TN 15 (10-09)
HI 00815.024 SSA’s Role in Medicare Savings Programs (MSP) Applications
Social Security Act Section 1144
A. Background on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
Public Law 110-275, MIPPA amends the Social Security Act to require that applications for Extra Help (SSA-1020) effectively filed on or after January 1, 2010 will start the application process for Medicare Savings Programs (MSP) benefits unless the beneficiary objects. In addition, effective January 2010, MIPPA amended the Act to make the resource limits for the Qualified Medicare Beneficiary program, Specified Low-Income Medicare Beneficiary program, and Qualifying Individual program the same as the resource limits for individuals who qualify for the full low-income subsidy under the Medicare prescription drug coverage program. This MIPPA provision does not apply to the Qualified Disabled Working Individual program.
MSPs are administered by the States. Unless the beneficiary refuses on the Extra Help (also known as low income subsidy or LIS) application, data from the Extra Help determination will be sent daily (except Saturdays, Sundays, and holidays) to the appropriate state Medicaid agency to begin the MSP application process. See HI 03010.005 and HI 03010.010 regarding interviewing and filing procedures for Extra Help.
Social Security is also not sending data to the state Medicaid agency if the beneficiary is already deemed (see HI 03001.005A for definition of deemed) for LIS or the application received is a duplicate or the beneficiary’s LIS application was denied because he was not a US resident.
B. Description of the MSP
A Medicare beneficiary may qualify to get help paying for their Medicare Part A and/or Part B premiums. States have programs that can help pay their Medicare expenses like premiums, deductibles, and coinsurance.
There are four Medicare Savings Programs:
Qualified Medicare Beneficiary (QMB)
Specified Low-Income Medicare Beneficiary (SLMB)
Qualifying Individual (QI or QI-1)
Qualified Disabled & Working Individuals (QDWI)
If a beneficiary qualifies for QMB, SLMB, or QI, he or she automatically qualifies for Extra Help, which pays for all costs, except for a minimal co-payment of Medicare prescription drug coverage (see the chart in HI 03001.005G.1).
To qualify for the QMB, SLMB, or QI programs a beneficiary must meet all of these conditions:
Have Medicare Part A (hospital insurance) including Premium-free HI or Premium HI for the Aged, but excluding Premium HI for the Working Disabled;
Reside in a state or the District of Columbia; and
Meet the following standard income and resource limits:
2017 limits – Single person – monthly income of $1,377 or less (higher in Alaska and Hawaii) and resources not more than $8,890.
Married and living together – monthly income of $1,847 or less (higher in Alaska and Hawaii) and resources not more than $14,090.
2016 limits – Single person – monthly income of $1,357 or less (higher in Alaska and Hawaii) and resources not more than $8,780.
Married and living together – monthly income of $1,823 or less (higher in Alaska and Hawaii) and resources not more than $13,930.
To qualify for the QDWI program, a beneficiary must:
Have lost entitlement to free Part A solely because of substantial gainful activity (SGA);
Continue to be disabled and under age 65;
Reside in a state or the District of Columbia;
Not be otherwise eligible for Medicaid;
Be eligible to enroll in Medicare Part A; and
Meet the following income and resources limits:
2017 limits – Single person – monthly income of $4,105 or less (higher in Alaska and Hawaii) with resources not more than $4,000.
Married and living together – monthly income of $5,499 or less (higher in Alaska and Hawaii) with resources not more than $6,000.
2016 limits – Single person – monthly income of $4,045 or less (higher in Alaska and Hawaii) with resources not more than $4,000.
Married and living together – monthly income of $5,425 or less (higher in Alaska and Hawaii) with resources not more than $6,000.
Only the state can determine if an individual qualifies for coverage under one of these programs. Many states apply different standards and methods to determine MSP eligibility. Some states, for example, have no resources for these programs or figure the income and resources differently.
NOTE: For more information regarding MSP, see HI 00815.023 and HI 00815.025. Additional information regarding QDWI is found in HI 00801.170.
The chart below explains how MSP can help with Medicare expenses:
Medicare Savings Programs
Helps Pay For
Part A and Part B premiums and other covered cost-sharing expenses like deductibles and coinsurance.
Part B premiums only
Part B premiums only
Part A premiums only
C. Beneficiary requests information about MSP
If a beneficiary requests an MSP application, check the Medicare Application Processing System (MAPS). If listed in MAPS, check the effective filing date of the Extra Help application. If the application was effectively filed on or after January 1, 2010, and the applicant did not refuse data referral to the state, explain that the Extra Help application was also an application for MSP and that he or she should hear from the state soon. If the beneficiary still requests current status refer the beneficiary to the state medical assistance office (Medicaid).
If MAPS shows the beneficiary refused data referral to the state or the Extra Help application was effectively filed before January 1, 2010, explain the Medicare Savings Programs and refer the beneficiary to the State Health Insurance Counseling and Assistance Program (SHIP) for more information. You can use this language: “Beneficiaries can obtain assistance through their State Health Insurance Counseling and Assistance Program. SHIP telephone contact information is on the back of the Medicare & You handbook or may be accessed by selecting the state at http://www.medicare.gov/contacts/organization-search-criteria.aspx or through SSA’s web site located at www.socialsecurity.gov/prescriptionhelp
If the beneficiary is on the phone and not listed in MAPS, ask if you can refer him or her for an Extra Help application (or mail an application). If the beneficiary is in the field office offer to complete an application for Extra Help. Explain that unless they tell us otherwise, the Extra Help application will start the MSP process with their state. Also, explain the MSP benefits to the beneficiary. See HI 00815.025 for more information about MSP.
D. MSP Applications and the Extra Help program
If a beneficiary calls and wants an MSP application (regardless of whether he or she wants to file an Extra Help application), ask if he or she has computer access.
If yes, explain that an application is available at SSA.gov in English and also available in 10 other languages. They can scroll down on the right side, where the forms are located under “Additional Resources,” and click on “Medicare Savings Programs Model Application for Premium Assistance," or they can scroll down the middle and click on “The Official Government Site for People with Medicare.”
If no, or the individual wants the application from SSA, print the model application in the appropriate language from SSA.gov and mail it.
The available languages are English, Arabic, Chinese, French, Haitian-Creole, Farsi, Korean, Spanish, Tagalog, Russian, and Vietnamese.
Even if the state uses a different MSP application form from the model forms on SSA’s web pages, when the state receives this form from the beneficiary it will start the MSP application process.
E. Procedure on obtaining status inquiries on MSP Applications
Refer beneficiaries to their state Medicaid agency for any inquiries concerning the status of their MSP application.
HI 00815.023, Medicare Savings Programs Income Limits
HI 00815.025, SSA Outreach to Low-Income Medicare Beneficiaries – Extra Help and Medicare Savings Programs
HI 03001.001, Description of the Medicare Part D Prescription Drug Program
HI 03001.005, Medicare Part D Extra Help (Low Income Subsidy or LIS)
HI 03010.005, Interviewing for Medicare Part D Extra Help
HI 03010.010, Filing Applications
HI 00801.131, Eligibility for Premium-HI
HI 00801.139, QMB Provisions
HI 00801.170, Premium-HI for the Working Disabled
TC 23001.050, Qualified Medicare Beneficiaries (QMB)
TC 23001.060, Specified Low-Income Medicare Beneficiaries (SLMB)
TC 23001.070, Qualifying Individual 1 (QI1)
MSOM INTRANETMEDQ 001.001, Medicare Query System (MEDQ)