2675.4 Benefits and Levels of Subsidy

Those eligible for subsidy will receive benefits according to countable income, assets and deemed status. The eligible person receives assistance with Medicare cost sharing - premiums, deductibles and copayments. The level of premium assistance is limited and is equal to the lesser of the following: The monthly Part D premium for basic prescription drug coverage or the portion of the monthly Part D premium attributable to basic prescription drug coverage for a Part D plan that has an enhanced alternative coverage; or the greater of the low-income benchmark premium amount or the lowest monthly beneficiary premium for a prescription drug plan that offers basic prescription drug coverage. See the Kansas Medical Assistance Standards in the Appendix for the Medicare Part D benchmark premium amount.

Deemed Eligibles - For deemed eligibles, the subsidy will cover the standard or basic Medicare Part D premium; the annual deductible; and the cost of all formulary and approved prescription drugs. Prescription copayments as determined by the Subsidy program will apply to those only eligible for MSP (QMB, LMB, or Expanded LMB), and to those eligible for full Medicaid coverage (including a met spenddown under Medically Needy) and to recipients of HCBS. No copayments apply to covered prescription drugs for those who are eligible for full Medicaid coverage and are a resident of an approved institutional living arrangement (nursing facility, state hospital, ICF-IID, swing bed hospital, head injury rehabilitation facility or other Medicaid approved institution) for at least 30 days, or who are enrolled in PACE.

Determined eligibles - Determined eligibles are eligible for assistance with premiums, copayments and deductibles at a level established by their countable income and resources. The following subsidy levels and benefits apply to SSA determined eligibles: Subsidy Level 0 - Persons with countable incomes at or below 135% of poverty and whose countable resources do not exceed the applicable limit for the appropriate household size. Coverage level is equal to that of a Medicare Savings Plan eligible. Subsidy Level 1 - Persons with countable incomes at or below 135% of poverty and whose countable resources do not exceed the applicable limit for the appropriate household size. The standard/basic monthly premium is covered. Subsidy Level 2 - Persons with countable incomes greater than 135% of poverty and at or below 140%, and whose countable resources do not exceed the applicable limit for the appropriate household size, 75% of the standard monthly premium is covered. Subsidy Level 3 - Persons with countable incomes greater than 140% of poverty and at or below 145%, and whose countable resources do not exceed the applicable limit for the appropriate household size, 50% of the standard monthly premium is covered. Subsidy Level 4 - Persons with countable incomes greater than 145% of poverty and below 150%, and whose countable resources do not exceed the applicable limit for the appropriate household size, 25% of the standard monthly premium is covered.

Late Enrollment Fees - An individual enrolling in Medicare Part D after their initial enrollment period may be subject to a late enrollment fee. The late enrollment fee is added to the monthly premium amount and is equal to 1% of the national base premium amount times the number of uncovered months since the initial enrollment period. An individual qualifying for subsidy coverage will not be subject to a late enrollment fee.