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32.1 Medicare Beneficiaries Introduction 32.1.1 Medicare Savings Programs Introduction Medicare is the health insurance program administered by the Centers for Medicare & Medicaid Services for people 65 years old or older, people determined disabled for two years or more, or people with end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or amyotrophic lateral sclerosis (ALS). People who receive Medicare are referred to as Medicare beneficiaries. Medicare is divided into four main types of health coverage: • Hospitalization insurance (Part A), which pays hospital bills and certain skilled nursing facility, home health care, and hospice expenses • Medical insurance (Part B), which pays doctor bills and certain other charges • Medicare Advantage (Part C), which allows private health insurance companies to provide Medicare benefits • Drug insurance (Part D), which pays for prescription drug charges Medicare beneficiaries who are eligible for Medicare only due to end stage renal disease (ESRD) lose Medicare coverage 36 months after a kidney transplant. Beneficiaries who meet certain criteria, including not having any other health insurance coverage that covers immunosuppressive drugs, are able to qualify for continuous Medicare-covered immunosuppressive drugs through the Medicare Part B Immunosuppressive Drug (Part B-ID) benefit. The Part B-ID benefit covers only immunosuppressive drugs and no other items or services. Medicare charges monthly premiums, and Medicare beneficiaries are responsible for deductibles and coinsurance payments to providers. These out-of-pocket charges are generally referred to as Medicare cost-sharing. Wisconsin Medicaid may pay some or all of the member’s Medicare cost-sharing for certain Medicare beneficiaries participating in the following programs: • QMB • SLMB • SLMB+ • QDWI These programs are called Medicare Savings Programs (MSP). They may also be referred to as Medicare Premium Assistance or Medicare Buy-In programs. A request for health care is also considered a request for MSP, unless the member specifically states otherwise. Any Medicaid applicant or member who has or becomes eligible for Medicare should have their eligibility determined for MSP without requiring an additional request. When determining eligibility for MSP, the same rules for determining financial eligibility for Medicaid are used with the exception of using the MSP asset limits in SECTION 32.6 MEDICARE SAVINGS PROGRAMS ASSET LIMITS and the MSP income limits in SECTION 39.5 FEDERAL POVERTY LEVEL TABLE. Nonfinancial eligibility is available as follows: • For QMB (see SECTION 32.2 QUALIFIED MEDICARE BENEFICIARY) • For SLMB (see SECTION 32.3 SPECIFIED LOW-INCOME MEDICARE BENEFICIARY) • For SLMB+ (see SECTION 32.4 SPECIFIED LOW-INCOME MEDICARE BENEFICIARY PLUS)