Medicare Savings Programs - Click to view assest limits
Medicare Savings Programs – Click to view assest limits

Medicare Savings Programs (MSP’s)

Categories of dual eligible beneficiaries
and out-of-pocket costs that must be paid by Medi-Cal – Medicaid:

Ca Health Advocates.org (SHIP – HI Cap)

  1. Qualified Medicare Beneficiary (QMB)
    1. Medicare Part A and Part B premiums; ♦ cost sharing for Part A & Part B benefits.
    2. QMB Plus – Medicare Part A and Part B premiums; cost sharing for Part A & Part B benefits; Full Medicaid benefits.
  2. Specified Low-Income Medicare Beneficiary (SLMB)
    1.  Medicare Part B premium.
    2. SLMB Plus – Medicare Part B premium; Full Medicaid benefits.
  3. Qualified Individual (QI)  
    1.  Medicare Part B premium.
  4. Qualified Disabled Working Individual (QDWI)
    1. QDWI (Qualified Disabled & Working Individual) – Part A premium. (AHIP Training * Medicare & You * CA Health Advocates)
  5. Other FBDE (Full Benefit Dual Eligible) – Medicare Part B premium; Full Medicaid benefits.
  6. 250% California Working Disabled (CWD) *  Evidence of Coverage Page 26 *
  7. How to Apply

Disability Benefits 101

medi helper.com They can help you qualify… they do charge a fee based on the complexity of the case. Free Intake – Assessment Form

Medicare.Gov – Savings Programs

Protecting Dual Eligibles from Balance Billing – Justice in Aging.com Power Point

 

Medicare Savings Programs 2 minutes

Share of Cost

Full Medi-Cal – pays Part A

 

Dual Demonstration Project – Cal Medi Connect

Can get MAPD too – stability, committement, qualify products – quality medical groups –

Plan 1 all UHC

Plan 2 – Health Care Partners – lower co pays

Plan 3 transportation, full network, ancillary benefits look a like plan, includes transportation

How to verify between Cal Medi Connect shows pcp and Medi-Cal Plan – no MD show

Show MAPD card, then don’t have to show Medi-Cal card

Medi-Cal picks up co pays

Continuous SEP

Share of Cost vs Fully qualified

Can no longer dual SNP – look a like plans are OK

 

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