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Medicare savings programs

By William C. Lane, PhD
Posted 7/26/20

As I begin writing this article it seems almost impossible that on March 3 Governor Cuomo announced the first confirmed case of person-to-person spread of the COVID-19 virus in New York. Just six …

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Medicare savings programs

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As I begin writing this article it seems almost impossible that on March 3 Governor Cuomo announced the first confirmed case of person-to-person spread of the COVID-19 virus in New York.

Just six days later, Mayor Bill de Blasio announced that there were 16 confirmed cases of the virus in New York City. And, on March16 an article in this newspaper reported the first lab-confirmed case of the virus in Oneida County.

So, we are only a little over four months into this pandemic. When compared to other states New York is currently doing very well in controlling the spread. But unless we remain vigilant that could change. So, remember to continue to wear a mask, practice social distancing, wash your hands often and avoid unnecessary trips.

Telehealth services. I mentioned in last month’s column that I was going to use telehealth for the first time. I actually had two virtual visits, one with a specialist and the other with my internist. Both went very well. The technology was easy to use and both offices were prepared to offer technical support. If you have a checkup that does not require in-office procedures, I recommend that you speak to your physician about using telehealth.

Medicare Savings Programs. A recent detailed post on the Medicare.gov website reminded all beneficiaries that the four Medicare Savings Programs (MSP) are underutilized. These programs are designed to help you pay your Medicare premiums and, in some cases, deductibles, coinsurance and copayments as well.

Too many eligible beneficiaries believe that they either will not qualify or they feel they will lose other benefits. You should be aware that the income and resource levels are increased almost every year. So, if you did not qualify in the past you may quality now.

Eligibility for all MSP programs are calculated using three resources, money in your checking or savings accounts as well as stocks and bonds. The resources that are not countable include the value of your home, one car, burial plot, up to $1,500 for burial expenses, furniture and other household and personal items. Even if you have income from working you may still qualify for one or more of the four programs listed below.

Four types of Medicare Savings Programs. These four MSPs can be confusing but a trained HIICAP counselor can help you sort out the differences. Here is a basic definition for each of the programs as well as their income and resource limits.

Qualified Medicare Beneficiary (QMB) program. The QMB program is designed for beneficiaries known as dual eligibles, those who are enrolled in both Medicare and Medicaid.

For 2020 the monthly income limit for an individual is $1,084 while it is $1,457 for a married couple. The individual resource limit is $7,860 for an individual and $11,800 for a married couple. This program helps you pay for both Medicare Part A and Part B premiums as well as deductibles. According to the Centers for Medicare and Medicaid Services (CMS), 7.7 million people in 2017 were enrolled in a QMB program. 

Specified Low-Income Medicare Beneficiary (SLMB) program. SLMB is a state program that helps people with limited incomes pay for their Part B premiums. All applicants must have Medicare Part A in order to apply. Individuals with incomes below $1,296 and married couples with monthly incomes below $1,744 are eligible. The resource limits for SLMB are $7,860 for individuals and $11,800 for married couples.

Qualifying Individual (QI) program. QI is also a state program that helps people pay for their Part B premiums. However, both the income and resource limits are higher for this program than for the QMB program. But you must reapply every year for QI with benefits granted on a first-come, first-served basis. Preference is given to applicants who are currently on the program. You are not eligible for QI benefits if you are on Medicaid. The income limits are $1,456 for individuals and $1,960 for married couples while the resource limits are $7,860 and $11,800 respectively.

Qualified Disabled and Working Individuals (QDWI) program. This program helps people pay for Part A only, not Part B. To qualify for QDWI you must fall into one of the following categories: (1) be a working disabled person under age 65, (2) have lost your premium-free Part A coverage when you returned to work, (3) are getting medical assistance from New York State or (4) you meet the income and resource limits. Those income limits are $4,339 for individuals and $5,833 for married couples. The resource limits are $4,000 for individuals and $6,000 for married couples.  

If you qualify for QMB, SLMB or QI you automatically qualify for Extra Help in paying for your Medicare Part D drug coverage. All of these are State run programs are administered by your Local Department of Social Services. However, HIICAP counselors can assist you in making the decision to apply. 

Preventing accidental drug overdoses. Next month this column will focus on accidental drug overdoses. This topic was inspired by a recent column by Gary Barg in his excellent Today’s Caregiver newsletter. While the focus of his article is on prescription medications, I will also look at the overuse of over-the-counter (OTC) medications. The on-line subscription to this newsletter is free. Brag also edits and publishes Today’s Caregiver magazine. For information about the newsletter, magazine or other caregiver resources go to www.caregiver.com.  

Who do I contact in Oneida County about MSP programs or any other Medicare related issues? Usually, the paragraph at the end of each article directs readers to one of two locations, the North Utica Senior Citizens Community Center or the Copper City Community Connection (formally the Ava Dorfman Senior Citizens Civic Center), where counselors are available. However, both of these facilities will remain closed until after this emergency is over.  

All HIICAP counseling services are now being provided directly by Oneida County Office for Aging and Continuing Care/NY Connects. Anyone with questions about any issues with your Medicare or long-term care insurance coverage can call the office directly at 315-798-5436 anytime during normal business hours. You will be directed to a trained counselor who can assist you.In order to maintain physical or social distancing all counseling services will be conducted over the telephone. All home visits and face-to-face counseling service have been suspended.

Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer, NY. He writes a monthly column on HIICAP related issues for the OFA.

Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.

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