409 Medicare Savings Program (MSP)

 

 

Revised 08/28/2020

Policy

The conditions of eligibility for the Medicare Savings Program (MSP) are:

·        Valid application (MA533);

·        Resident of Arizona (MA531);

·        Social Security number (MA532);

·        US citizen (MA507) or appropriate noncitizen status (MA524);

·        Not incarcerated (MA525);

·        Apply for potential benefits (MA526);

·        Assignment of rights to medical benefits and cooperation (QMB only) (MA503); and

·        Income at or below QMB, SLMB or QI-1 requirements (MA615.3, MA615.4 and MA615.5).

 

Definitions

Term

Definition

Medicare Savings Program (MSP)

The MSP provides help with Medicare expenses for customers who are entitled to Medicare Part A.

NOTE     There is no categorical element (i.e., aged, blind or disabled) requirement for the MSP. Persons with End Stage Renal Disease (ESRD) can be eligible, provided they have Medicare Part A..

The MSP offers the following programs:

·        Qualified Medicare Beneficiary (QMB);

·        Specified Low-Income Beneficiary (SLMB); and

·        Qualified Individual-1 (QI-1).

Qualified Medicare Beneficiary (QMB)

For customers who:

·        Meet the general conditions of eligibility;

·        Are entitled to Medicare Part A (MA523);

·        Have income less than or equal to 100% FPL.

Specified Low-Income Medicare Beneficiary (SLMB)

For customers who:

·        Meet the general conditions of eligibility;

·        Receive Medicare Part A (MA523); and

·        Have income greater than 100% FPL but less than or equal to 120% FPL.

NOTE     To be eligible for SLMB, a person does not have to be receiving Medicare Part B. 

Qualified Individual-1 (QI-1)

For customers who:

·        Meet the general conditions of eligibility;

·        Receive Medicare Part A (MA523); and

·        Have income greater than 120% FPL but less than or equal to 135% FPL.

NOTE     To be eligible for QI-1, a person does not have to be receiving Medicare Part B. 

 

 

Service Package

Customers eligible for the Medicare Savings Program (MSP) receive the Medicare Savings Program Service Package (MA302).

 

Enrollment

Customers approved for coverage under the Medicare Savings Program (MSP) are enrolled as follows:

If the customer is...

Then the customer is enrolled in...

QMB

Fee-for-Service (FFS)

·        QMB and:

·        SSI Cash;

·        SSI MAO;

·        AHCCCS Freedom to Work;

·        Caretaker Relative;

·        Pregnant Women;

·        Children;

·        YATI; or

·        State Adoption Subsidy

AHCCCS Complete Care (ACC) plan

QMB and:

·        ALTCS; or

·        AHCCCS Freedom to Work – ALTCS

Program Contractor

SLMB

Not enrolled

·        SLMB and:

·        SSI Cash;

·        SSI MAO;

·        AHCCCS Freedom to Work;

·        Caretaker Relative;

·        Pregnant Women;

·        Children;

·        YATI; or

·        State Adoption Subsidy

AHCCCS Complete Care (ACC) plan

Dual SLMB and AHCCCS Freedom to Work – ALTCS

Program Contractor

QI-1

NOTE     An individual cannot be eligible for QI-1 and any other Medical Assistance program.

Not enrolled

 

Customer Costs

AHCCCS does not charge MSP customers. MSP customers who are not QMBs are responsible for paying to their health care provider:

·        Medicare co-payments;

·        Medicare deductibles; or

·        Medicare co-insurance.

 

Legal Authority

This requirement applies to the following programs:

Program

Legal Authorities

Medicare Savings Program (MSP)

42 USC 1396a(a)(10)(E)

Title 36, Chapter 29, Article 3 of the ARS

Title 9, Chapter 29 of the AAC