32.1 Medicare Savings Programs

32.1.1 Medicare Savings Programs (MSP) Introduction

32.1.5 Part B Enrollment Via The MSP Buy-In Program

32.1.1 Medicare Savings Programs (MSP) Introduction

Medicare is the health insurance program administered by the federal Centers for Medicare & Medicaid Services ( CMS ) for people over 65 and for certain younger disabled people. People who receive Medicare are referred to as Medicare beneficiaries.

Medicare is divided into three types of health coverage. Hospitalization Insurance (Part A) pays hospital bills and certain skilled nursing facility expenses. Medical Insurance (Part B) pays doctors' bills and certain other charges. Drug Insurance (Part D) pays for prescription drug charges.

Medicare, being an insurance program, charges coinsurance, deductibles and monthly premiums. These out-of-pocket charges to Medicare beneficiaries are generally referred to as "Medicare cost-sharing.” For certain Medicare beneficiaries participating in the programs described below, Wisconsin Medicaid pays some or all of their Medicare cost-sharing. These programs are called " Medicare Savings Programs .” (They are also referred to as " Medicare Premium Assistance ,” or "Medicare Buy-In” programs.)

Use the same rules for determining financial eligibility as you do for Medicaid.

The following are types of Medicare beneficiaries that receive the Medicaid benefits described in 32.1.3:

Qualified Medicare Beneficiary ( QMB ). See 32.2 QMB.
Specified Low-Income Medicare Beneficiary ( SLMB ). See 32.3 SLMB.
Specified Low-Income Medicare Beneficiary Plus (SLMB+), also known as Qualifying Individuals - 1 (QI-1). See 32.4 SLMB+.
Qualified Disabled and Working Individuals ( QDWI ). See 32.5 QDWI.

If a member is also eligible for Medicaid, they will receive a ForwardHealth card. The ForwardHealth card will indicate that they are Medicare Beneficiaries.

Members eligible for QMB will receive a forward card even if he or she is not eligible for any other subprograms of Medicaid.

32.1.2 MSP Fiscal Test Group

The fiscal test group ( FTG ) size is two when a couple is living together at home. If they are both living in the same nursing home, each person is an individual FTG.

32.1.3 MSP Benefits

QMB Medicaid pays Medicare Part A & B premiums and Medicare deductibles, copays, and coinsurance.
SLMB Medicaid pays Medicare Part B premiums.
SLMB +. Medicaid pays Medicare Part B premiums.
QDWI Medicaid pays Medicare Part A premiums.

32.1.4 LIS Requests

See 2.6.5 Low Income Subsidy (LIS) Program of Medicare Savings Programs (MSPs) for information on LIS Requests for MSP .

32.1.5 Part B Enrollment Via The MSP Buy-In Program

Members receiving Medicare Part A coverage, who chose not to enroll in Part B, may be eligible for the State to enroll them into Part B with no increase in the premium, via the MSP Process. The MSP eligibility should be determined in CWW . If the member is eligible for MSP, the worker must contract the ForwardHealth Medicare Buyin Analyst by phone, email, or by filling out a F-10110 stating when the member will begin their Buyin eligibility. The Buyin analyst will create a manual transaction to send to CMS with the appropriate MSP information. Once CMS processes the record, the member should be enrolled into Part B with coverage beginning the first month of MSP eligibility.

Example 1: In January, the member applies for QMB benefits and is only receiving Part A Coverage. The case worker determines the member qualifies for QMB starting February. After the confirmation is done in CARES, the worker contacts the ForwardHealth Buyin Analyst to report the enrollment. The Buyin Analyst creates a transaction with the QMB information. This transaction is sent to CMS in February.

Once CMS processes the record and bills the State, the member will show Part B coverage starting in February.

This page last updated in Release Number: 15-01

Release Date: 06/10/2015

Effective Date: 06/10/2015