1305 Medicare Savings Program (MSP) Application Process

 

 

 

Revised 11/29/2018

Policy

This section describes application requirements that are specific to the Medicare Savings Program (MSP) program. 

·         Dual Eligibility

·         Receiving SSI-Cash

·         Conditional QMB

·         Medicare buy-in

 

General information about the application process can be found in MA1301 and MA1302

 

1)    Dual Eligibility

People who qualify for QMB or SLMB may also qualify for AHCCCS Medical Assistance.  This is known as “dual eligibility”, because the person is eligible for both programs at the same time.

No dual eligibility is possible for people who qualify for QI-1 because the program requires that the customer cannot be eligible for any other Medicaid program.

 

2)    SSI-Cash Recipients

SSI Cash recipients are automatically eligible for QMB benefits if receiving free Medicare Part A.  These customers do not need to apply for QMB.

SSI Cash recipients who are required to pay a premium for Medicare Part A must apply for QMB.

 

3)    Conditional QMB

Most customers who are eligible for Medicare Part A receive free Part A coverage.  However, some customers are required to pay a monthly premium. 

Customers who are unable or unwilling to pay the Part A premium must apply for Medicare Part A on the condition that their Part A enrollment will only be effective if QMB is later approved.  After filing a conditional Part A application with SSA, these customers must apply for QMB

 

4)    Buy-In Process

When a customer is approved for MSP, the request for Medicare Part A and Part B buy-in is sent to the Centers for Medicare and Medicaid Services (CMS).  Requests are sent in once a month.  CMS processes the request for buy-in and either accepts or rejects the request.  It may take two or three months for payment of the Medicare premiums to begin through the buy-in process.

 

5)    No Medicare Part B but Eligible for SLMB or QI-1

When a customer has Medicare Part A and meets all other requirements, the customer can qualify for SLMB or QI-1 even if they do not have Medicare Part B. The customer can choose to enroll in Medicare Part B and the Part B premium will be paid for through the SLMB or QI-1 eligibility. Customers do not have to enroll in Medicare Part B through this option, and some may not want to enroll. When a customer obtains Medicare part B and later loses eligibility for SLMB or QI-1, they will be responsible to pay the Medicare part B premium. It may take a few months for the buy-in records to update, and the Part B premiums for all months between losing MSP and Social Security records being updated may be deducted at one time from the customer’s Social Security benefit.

 

 

Definitions

 

Term

Definition

Medicare Savings Program (MSP)

Provides help with Medicare expenses for customers who are entitled to Medicare Part A.

Dual Eligibility

A customer is eligible for a Medicare Savings Program as well as another AHCCCS program.

 

Timeframes

 

See MA1301.B for the processing timeframes.