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20 130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 258 Rev. 02/13/26

130 CMR 519.000: MASSHEALTH: COVERAGE TYPES

(3) If more than one application has been submitted and not denied, the start date of coverage will be based on the earliest application that is approved.

519.010: Medicare Savings Program (MSP)—Qualified Medicare Beneficiaries (QMBs)

(A) Eligibility Requirements. MSP (Buy-in) QMB coverage is available to Medicare beneficiaries who (1) are entitled to hospital benefits under Medicare Part A; (2) have a countable-income amount (including the income of the spouse with whom they live) that is less than or equal to 190% of the federal poverty level; and (3) meet the universal requirements of MassHealth benefits in accordance with 130 CMR 503.000: Health Care Reform: MassHealth: Universal Eligibility Requirements or 130 CMR 517.000: MassHealth: Universal Eligibility Requirements, as applicable.

(B) Benefits. The MassHealth agency pays for Medicare Part A and Part B premiums and for deductibles and coinsurance under Medicare Parts A and B for members who establish eligibility for MSP coverage in accordance with 130 CMR 519.010(A).

(C) Start Date. The start date for MSP coverage is the first day of the calendar month following the date of the MassHealth eligibility determination.

519.011: Medicare Savings Program (MSP)—Specified Low-income Medicare Beneficiaries (SLMBs) and Qualifying Individuals (QIs)

(A) Medicare Savings Program (MSP) (Buy-in) for Specified Low-income Medicare Beneficiaries (SLMBs) (1) Eligibility Requirements. MSP is available for SLMBs who (a) are entitled to hospital benefits under Medicare Part A; (b) have a countable-income amount (including the income of the spouse with whom they live) greater than 190% and less than or equal to 210% of the federal poverty level (FPL). The MassHealth agency will disregard all assets or resources when determining eligibility for MSP only benefits; and (c) meet the universal requirements of MassHealth benefits in accordance with 130 CMR 503.000: Health Care Reform: MassHealth: Universal Eligibility Requirements or 130 CMR 517.000: MassHealth: Universal Eligibility Requirements, as applicable. (2) Benefits. The MassHealth agency pays the entire monthly Medicare Part B premium, in accordance with § 1933 of the Social Security Act (42 U.S.C. § 1396u-3), for members who establish eligibility for MSP for SLMB coverage in accordance with 130 CMR 519.011(A). (3) Start Date. MSP for SLMB coverage, in accordance with 130 CMR 519.011(A), begins with the month of application and may be retroactive up to the first day of the third calendar month before the month of application.