MSP PROGRAMS OFFER $88.50 MORE IN SOCIAL SECURITY CHECKS, PRESCRIPTIONS WITH SMALL CO-PAYS AND EVEN---FOR MANY-- COVERAGE OF MEDICARE DEDUCTIBLES AND CO-PAYENTS

by Thomas P. McCormack 

July19, 2006

The little-known Medical Savings Programs (MSPs) can mean an extra $88.50 monthly in Social Security checks in 2006 and extra medical and prescription drug benefits for disabled and elderly persons who are on Medicare but are not also on SSI or Medicaid already.

Those with Social Security and other income under $1,123* monthly in 2006 will see the Medicare Part B premium ($88.50 in 2006) that’s now being deducted restored to their checks once the Specified Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI) programs begin paying it for them.

Those with Social Security and other income under $837* per month in 2006 will not only have the $88.50 Part B premium restored to their Social Security checks too – the Qualified Medicare Beneficiary (QMB) program will also pay 2006’s hospital admission deductible ($952), its annual doctor bill deductible ($124), the 20% of doctor and outpatient bills that Medicare doesn’t cover and even any Part A premium that may be due.

All patients enrolled in SLMB, QI and QMB became automatically eligible on January 1, 2006 for full, no-deductible, premium-free, very low co-pay Extra Help coverage in a Medicare Part D prescription drug plan.

Both SLMB/QI and QMB are run by state Medicaid programs through local welfare offices – not Social Security offices – even though they involve federal Medicare benefits.  To be eligible for both SLMB/QI and QMB, one can have assets up to $4,000, an automobile and a lived-in home of any value.  An additional $1,500 in savings is permitted if it’s kept separately from other money and the applicant plans to use it for burial. (But some states have even more liberal asset rules and/or more generous income rules.*)

 Applications are taken at local welfare offices – not at Social Security branches. When applying bring birth, death, marriage, divorce, separation and child support/custody papers; citizenship or immigration forms; any pension statements; bank account and other financial asset records; deeds, mortgages, leases and utility bills; auto registrations; job pay stubs; and driver’s licenses or other picture ID cards.  Above all, applicants need to show their Medicare cards and the latest letter from Social Security stating what their benefit total is.  (Call 800-722-1213 for a copy.)

In computing eligibility, it’s the total Social Security amount that counts against the $1,123 and $837 income levels. But checks (or automatic bank deposit statements) only show the net amount – after the Medicare Part B premium is deducted from the total benefit. So, to calculate total income, one must add the $88.50 Part B deduction back onto the net check amount.

Applying for SLMB/QI(I) or QMB at the welfare office can bring a $88.50 monthly income increase for those who qualify, coverage of Medicare deductibles and co-payments too for those who get the more generous QMB coverage---and  full, no-deductible, premium-free, low co-pay Extra Help coverage in a  Part D Medicare prescription drug plan. But again, those who are already on full, regular Medicaid don’t need to apply for QMB, SLMB or QI because (whether they know it or not) the state is already paying their Medicare premiums---and they’ll also be automatically signed up for Part D Extra Help.

AND IF YOU’RE BACK AT WORK OR THINKING ABOUT IT . . .

Social Security Disability Insurance (SSDI) beneficiaries can keep their Medicare even if they return to work – and they should do so, even if they secure employer health coverage.    (When you have a serious illness, two health insurances in force beat only one, and, besides, Medicare covers some things private coverage doesn’t, and it won’t lapse --like the employer plan will-- if you are laid off or become too sick to work again.)  Medicare coverage is available – for a lifetime, even after returning to work – as long as one continues to have the condition which originally qualified one for SSDI.

For those who are working, QMB and SLMB/QI disregard*(that is, don’t count) $65 and half the rest of gross earnings per month, and out-of-pocket medical expenses you pay yourself, before comparing your net, countable income to their eligibility levels. This means that a single person who has given up SSDI to resume work can have gross monthly earnings of $2309*--or more, depending on paid medical expenses--and still get SLMB/QI to pay his Part B premium in 2006.  And, to get QMB to pay the premium and also deductibles, co-payments and any Part A premiums that may be due, one’s total monthly wages must be below $1,719*-- or more, depending on medical costs. Income levels are higher if there are additional family members.

And, after 99 months back at work, Medicare Part A starts charging a premium too (in 2006, either $216 or $393 monthly; you get the lower premium if you’ve already paid Medicare payroll taxes for over 7.5 years while working previously).  But in 2006 single persons with gross monthly earnings under $3,353*--or more depending on medical costs-- can have the welfare office’s Qualified Disabled Working Individual (QDWI) program pay their Part A premiums. QDWI uses the same income-counting and asset rules as QMB, SLMB and QI—but its net, countable income level is twice that of QMB. (In this case, first visit the Social Security office; state that you are a disabled person back at work whose premium-free Part A is expiring and that you wish to complete an “Application for Hospital Insurance” under Section 1818A of the Social Security Act; then go to the welfare office to apply for QWDI if your earnings are low enough.) 

In addition, recent laws now allow over half the states to give full Medicaid to employed disabled persons using income levels far higher than used for disabled persons who are not working; ask the welfare office’s Medicaid staff about eligibility for the working disabled. 

GETTING COVERAGE FOR DRUGS AND OTHER ITEMS NOT COVERED BY MEDICARE, QMB OR SLIMB/QI

Medicare patients who are also eligible for QMB, SLMB and QI became eligible on January 1, 2006 for premium-free, no-deductible, low co-payment Extra Help Part D Medicare drug coverage---as did those who are on full Medicaid. But even now, those applying for QMB, SLMB and QI at welfare offices in Alaska, California, Connecticut, the District of Columbia, Hawaii, Illinois, Maine, Michigan, Missouri, Massachusetts, Minnesota, New Jersey, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont and Virginia should remember that income levels for full Medicaid for the disabled and aged there are at least as high as – or almost as high as – the QMB level. Ask about full Medicaid too there.

Those aged and disabled parents and other relatives who are also raising minor children should note that Medicaid income levels for parents or such other relatives---even if they’re working at modestly-paid jobs--- are much higher than ordinary “welfare” levels in Arizona, California, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Iowa, Massachusetts, Maine, Minnesota, New Jersey, New Mexico, New York, Ohio, Rhode Island, Vermont and Wisconsin. So, for those parents or other related child caretakers on Medicare, it would pay to ask for full Medicaid (called MediCal in California) as well while applying for QMB, SLMB and QI.

 Those who can’t qualify for Medicaid and are HIV-positive and need drug coverage might be eligible for their state’s AIDS Drug Assistance (ADAP) program, which has much higher income limits.  Call (800) 432-AIDS to find out how to contact a state’s ADAP program. 

But, in 2006, if any disabled or aged persons can’t get full coverage for the drugs they need from Medicare, Medicaid or ADAP – and they live in Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Missouri, Montana, Nevada, New Jersey, Rhode Island, Vermont or Wyoming-- there are State Pharmacy Assistance Programs (SPAPs) for the disabled and aged which use income levels higher than for regular Medicaid. (These state drug programs are separate from ADAP; they’re for all aged and disabled persons under state income levels.)  Call the city or county aging office (even if you’re under 65) for details about these state drug programs. Alaska, Indiana, New York, Pennsylvania, South Carolina and Wisconsin have SPAPs for needy residents over age 65, but not for younger disabled ones.

For those not covered by any of these programs, the AIDS Treatment Data Network (800-734-7104) [ http://www.aidsinfonyc.org/network/access/pa.html  on your own or the public library’s computer] has a list of free AIDS drug programs run by distributors; the Pharmaceutical Manufacturers’ Association (202-835-3400) has a list of free programs [ www.volunteersinhealthcare.org or http://rxassist.org and http://PhRMA.org/patients/index.html on your own or the library’s computer] for all  kinds of drugs run by the industry, and patients’ doctors can order free prescriptions for those who have no other way to pay.

Income levels for these programs are higher in Alaska and Hawaii (see the Assistant Secretary for Planning and Evaluation pages at www.dhhs.gov for their poverty levels). For those with no earnings, subtract $20 from gross before comparing net income to the appropriate eligibility level; for those working , subtract $85 and half the rest of gross earnings, plus paid medical expenses, before comparing net income to the eligibility level. The income levels quoted here are based on the year 2006 poverty level figures which are updated by the federal government late each February at www.dhhs.gov.

* For example, CT, IL, ME, MS and other states have higher income levels---and AL, AZ, CT, DE, MS, NY and other states have no asset test---for some or all of their MSP programs.  See http://www.healthassistancepartnership.org/assets/docs/chart_-_more_liberal_state_rules-rev033a.doc for chart of more liberal income and asset rules used by some states. Also, in early 2006, the District of Columbia raised its QMB and SLMB income levels to 3 times the SSI payment level ($1809 monthly for one person in 2006). Also see  “The Role of the Asset Test…” at www.cmwf.org.