare Savings Program.

 


 

C. General Conditions of Eligibility

 

The general conditions of eligibility applicable to Medicare Savings Program are:

 


 

D. Special Conditions of Eligibility

 

The special conditions of eligibility for Medicare Savings Program are listed in the following chart:

 

IF the customer... AND... THEN the customer qualifies under...
Meets the general conditions of eligibility
  • Is entitled to Medicare Part A (MS 521.00);

  • Cooperates with TPL requirements (MS 504.00); and

  • Has income less than or equal to 100% FPL (MS 615.00.D).

 

NOTE: AHCCCS automatically pays the Medicare costs for many of the Medicaid coverage groups, so a separate QMB eligibility determination is not necessary. However, a separate QMB determination is needed for the following coverage groups/key codes:

  • AHCCCS Care (In the following Key codes only 585, 587, 463, 467)

  • AHCCCS Freedom to Work (Key codes 393, 403, 482, 492, 725, 735)

  • Pregnant Women (Key codes 120, 360, 361, 464)

  • S.O.B.R.A. Child (Key codes 100, 350, 351, 462)

  • State Adoption Subsidy (Key code 265)

  • Young Adult Transitional Insurance (YATI) (Key code 275)

 
Qualified Medicare Beneficiary (QMB)
Meets the general conditions of eligibility
  • Receives Medicare Part A (MS 521.00); and

  • Has income greater than 100% FPL but less than or equal to 120% FPL (MS 615.00.E).

 

NOTE: AHCCCS automatically pays the Medicare Part B premium for many of the Medicaid coverage groups, so a separate SLMB eligibility determination is not necessary. However, a separate SLMB eligibility determination is needed for the following coverage groups/key codes:

  • AHCCCS Freedom to Work (Key codes 393, 403, 482, 492, 725, 735),

  • Pregnant Women (Key codes 120, 360, 361, 464),

  • S.O.B.R.A. Child (Key codes 100, 350, 351, 462),

  • State Adoption Subsidy (Key code 265),

  • Young Adult Transitional Insurance (YATI) (Key code 275)

 

NOTE: To be eligible for SLMB, an individual does not have to be receiving Medicare Part B. If an individual is not enrolled in Medicare Part B at the time of the SLMB application, the Medicare Part B enrollment occurs when the state buy-in is processed by MDMA. Refer to How to Process Applications for Medicare Savings Program for People Who do Not Have Part B.

 
Specified Low-Income Medicare Beneficiary (SLMB)
Meets the general conditions of eligibility and is not eligible for Medicaid through any of the programs at MS 101.00.B.
  • Receives Medicare Part A (MS 521.00); and

  • Has income greater than 120% FPL but less than or equal to 135% FPL (MS 615.00.F).

 

NOTE: To be eligible for QI-1, an individual does not have to be receiving Medicare Part B. If an individual is not enrolled in Medicare Part B at the time of the QI-1 application, the Medicare Part B enrollment occurs when the state buy-in is processed by MDMA. Refer to How to Process Applications for Medicare Savings Program for People Who do Not Have Part B.

 
Qualified Individual-1 (QI-1)
  • Lost Title II disability benefits due to earnings;

  • Lost entitlement to free Medicare Part A due to earnings

  • Entitled to enroll for Medicare Part A (Premium HI) (MS 521.00);

  • Continues to be disabled (MS 511.00);

  • Is not otherwise entitled to any other Medicaid benefits; and

  • Has income less than or equal to 200% FPL (MS 615.00.G).

 
Qualified Disabled Working Individual (QDWI)

 


 

E. Service Package

 

Customers eligible for Medicare Savings Program receive the Medicare Savings Program Service Package (MS 302.05).

 


 

F. Customer Cost

 

AHCCCS does not charge Medicare Savings Program customers. Medicare Savings Program customers who are not Qualified Medicare Beneficiaries (QMB) are responsible for paying Medicare co-payments, deductibles or co-insurance to the health care provider.

 


 

G. Enrollment

 

Customers approved for coverage under MSP are enrolled as follows:

 

IF the customer is... THEN the customer is enrolled in...
QMB

Fee-For-Service (FFS)

Dual QMB and:

  • SSI cash;

  • AF related;

  • SSI MAO;

  • AHCCCS Freedom to Work;

  • Pregnant Women; or

  • S.O.B.R.A. Child

AHCCCS Health Plan (PHP)

Dual QMB and:

  • ALTCS: or

  • AHCCCS Freedom to Work-ALTCS

Program Contractor (PC) or FFS in a FFS county

SLMB

Not enrolled

Dual SLMB and:

  • AHCCCS Freedom to Work

  • Pregnant Women

  • S.O.B.R.A. Child

  • Young Adult Transitional Insurance (YATI)

  • State Adoption Subsidy

AHCCCS Health Plan (PHP)

Dual (SLMB and AHCCCS Freedom to Work-ALTCS)

Program Contractor (PC) or FFS in a FFS county

QI-1

Not Enrolled

QDWI

 


 

H. Legal Authorities

 

The table below shows the legal authorities and the references applied to Medicare Savings Program eligibility.

 

Legal Authority

References

United States Code 42 USC 1396a(a)(10)(E)
Arizona Revised Statute (ARS) Title 36, Chapter 29, Article 3
Arizona Administrative Code (AAC) Title 9, Chapter 29

 


 

I. PMMIS Key Codes

 

Listed below are the PMMIS eligibility key codes and a description of each.

 

Code

Description

800 QMB Only, Other
810 QMB Only, Over Age 65
820 QMB Only, Blind
830 QMB Only, Disabled
840 SLMB
850 QI-1