Ch 13-MSP Flashcards
What is MSP?
MSP is a medical program which benefits Medicare recipients by paying cost associated with Medicare insurance, commonly known as QMB, SLMB, and QI-1.
When do you evaluate for MSP?
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.
What does MSP stand for?
MSP stands for Medicare Saving Programs
What is Medicare?
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.
Medicare for disabled people, please explain
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
How many parts does Medicare have?
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.
Is Medicare free?
No, Medicare is not free
What are some of the costs included in Medicare?
Some costs include penalties, deductibles, coinsurance fees, and premiums for part Aand part B
What are some of the benefits of the Medicare savings program?
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
What is the difference between QMB, SLMB, and QI-1?
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
Are there property limits with MSP
Yes, there are property limits for MSP that are the same as for non-magi programs
When does evaluations for the MSP programs be made?
They must be made an application, RRR, or when the county receives information that the customer is now receiving Medicare
How do you evaluate for MSP?
You use the same medical income methodology, except for deductions for health insurance, and Medicare premiums are NOT allowed
What are the aid codes for Medicare savings programs?
QMB-80,
SLMB-8C,
QI1-8D
Does Medicare status need to be verified for MSP?
Yes, Medicare status must be verified to qualify for MSP
When do penalties occur for applicants?
Those who do not apply for part A and B during the enrollment periods, are charged a penalty turn when they turn 65
How much does Medicare pay?
Medicare pays 80% and the beneficiary pays 20%. Deductibles must be paid before Medicare will be billed.
What happens if you have an MSP that can pay for the cost associated with part A and part B insurance?
Medicare premiums will no longer be deducted from your SSA check
For MSP’s QMB what happens if a person currently does not have Part A insurance?
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.
What is the effective date for the QMB?
The QMB effective date is the first day of the month, following the dates on which the county makes the determination of eligibility
Does the customer need to receive Medi-Cal to receive QMB?
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.
What is dual eligible with QMB?
Dual eligible is QMB and Medi-Cal. Medi-Cal will cover medical expenses, not covered by Medicare.
What is covered under SLMB?
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.
What is the benefits of QI-1?
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.
What does MSP stand for?
MSP stands for medical savings programs.
