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Aged, Blind and Disabled Manual Section: Medicare Savings Programs Policy Manual Number: 120.005 Chapter: Medicare Savings Programs Overview

March 1, 2024 Division of TennCare 1 MEDICARE SAVINGS PROGRAMS OVERVIEW Legal Authority: Social Security Act § 1905(p)(1); 42 CFR 400.200; 42 CFR 435.406 1. Overview

Medicare is a national health insurance program administered by the federal government for individuals aged 65 and above, and disabled individuals. Medicare is a comprehensive health insurance program, but Medicare enrollees are required to pay premiums, certain out of pocket costs, and for services not covered by the program. The Medicare Catastrophic Coverage Act (MCCA) of 1988 created the Medicare Savings Programs (MSPs), which are a set of Medicaid programs available only to Medicare enrollees who meet specific resource and income standards. The MSPs provide for payments of Medicare premiums, coinsurance, and deductibles for Medicare-covered services.

The four MSPs are:

• Qualified Medicare Beneficiaries (QMB); • Specified Low-Income Medicare Beneficiaries (SLMB); • Qualifying Individuals (QI1); and • Qualified Disabled Working Individuals (QDWI).

2. Medicare Eligibility

An individual is entitled to receive Medicare benefits when:

• He or she is 65 years or older, is a U.S. citizen or has been permanent legal residents for 5 continuous years, and the individual or his or her spouse has paid Medicare taxes for at least 10 years; or • He or she is under age 65 and has been receiving either Social Security or Railroad Retirement Board disability benefits for at least 24 months; or • He or she is receiving dialysis for End Stage Renal Disease (ESRD) or needs a kidney transplant; or • He or she is eligible for Social Security Disability Insurance (SSDI) and has ALS or Lou Gehrig’s disease. Most Medicare beneficiaries are automatically enrolled in Medicare Parts A and B when they become eligible. Those who are not entitled to premium-free Medicare Part A, such as those individuals who are over age 65 but did not pay enough Medicare taxes, must apply for coverage and pay a monthly premium. These individuals are considered entitled to enroll in Medicare and are eligible for the MSPs. 3. Medicare Enrollment Period

There are two enrollment periods for Medicare Parts A and B:

a. The initial enrollment period, which includes: