Ch 13-MSP

Question 1

What is MSP?

Answer 1

MSP is a medical program which benefits Medicare recipients by paying cost associated with Medicare insurance, commonly known as QMB, SLMB, and QI-1.

Question 2

When do you evaluate for MSP?

Answer 2

Evaluate for MSP for all MSP because of Medicare cost (example part B-164.90) monthly cost. We want to help a customer bring down cost so we always evaluate for MSP.

Question 3

What does MSP stand for?

Answer 3

MSP stands for Medicare Saving Programs

Question 4

What is Medicare?

Answer 4

Medicare is insurance and coverage programs administered by the Social Security administration (SSA ) for people, age 65 and older, and those under age 65 who’ve been deemed disabled for certain disabilities. Other individuals eligible for Medicare are those receiving dialysis related healthcare services. Medicare is a federally administered health insurance program for qualified persons.

Question 5

Medicare for disabled people, please explain

Answer 5

Those under 65 and who have been deemed disabled for certain disabilities, disabled individuals, have to have been deemed disabled for 24 months before being eligible for Medicare

Question 6

How many parts does Medicare have?

Answer 6

Medicare has three parts: Part A it covers hospital, skilled nursing home health, hospice, other. Part B, which covers doctors services, outpatient hospital, diagnostic test, medical equipment, ambulance, many other services and supplies. Part D cover is prescription, drugs, part D premiums and deductibles are allowed as a deductible in MC charge determining program eligibility, and share of cost.

Question 7

Is Medicare free?

Answer 7

No, Medicare is not free

Question 8

What are some of the costs included in Medicare?

Answer 8

Some costs include penalties, deductibles, coinsurance fees, and premiums for part Aand part B

Question 9

What are some of the benefits of the Medicare savings program?

Answer 9

A Medicare savings program (MSP) (QMB,SLMB, QI-1) can pay for the cost associated with part A and part B insurance, therefore increasing the monthly spendable income in your pocket

Question 10

What is the difference between QMB, SLMB, and QI-1?

Answer 10

QMB-100% FPL (the customer must have Part A) and this pays for Medicare part A and B premiums coinsurance, deductibles and penalty fees
SLMB -120% FPL (customer must have Part A) medicare pays for part B premiums only
QI-1-135%FPL (customer must have Part A) pays for Medicare part B premiums only

Question 11

Are there property limits with MSP

Answer 11

Yes, there are property limits for MSP that are the same as for non-magi programs

Question 12

When does evaluations for the MSP programs be made?

Answer 12

They must be made an application, RRR, or when the county receives information that the customer is now receiving Medicare

Question 13

How do you evaluate for MSP?

Answer 13

You use the same medical income methodology, except for deductions for health insurance, and Medicare premiums are NOT allowed

Question 14

What are the aid codes for Medicare savings programs?

Answer 14

QMB-80,
SLMB-8C,
QI1-8D

Question 15

Does Medicare status need to be verified for MSP?

Answer 15

Yes, Medicare status must be verified to qualify for MSP

Question 16

When do penalties occur for applicants?

Answer 16

Those who do not apply for part A and B during the enrollment periods, are charged a penalty turn when they turn 65

Question 17

How much does Medicare pay?

Answer 17

Medicare pays 80% and the beneficiary pays 20%. Deductibles must be paid before Medicare will be billed.

Question 18

What happens if you have an MSP that can pay for the cost associated with part A and part B insurance?

Answer 18

Medicare premiums will no longer be deducted from your SSA check

Question 19

For MSP’s QMB what happens if a person currently does not have Part A insurance?

Answer 19

If a customer does not have part A they must apply at the SSA office. The benefits cannot start until the client is receiving part A.

Question 20

What is the effective date for the QMB?

Answer 20

The QMB effective date is the first day of the month, following the dates on which the county makes the determination of eligibility

Question 21

Does the customer need to receive Medi-Cal to receive QMB?

Answer 21

No a customer does not need to receive Medi-Cal to meet eligibility requirements. If QMB only, customer does not want medical coverage or already received MC through SSI or CalWorks.

Question 22

What is dual eligible with QMB?

Answer 22

Dual eligible is QMB and Medi-Cal. Medi-Cal will cover medical expenses, not covered by Medicare.

Question 23

What is covered under SLMB?

Answer 23

For SLMB there is property limits. Customer must be eligible for part A. If customer does not have part A, they must apply at the SSA office benefits cannot start until the client is receiving part A. They are eligible affective month of application. And they can receive up to three months of retroactive coverage.

Question 24

What is the benefits of QI-1?

Answer 24

Customer must have part A. Pays for Medicare part B premiums only they have property limits and have an SOC. They are eligible affective month of application. Can receive up to three months of retroactive coverage.

Question 25

What does MSP stand for?

Answer 25

MSP stands for medical savings programs.