580 MEDICARE SAVINGS PROGRAM

580 MEDICARE SAVINGS PROGRAMS

What is it?

Medicare Savings Programs help Medicare recipients pay for all or part of their Medicare premiums.

Medicare Savings Programs generally use the financial and non-financial eligibility of the APA Adult Public Assistance and SSI Supplemental Security Income programs, except that the resource limits are higher.

Who is eligible?

Medicare recipients who meet income and resource requirements. The Medicare recipient must meet all non-financial requirements for SSI Supplemental Security Income / APA Adult Public Assistance related Medicaid (i.e., filing an application, Social Security number, citizenship, residency, assignment of rights) or MAGI Parent/Caretaker Relative category as explained in MAGI MS 816 .

Note: Effective October 1, 2026 individuals must also meet Medicaid qualified alien requirements. Refer to section 522 and MAGI Manual Section 808 for policy on U.S. citizenship and eligible alien status.

Caseworkers must automatically enroll SSI Supplemental Security Income recipients who are enrolled in Medicare part A in the QMB Qualified Medicare Beneficiaries program the first of the month after Medicaid eligibility is determined.

SLMB Specified Low Income Medicare Beneficiaries benefits are available for the three months before the month of application, as well as for the application and processing months, for individuals who meet all eligibility requirements. See MS 580(B) .

Note: An individual who is incarcerated is not eligible for any Medicare Savings Programs.

Eligibility for Medicare Savings Programs should be determined at every application, and redetermined at every renewal and whenever a change is reported that may affect their eligibility.

Programs available:

Qualified Medicare Beneficiary Program (QMB)

Specified Low-Income Medicare Beneficiary Program (SLMB Base)

Specified Low-Income Medicare Beneficiary Program (SLMB Plus)

Qualified Disabled Working Individual (QDWI)

Resource requirements:

For QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries , resources must be under $9,950 for an individual and $14,910 for a couple. For the QDWI Qualified Disabled and Working Individuals program, resources must be under $4,000 for an individual and $6,000 for a couple (twice the SSI Supplemental Security Income resource limit).

Income determinations:

The financial determination is done in accordance with APA Adult Public Assistance methodology except for those requirements that are prohibited by the Medicaid program as described in ADLTC MS 523 and ADLTC MS 524 . For a couple case in which one person is eligible and one is ineligible, spousal deeming according to SSI Supplemental Security Income rules is required and the poverty level based income standard for a household of two is used.

As in APA Adult Public Assistance income determinations, countable income is used to determine financial eligibility. Countable income is total gross income (not including SSI Supplemental Security Income and APA Adult Public Assistance payments), less allowable disregards.

SSA Social Security Administration COLA Cost of Living Allowance Disregard: The January 1st cost of living ( COLA Cost of Living Allowance ) increases in Social Security Title II benefits are disregarded in determining income eligibility for SLMB Specified Low Income Medicare Beneficiaries until the annual federal poverty guidelines are implemented. This means that COLA Cost of Living Allowance s are usually disregarded through March since the new poverty guidelines ( FPG Federal Poverty Guidelines ) are effective April 1st of each year.

EIS information:

If an individual is determined eligible for a Medicare Savings Plan, it is important that the following steps are completed properly:

Enter the verified HIC Health Insurance Claim number on the " HIC Health Insurance Claim Number" field on the MERE Medical Reference screen for an individual who is currently enrolled in Medicare.

Enter the correct start date on the MCR Medicare line of the MERI Medical Resource Information screen. This date always starts with the first day of the month, and is the effective date of Medicare Part A.

Enter the "J" resource code on the MCR Medicare line (not the TPR Third Party Resource line) on the MERI Medical Resource Information screen for an individual enrolled in both Medicare Part A and Part B.

After the case is authorized, email DHCS Division of Health Care Services at doh.hcs.rec.info@alaska.gov asking that they start the Medicare Savings Program.

Premium refunds:

Once a client is enrolled in a Medicare Savings Program, the state assumes liability of the beneficiary's Medicare premiums. The recipient will receive a refund for any Part B premiums deducted or paid for.

Note: Premium refunds are not counted as income when determining eligibility. They are counted in the post eligibility or nursing home determination, only up to the amount that has been allowed as a medical expense deduction on previous income credits. If prior nursing home credits contained an allowance for the individual to pay the Part B premium, the current income credit must be adjusted to remove that allowance when the State begins paying the premiums.

Medicare Savings Program failures:

Medicare Savings Program failures may be caused by an incorrect HIC Health Insurance Claim # entered on the MERE Medical Reference screen, system logic failures, data transmission problems, conflicts with a Medicare Savings Program from another state, or with conflicting vital data between SSA Social Security Administration and EIS Eligibility Information System .

If a Medicare Savings Program recipient indicates that they are still being charged a Medicare premium two months after issuance, review the case to ensure that the correct HIC Health Insurance Claim # was entered on the MERE Medical Reference screen and that the Medicare ( MCR Medicare ) segment on the MERI Medical Resource Information is correctly coded. If the case is correct, report the problem to DHCS Division of Health Care Services via email at doh.hcs.rec.info@alaska.gov and provide the beneficiary's:

Name and case number;

HIC Health Insurance Claim number; and

Medicare start date.

Note: A previously authorized Medicare Savings Program only continues on the billing side for one month after the last benefit issuance. This means that if a case approved for a Medicare Savings Program does not issue another month of eligibility within 30 days of the last issuance, the Medicare Savings Program will stop. If this occurs, email DHCS Division of Health Care Services at doh.hcs.rec.info@alaska.gov requesting that they restart the Medicare Savings Program. This happens most often at renewal due to late processing.

580 A. QUALIFIED MEDICARE BENEFICIARIES ( QMB )

Pays Part A and Part B premium

Pays deductible

Pays co-payments, except for prescriptions

The effective date of QMB Qualified Medicare Beneficiaries coverage is the beginning of the month after the month in which the eligibility determination is made. For example, an individual applying for Medicaid on March 30th and found eligible on April 15th will be eligible to begin receiving QMB Qualified Medicare Beneficiaries benefits effective May 1st.

SSI Supplemental Security Income recipients who are enrolled in Medicare part A are automatically eligible for QMB Qualified Medicare Beneficiaries . Non-SSI recipients must have countable income equal to or less than 100% of the FPG Federal Poverty Guidelines .

EIS Eligibility Information System Coding:

EIS Eligibility Information System CODING QMB Qualified Medicare Beneficiaries ONLY ELIGIBILITY Eligibility Code: 67 QMB Qualified Medicare Beneficiaries -only Medicaid Subtype: QM Eligible only as QMB Qualified Medicare Beneficiaries DUAL MEDICAID / QMB Qualified Medicare Beneficiaries ELIGIBILITY Eligibility Code: 69 Dual Medicaid / QMB Qualified Medicare Beneficiaries Medicaid Subtype: ** Use the subtype appropriate for the type of APA Adult Public Assistance or APA Adult Public Assistance -related coverage the individual receives (SI, ST, NH Nursing Home , etc.).

580 B. SPECIFIED LOW INCOME MEDICARE BENEFICIARY ( SLMB )

SLMB Specified Low Income Medicare Beneficiaries Base:

Pays Part B premiums

To be eligible, countable income must be no more than :

120% of the Federal Poverty Guidelines ( FPG Federal Poverty Guidelines )

SLMB Specified Low Income Medicare Beneficiaries Plus:

Pays Part B Premiums

To be eligible, countable income must be no more than:

135% of the Federal Poverty Guidelines ( FPG Federal Poverty Guidelines )

SLMB Specified Low Income Medicare Beneficiaries benefits begin the month of application. In addition, the applicant may request three months of retroactive SLMB Specified Low Income Medicare Beneficiaries coverage. In order to qualify for retroactive SLMB Specified Low Income Medicare Beneficiaries , the applicant must meet all eligibility factors in the months requested.

Note: The difference between SLMB Specified Low Income Medicare Beneficiaries Base and SLMB Specified Low Income Medicare Beneficiaries Plus (aside from the income standard) is the SLMB Specified Low Income Medicare Beneficiaries Plus is a capped entitlement under federal law. This means there is an annual limit on the amount of money available to pay for the expanded eligibility category. All individuals applying for coverage of their Part B premiums will have their eligibility determined for SLMB Specified Low Income Medicare Beneficiaries Plus until the annual spending limit is reached. Once the spending limit is reached, three things happen: 1. Staff will be notified via broadcast with instructions; 2. Eligibility determinations for new applicants revert back to the SLMB Specified Low Income Medicare Beneficiaries Base category; and 3. Retroactive SLMB Specified Low Income Medicare Beneficiaries Plus coverage is no longer available. If spending reaches the annual limit before the end of the calendar year, monthly eligibility determinations for existing SLMB Specified Low Income Medicare Beneficiaries Plus recipients will continue to use the SLMB Specified Low Income Medicare Beneficiaries Plus criteria, as the spending on these individuals has already been charged against the annual limit. Any new eligibility determination must be made under the SLMB Specified Low Income Medicare Beneficiaries Base category. If staff are notified that the annual spending limit has been reached, caseworkers must send an email to hss.dpa.policy@alaska.gov with information (e.g., client name, ID number, and household size), and the countable income of an individual who would have been eligible under the 135% level. These individuals will be given preference over any new applicants for SLMB Specified Low Income Medicare Beneficiaries Plus in the next calendar year, as explained below. Beginning in January of each year, eligibility determinations return to using the SLMB Specified Low Income Medicare Beneficiaries Plus criteria. Because of the limited funding, eligibility determinations will be made in the following order: 1. Individuals who were SLMB Specified Low Income Medicare Beneficiaries Plus recipients in the previous calendar year; 2. Individuals who applied for SLMB Specified Low Income Medicare Beneficiaries Plus in the previous calendar year, but who were denied because that year's annual cap had been reached; 3. New applicants in the current calendar year; and 4. New applicants for retroactive coverage in the current calendar year. Retroactive Coverage Limit: For a current year applicant, retroactive SLMB Specified Low Income Medicare Beneficiaries Plus coverage may not cover any months prior to January.

EIS Eligibility Information System Coding:

EIS Eligibility Information System CODING Eligibility Code: 68 SLMB Specified Low Income Medicare Beneficiaries – eligible for Part B payment only 78 SLMB Plus Specified Low Income Medicare Beneficiary Plus – eligible for Part B payment only Medicaid Subtype: SL Eligible only as a Specified Low Income Medicare Beneficiary or SLMB Plus Specified Low Income Medicare Beneficiary Plus

580 C. QUALIFIED DISABLED AND WORKING INDIVIDUALS ( QDWI )

Pays Part A premiums

To be eligible, countable income must be no more than:

200% of the Federal Poverty Guidelines ( FPG Federal Poverty Guidelines )

QDWI Qualified Disabled and Working Individuals benefits begin the month of application.

An individual who loses their SSA Social Security Administration disability benefits because of earnings from work, but who continues to have the disabling condition, may continue to receive Medicare coverage if they continue to pay the premiums.

EIS Eligibility Information System Coding:

EIS CODING Eligibility Code: 66 QDWI Qualified Disabled and Working Individuals Only Medicaid Subtype: QD Eligible only as a Qualified Disabled and Working Individual Household Type QD1 One person household (200% FPG Federal Poverty Guidelines ) QD2 Two person household (200% FPG Federal Poverty Guidelines )

580 D. LOW-INCOME SUBSIDY ( LIS Low Income Subsidy ) PROGRAM

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 ( MMA Medicare Modernization Act ) established a subsidy program that provides extra help with Medicare Part D premiums, deductibles, and co-payments. (See section 506 for more information about Medicare Part D). This Low-Income Subsidy ( LIS Low Income Subsidy ) program is available to Medicare beneficiaries beginning January 1, 2006.

Note: Medicaid recipients who are Medicare eligible are automatically eligible for and enrolled in the LIS Low Income Subsidy and do not need to apply. This includes Qualified Medicare Beneficiaries ( QMB Qualified Medicare Beneficiaries ), Specified Low-Income Medicare Beneficiaries ( SLMB and SLMB Specified Low Income Medicare Beneficiaries Plus), and Qualified Disabled and Working Individuals ( QDWI Qualified Disabled and Working Individuals ).

Starting January 1, 2010, LIS Low Income Subsidy applications received and processed by the SSA Social Security Administration from residents of Alaska will generate an electronic referral to DPA Division of Public Assistance . Using information from this referral, DPA Division of Public Assistance will send an application form to the individual on which they may provide information needed to determine eligibility for Medicare Savings Programs or other Medicaid categories. The application form may also be used to apply for other DPA Division of Public Assistance programs for which the individual may qualify.

1. Taking the LIS Low Income Subsidy Application

The Social Security Administration ( SSA Social Security Administration ) has primary responsibility for determining eligibility for the LIS Low Income Subsidy . DPA Division of Public Assistance will make an LIS Low Income Subsidy eligibility determination only if the applicant specifically requests a state determination. Medicare beneficiaries must apply for the Low-Income Subsidy ( LIS Low Income Subsidy ) using the SSA Social Security Administration -1020 form, Application for Help with Medicare Prescription Drug Plan Costs.

DPA Division of Public Assistance staff may assist individuals with completing the application for the subsidy and forward it to SSA Social Security Administration . When submitting the application to SSA Social Security Administration , follow the instructions below:

Do not photocopy the SSA Social Security Administration -1020 form . SSA Social Security Administration electronically scans these applications and photocopying makes the form unscannable, which could delay an SSA Social Security Administration decision.

Do not date-stamp . Enter a hand-written date in the For Official Use Only box using MM/DD/YYYY format.

Do not fold the application other than where it is pre-folded . Additional folds may affect scanning.

Do not send any additional material with the application . SSA Social Security Administration will contact the individual if more information is needed.

Mail the LIS Low Income Subsidy application form to:

Social Security Administration

Wilkes-Barre Data Operations Center

PO Box 1020

Wilkes-Barre, PA 18767-9910

2. When DPA Division of Public Assistance Processes the Application

If an individual insists that DPA Division of Public Assistance make the LIS Low Income Subsidy eligibility determination, refer to Administrative MS 126-3 for more detailed instructions.

3. Income and Resource Limits

The LIS Low Income Subsidy has two basic levels of assistance:

The LIS is for individuals with annual incomes below 150% of the Federal Poverty Guidelines (FPG). These individuals pay no premium, no deductible, and fixed copays for certain medications. See Addendum 1 for the current annual federal poverty guidelines for Alaska.

The resources limits are $16,590 for an individual and $33,100 for a couple.

4. LIS Low Income Subsidy Premium Payment Limits

In order to get Medicare Part D coverage, the individual must enroll in a prescription drug plan ( PDP ). The prescription drug benefit is provided through private stand-alone PDP's PDP's prescription drug plans . Each plan will contract with certain pharmacies, and may have different costs.

Medicare Part D (Prescription Drug Coverage) information can be found at https://health.alaska.gov/en/services/extra-help-on-medicare-drug-costs/ . The maximum amount of the Medicare Part D premium covered by the LIS Low Income Subsidy is limited. See Addendum 1 for the standard premium rate that the LIS Low Income Subsidy will cover in Alaska. If an individual chooses a plan that has a premium in excess of this amount, the individual must pay the difference.

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