Medicare can be confusing, but it does not have to be. Since Medicare Parts A, B, C, and D are most used, you should understand them and know how they work. The chart below highlights basic information about what is covered by each one.
| Part A – hospital/inpatientPart B – medical/outpatientPart C -Medicare Advantage PlansPart D – Medicare prescription drug |
Whether you are disabled, turning 65 years old, or are eligible to apply for Medicare for health reasons, it would be prudent to obtain a financial readiness checkup to know where you stand. Acting in this manner would also help you to find out what other resources are available to assist you and make your healthcare affordable. There are programs that have income limits to help Medicare beneficiaries for Parts A-D.
To be eligible for Part A, you must be 65 years or older, and you or your spouse must have worked and paid Medicare taxes for at least 10 years. If you are receiving retirement benefits for Social Security or Railroad Retirement Benefits (RRB) at least 4 months prior to your eligibility for Medicare, you are automatically enrolled. Your premiums for Parts A and B are free. Part B is voluntary. However, eligibility is based on how you qualify for Part A, with or without a premium. Part C, also known as Medicare Advantage Plans (like an HMO or PPO), are provided by private, pre approved health insurance companies. Medicare provides a fixed amount for your care to them monthly. Part D is usually paired with a Medicare supplemental plan. The costs vary based on the plan you choose.
If you are eligible to receive Medicare Part A, one of the programs that can help pay for coverage with Medicare Part B premiums; Medicare cost-sharing or co-insurance; and Part A premiums is the Medicare Savings Program (MSP). There is also Medicare Assistance for the Aged, Blind and Disabled (MA-ABD) population.
The MSP is designed to help people who would not otherwise be able to afford Medicare. Part B Medicare premiums can be paid through four programs under the MSP. They include: the Qualified Medicare Beneficiary (QMB); the Specified Low-Income Medicare Beneficiary (SLMB); the Qualified Individual (QI); and the Qualified Disabled and Working (QDWI).
Each program has income and resource limits based on marital status and household size. The QMB; SLMB; and QI are based on marital status. However, the QDWI and MA-ABD are based on the household size.
MSP Monthly Income Limits
Marital Status QMB* SLMB** QI** Resource Limit
| Single | $1,153 | $1,379 | $1,549 | $8,400 |
| married | $1,546 | $1,851 | $2,080 | $12,600 |
*Pays for Part A premiums if the beneficiary owes them, Part B premiums, Part A and B cost-sharing, deductibles,
and co-payments
**Pays for Part B only if you have Part A and limited income and resources
If you qualify for the QMB, SLMB or QI, you automatically qualify for extra help with paying for Part D, Medicare prescription drug coverage.
Household Size QDWI Resource Limit MA-ABD Resource Limits
| 1 | $4,615 | $4,000 | $350 | $2,500 |
| 2 | $6,189 | $6,000 | $392 | $3,000 |
Pays for Part A premiums if you are disabled, working, or lost your SSD benefits (Social Security Disability) and free Part A benefits if you have returned to work
You cannot receive QI benefits if you qualify for Medicaid. Claimants will have to be determined ineligible for QMB to be eligible for a SLMB. The countable resources for the resource limits are checking and savings accounts, and stocks and bonds. Although considered a resource, such as your home, one car, burial for up to $1,500, and burial plot, it is not countable for an MSP.
If you do not fit into any of the categories referenced above, you can apply for Social Security Disability Insurance (SSDI) to determine you qualify for it. To be eligible, you must have worked long enough to earn a certain number of credits (60 months for 10 years before applying), and paid Social Security taxes (FICA). If you haven’t worked long enough and your income and assets are low, you can see if you are eligible for Supplemental Security Income (SSI). You must have earned up to four credits each year to be eligible for this.
Remember to always check the state where you live to find out income and resource limit requirements.
Recap: In the article entitled “ Balanced Billing (6/17/22),” I talked about billing waivers, patient responsibility, and what you are agreeing to as an insuree. Keep in mind, the purpose of the billing waiver is to make you aware of deductibles, co-pays, co-insurances, and your responsibility for any monies owed. You can decline to sign it, which is also stipulated in the billing waiver, however, if you decline to sign, the claim to your insurer will be rejected and your doctor’s office can still send you a bill to cover the cost of treatment.
Did You Know?
Always let the provider know when you have an MSP to avoid getting a bill. Medicare providers are not allowed to bill you for services that are covered under Medicare. This includes co-payments; co-insurance; and deductibles. If this does occur, contact Medicare at 1-800-633-4227.
If you have questions or would like to read about a specific healthcare topic, please send correspondence by email to LrTBrooks@gmail.com. I look forward to your engagement.