DEAR SENIOR LEGAL LINE:
I am enrolled in Medicare, but am finding it difficult to pay the monthly premium on my small income and still pay for my basic expenses. Is there any program that will help me pay for the Medicare premium? The catch is that I do not want my house to be at risk of a lien if the government pays for my premiums. Is my wish a pipe dream?
Your wish is not a pipe dream! There are programs that will pay for your Medicare premiums and will not result in a lien on your house. The programs are collectively called Medicare Savings Programs (or MSP, in social service parlance). They were formerly known as Medicare Supplement Programs. These relatively little-known programs can by quite helpful as they can pay for some Medicare premiums, co-pays, and deductible costs.
The specific programs are: QMB, SLMB, QI and QWD. This alphabet soup is short for Qualified Medicare Beneficiary (QMB), Service Limited Medicare Beneficiary (SLMB), Qualified Individual (QI), and Qualified Working Disabled adult (QWD). The following provides some information about the eligibility guidelines and what the programs pay for, but for further information, I recommend that you contact your local Health and Human Services Department. All of these programs disregard $20 from the monthly income, so the figures below have already subtracted $20 from the income. Remember, because these programs base their eligibility on the federal poverty guidelines, the figures change every year. Also, your home is not counted when determining asset eligibility.
1. Qualified Medicare Beneficiary (QMB) - (100% FPG) Pays Medicare Part A and Part B premiums, co-pays, and deductibles. Eligible if income is equal or less than $923 per month for an individual and $1235 per month for a couple; countable assets are equal or less than $10,000 for an individual and $18,000 for a couple.
2. Service Limited Medicare Beneficiary (SLMB) - (120% FPG) Pays Medicare Part B premiums. Eligible if income is equal or less than $1,103 per month for an individual and $1,477 per month for a couple; countable assets are equal or less than $10,000 for an individual and $18,000 for a couple.
3. Qualified Individual (QI) - (135% FPG) Pays Medicare Part B premiums, but there is limited funding. Eligible if income is equal or less than $1,239 per month and $1,660 for a couple; countable assets are equal or less than $10,000 for an individual and $18,000 for a couple.
4. Qualified Working Disabled adult (QWD) – (200% FPG) This program is available for people who have not yet become eligible for Medicare based on their age. In other words, some employed disabled people under 65 lose their RSDI benefits and Medicare benefits if their income is over the substantial gainful activity limits. If they are blind or disabled and are eligible to enroll in Medicare Part A with a premium under the Qualified Working Disabled Adult provisions of the Social Security Act, they can apply for QWD. Eligible if income is equal or less than $1,805 per month and $2,429 for a couple; countable assets are equal or less than $4,000 for an individual and $6,000 for a couple.
Because the Medicare Savings Programs follow Medical Assistance (aka Medicaid) policies, unless specifically exempted by law, a lien would normally result. However, the law recently changed so that no lien will result from receiving Medicare Savings Program benefits. The Minnesota legislature changed the definition of “Medical Assistance” for estate recovery purposes to not include the cost of any Medicare cost-sharing benefits. The Minnesota legislature was acting in response to the “Medicare Improvements for Patients and Providers Act of 2008” also known as MIPPA. MIPPA prohibits States from including in an estate claim certain Medicare cost-sharing benefits paid while the deceased was enrolled in a Medicare Savings Program (MSP). Under Minnesota Statutes Section 256B.15 subdivision (1)(c): “For purposes of this section, beginning January 1, 2010, ‘medical assistance’ does not include Medicare cost-sharing benefits in accordance with United States Code, title 42, section 1396p.” Thus, this appears to mean that starting on January 01, 2010, there is no claim to repay the benefits you receive under QMB, SLMB, QI and/or QWD, and thus no risk of lien placed on your home for these benefits.
Thus, these Medicare cost savings programs became even more helpful to low income beneficiaries. Please contact your local Health and Human Services department for further information.
This column is written by the Senior Citizens’ Law Project. It is not meant to give complete answers to individual questions. If you are 60 years of age or older and live within the Minnesota Arrowhead Region, you may contact us with questions for legal help by writing to: Senior Citizens’ Law Project, Legal Aid Service of Northeastern Minnesota, 302 Ordean Bldg., Duluth, MN 55802. Please include a phone number and return address. To view previous articles, go to: www.lasnem.org. Reprints by permission only.