What Is Medicare 2017 Subsidy Program? (TOP 5 Tips)

What is a Medicare subsidy?

  • The government paying a portion or all of your Medicare Advantage premiums, coinsurance, copayments, and deductibles is generally considered by most people to be a Medicare subsidy, even if the payment is for a Medicare Advantage plan instead of for Original Medicare.

How do I get my $144 back from Medicare?

Even though you’re paying less for the monthly premium, you don’t technically get money back. Instead, you just pay the reduced amount and are saving the amount you’d normally pay. If your premium comes out of your Social Security check, your payment will reflect the lower amount.

Who qualifies for Medicare subsidies?

Eligibility for the Low-Income Subsidy To be eligible for Extra Help, you must: Be enrolled in Medicare Part A and Part B. Live in one of the 50 United States or the District of Columbia. Have a yearly income of $18, 735 or less (for individuals) or $25, 365 or less (for married couples living together).

What is a subsidy for Medicare?

What’s the Low Income Subsidy (LIS)? The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage.

How does Medicare Low income Subsidy work?

The low-income subsidy helps pay for some of Part D prescription drug plan costs. A person with both Medicare and full Medi-Cal benefits (no share of cost) receives the low income subsidy automatically. A customer with Medi-Cal with a share of cost (SOC) may qualify for LIS.

Does anyone get Medicare Part B free?

While Medicare Part A – which covers hospital care – is free for most enrollees, Part B – which covers doctor visits, diagnostics, and preventive care – charges participants a premium. Those premiums are a burden for many seniors, but here’s how you can pay less for them.

Why did I get an extra Social Security payment this month 2021?

Social Security benefits are getting their biggest increase in 40 years this month, thanks to soaring inflation in 2021. A new cost of living adjustment has increased payments by 5.9%, about $93 more per month on average for seniors and other beneficiaries, or $1,116 more per year.

What does subsidy eligible mean?

If you’re insured through your employer, or eligible for programs like Medicare or Medicaid, you’re covered. Either way, the good news is you may be able to get help paying for individual health insurance. This help is called a subsidy.

Does Social Security count as income for Medicare Savings Program?

This means that Social Security Disability Insurance (SSDI), Worker’s Compensation, California State Disability Insurance, and any federal, state, or private disability benefits are not considered as countable income for this program.

What is the income limit for extra help with Medicare?

To qualify for Extra Help, your annual income must be limited to $19,320 for an individual or $26,130 for a married couple living together.

How do I get my Medicare premium refund?

Call 1-800-MEDICARE (1-800-633-4227) if you think you may be owed a refund on a Medicare premium. Some Medicare Advantage (Medicare Part C) plans reimburse members for the Medicare Part B premium as one of the benefits of the plan. These plans are sometimes called Medicare buy back plans.

Is Medicare Extra Help the same as Medicaid?

The income limits for Medicaid vary from state to state. If you qualify for Medicaid, you automatically qualify for the Medicare Part D “Extra Help” program that may lower the cost of your prescription drugs.

Can a consumer who qualifies for low-income subsidy receive financial assistance for Medicare Part D?

Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs. Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments.

What is extra help from Social Security?

Extra Help is a program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance.

How are formularies established?

A drug formulary is a list of generic and brand-name prescription drugs covered by a health plan. The health plan generally creates this list by forming a pharmacy and therapeutics committee consisting of pharmacists and physicians from various medical specialties.

What is the asset limit for extra help in 2021?

In 2021, if your income is limited to $19,320 for an individual ($26,130 for a married couple living together) AND your resources are limited to $14,790 for an individual ($29,520 for a married couple living together), you may qualify for Extra Help. Note: Income and resource limits may change each year.

How is Medicare funded?

In the United States, the Centers for Medicare and Medicaid Services (CMS) is the government organization in charge of administering the Medicare Program. A part of the government agency that supervises CMS, which manages programs for preserving the health of all Americans, such as Medicare, the Marketplace, Medicaid and the Children’s Health Insurance Program, is known as the Centers for Medicare and Medicaid Services (CMS) (CHIP). “Department of Health and Human Services role=”article” about=”/node/32176″> Department of Health and Human Services (Hhs).

Medicaid policies differ from state to state, but if you qualify for both Medicare and Medicaid, you will be able to cover the majority of your medical expenses.

In 2017, Medicare provided coverage to more than 58 million people.

The Medicare Trust Funds provide the funding for this program.

Medicare Trust Funds

Medicare is funded by two trust fund accounts owned by the United States Treasury, one for each state. These money can only be used to pay for Medicare-related expenses.

Hospital Insurance (HI) Trust Fund

  • Payroll taxes are paid by the vast majority of employees, companies, and self-employed individuals. Other sources, such as the following:
  • Income taxes paid on Social Security payments
  • Interest made on trust fund assets
  • Social Security benefits received
  • Paying premiums for Medicare Part A on behalf of persons who aren’t eligible for premium-free Medicare Part A

What does it pay for?

  • Part A of the Medicare program covers inpatient hospitalizations, skilled nursing facility care, hospice care, and a portion of home health care.” Medicare Part A is described in detail in the following article: role=”article” about=”/node/32351″> (Hospital Insurance) The health-care commodities or services that are covered by a health-insurance plan are called benefits. The coverage documentation for a health insurance plan outline the benefits that are covered and the treatments that are not covered.” advantages, including as inpatient hospitalization, skilled nursing care and therapy services delivered on a daily basis in a skilled nursing facility. role=”article” about=”/node/34356″> Physical therapy and intravenous injections, for example, are examples of skilled nursing facility treatment that can only be provided by a physical therapist or a certified nurse,” says the author. Care in a skilled nursing facility (snf) is described in detail in the page about /node/32526. Health care services and supplies that a doctor determines you are eligible to receive in your home as part of a treatment plan developed by your doctor. Home health care is only covered by Medicare on a limited basis if it is authorized by your doctor.” In addition to home health care, and a unique style of caring for those who are terminally ill, role=”article” about=”/node/32246″> An interdisciplinary approach is used to provide hospice care, which meets the medical, physical, social, emotional, and spiritual requirements of the patient. Additionally, hospice gives assistance to the patient’s family or primary caregiver.” hospice care
  • Medicare Program administrative expenses, such as those associated with providing benefits, collecting Medicare taxes, and combating fraud and abuse
  • And other expenditures associated with aging.
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Supplementary Medical Insurance (SMI) Trust Fund

  • Funds appropriated by Congress
  • Premiums collected from persons registered inPart B, which covers some doctor’s services, outpatient care, medical supplies, and preventative treatments, among other things.” In addition to standard Medicare Part B (Medical Insurance) and optional prescription drug benefits, which are accessible to all individuals with Medicare for an extra fee, Medicare Part B (Medical Insurance) and optional prescription drug benefits are also available to all persons with Medicare. This coverage is provided by insurance companies as well as other private firms that have been approved by the Medicare program.” about=”/node/32366″ role=”article” about=”/node/32366″> Part D of Medicare provides coverage for prescription drugs. Interest generated on trust fund assets, for example, are additional sources of income.

What does it pay for?

  • Part B benefits
  • Part D benefits
  • Medicare Program administrative expenses, such as those associated with providing benefits and combating fraud and abuse

Find out who to call about Medicare options, claims and more.

Each year, beneficiaries can enroll in a plan that provides Part D drug coverage during the Medicare open enrollment period, which runs from October 15 to December 7 each year. Beneficiaries can choose between a stand-alone prescription drug plan (PDP) as a supplement to traditional Medicare or a Medicare Advantage drug plan (MA-PD), which covers all Medicare-covered benefits, including drugs. Approximately 6 in 10 of the almost 41 million beneficiaries enrolled in Part D plans are in PDPs, with the remaining participants registered in MA-PD plans.

3 The following are some of the most important findings:

  • The average monthly PDP premium in 2017 would rise over 9 percent over the previous year, reaching $42.17 per month (weighted by 2016 plan enrollment). This estimate covers premiums for both basic and enhanced PDPs, and it assumes that current PDP participants will continue in their current plan for 2017. It does not make any assumptions regarding the plan choices of new members for the 2017 enrollment year. It is expected that the average Part D PDP deductible would increase by 7 percent in 2017, and that PDP rates will continue to vary substantially between plans, as they have in recent years. Average rates for the ten PDPs with the largest enrollment will range from a low of $16.81 per month, or $202 annually, for the Humana Walmart Rx PDP to a high of $71.66 per month, or $860 annually, for the AARP Medicare Rx Preferred PDP—a difference of $658 in annual premiums (Figure S1).

Average monthly premiums in 2017 for the ten Medicare Part D stand-alone PDPs with the highest 2016 enrollment, as shown in Figure S1.

  • Premiums for personal disability insurance (PDI) will continue to vary among states in 2017, with a low of $31.27 in New Mexico and a high of $50.95 in New Jersey. Participants in certain locations will suffer higher premium increases than those in others between 2016 and 2017, with average PDP premiums increasing by 6 percent or less in seven regions, but by as much as 18 percent in Arizona and as much as 20% in California between 2016 and 2017. As in previous years, virtually all public-private partnerships (PDPs) in 2017 feature five cost-sharing categories, although the particular cost-sharing amounts vary substantially between PDPs. When it comes to higher-cost specialty and non-preferred pharmaceuticals, nearly all PDPs charge coinsurance, which often results in participants paying more out-of-pocket expenses than when plans charge copayment levels. In order to encourage the use of preferred generics, approximately one-third of PDPs charge no fee for these medications. While Medicare users in each region will have fewer PDP alternatives in 2017 than they have had in any other year since 2006, there will still be a significant number of PDP options available. In 2017, beneficiaries receiving the Low-Income Subsidy (LIS) will have an average of seven premium-free PDPs to choose from
  • 1.4 million low-income beneficiaries who are eligible for premium-free Part D coverage will begin paying Part D premiums in 2017, with an average of nearly $24 per month or $286 per year if they do not switch plans or are not reassigned to a new plan by CMS
  • And 1.4 million low-income beneficiaries who are eligible for premium-free Part D

SSA – POMS: HI 00815.024 – SSA’s Role in Medicare Savings Programs (MSP) Applications

TN 37 is an abbreviation for Tennessee 37. (01-22)

A.Background on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)

By amending the Social Security Act with Public Law 110-275, the Medicare Improvement and Portability Act, it is mandated that applications for Extra Help (SSA-1020) that are effective on or after January 1, 2010 will initiate the application process for Medicare Savings Programs (MSP) benefits unless the beneficiary objects. Aside from that, effective January 2010, MIPPA amended the Act to ensure that the resource limits for the Qualified Medicare Beneficiary program, the Specified Low-Income Medicare Beneficiary program, and the Qualifying Individual program are equal to the resource limits for individuals who qualify for the full low-income subsidy under the Medicare prescription drug coverage program, which was previously separate from other programs.

In the case of the Qualified Disabled Working Individual program, this MIPPA clause is not applicable.

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The data from the Extra Help determination (also known as low income subsidy or LIS application) will be submitted daily (except on Saturdays, Sundays, and holidays) to the appropriate state Medicaid agency to begin the MSP application process, unless the recipient declines.

In addition, if the beneficiary has already been deemed (seeHI 03001.005A for definition of deemed) for LIS, if the application received is a duplicate, or if the beneficiary’s LIS application was denied because he was not a legal resident of the United States, Social Security will not send data to the state Medicaid agency.

B.Description of the MSP

A Medicare recipient may be eligible for financial assistance to cover the costs of their Medicare Part A and/or Part B premiums. Several state programs are available to assist Medicare beneficiaries in paying their premiums, deductibles, and coinsurance. Medicare Savings Programs are divided into four categories:

  • Qualified Medicare Beneficiary (QMB)
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Qualifying Individual (QI or QI-1)
  • Qualified Disabled Working Individuals (QDWI)

Whenever a beneficiary qualifies for QMB, SLMB, or QI, he or she is also immediately eligible for Extra Help, which covers all expenditures, with the exception of a small co-payment for Medicare prescription medication coverage (see the chart inHI 03001.005G.1). A recipient must fulfill all of the following requirements in order to be eligible for the QMB, SLMB, or QI programs:

  • To be eligible for Medicare Part A (hospital insurance), which includes premium-free hospitalization or premium-free hospitalization for the elderly, but not premium-free hospitalization for the working disabled. Reside in one of the 50 states or the District of Columbia
  • And, meet the standard income and resource requirements as outlined below:
  • –2022 income and resource limits: Single individual with a monthly income of $1,549 or less (higher in Alaska and Hawaii) and no more than $9,900 in assets. Monthly income of $2,080 or less (higher in Alaska and Hawaii) and assets of no more than $15,600 for married couples living together. Maximum income and resources in 2021 for a single individual are $1,469 or less per month (higher in Alaska and Hawaii) and not more than $9,470 in total assets. Monthly income of $1,980 or less (higher in Alaska and Hawaii) and assets of no more than $14,960 for a married couple living together

A recipient must meet the following requirements in order to be eligible for the QDWI program:

  • Have lost their eligibility for free Part A merely as a result of engaging in significant gainful activity (SGA)
  • Continue to remain incapacitated and younger than 65 years old
  • Reside in one of the fifty states or the District of Columbia. If you are not otherwise qualified for Medicaid, Be qualified to participate in Medicare Part A
  • And, meet the income and resource requirements listed below:
  • –2022 income limits– Single individual with a monthly income of $4,615 or less (higher in Alaska and Hawaii) and no more than $4,000 in assets is eligible. Married and living together with a monthly income of $6,189 or less (higher in Alaska and Hawaii) and no more than $6,000 in assets is considered low-income. Limits for 2021: Single individual with a monthly income of $4,379 or less (higher in Alaska and Hawaii) and no more than $4,000 in resources are allowed. A monthly income of $5,892 or less (higher in Alaska and Hawaii) and resources of no more than $6,000 are required for married couples living together.

A person’s eligibility for coverage under one of these programs can only be determined by the individual’s state. Many states use a variety of standards and techniques to assess whether or not a person is eligible for the MSP. Some states, for example, may not have the resources to support these initiatives, or they calculate income and resources in a different manner. The following graphic demonstrates how Medicare Supplemental Insurance (MSP) can assist with Medicare expenses:

Medicare Savings Programs Helps Pay For
QMB Part A and Part B premiums and other covered cost-sharing expenses like deductibles and coinsurance.
SLMB Part B premiums only
QI Part B premiums only
QDWI Part A premiums only

C.Beneficiary requests information about MSP

If a beneficiary wants a Medicare Supplemental Security Program application, check the Medicare Application Processing System (MAPS). If the Extra Help application is mentioned in MAPS, double-check the date on which it became effective. If the application was effectively submitted on or after January 1, 2010, and the applicant did not object to data referral to the state, explain to him or her that the Extra Help application was also an application for MSP and that he or she should expect to hear from the state shortly after filing.

The beneficiary should be informed about Medicare Savings Programs and referred to a State Health Insurance Counseling and Assistance Program (SHIP) for more information if the beneficiary’s MAPS report indicates that he or she refused a data referral to the state or if the Extra Help application was effectively filed before January 1, 2010, the beneficiary should be informed about Medicare Savings Programs and referred to a State Health Insurance Counseling and Assistance Program (SHIP) for more information.

You can express yourself in the following language: The State Health Insurance Counseling and Assistance Program can aid beneficiaries in obtaining assistance.

If the recipient is on the phone and is not identified in MAPS, inquire as to whether you may direct him or her to an Extra Help application instead (or mail an application).

Make it clear to them that, unless they choose otherwise, the Extra Help application will begin the MSP process with their current condition. Also, explain to the beneficiary what the MSP benefits are. H 00815.025 contains further information regarding MSP.

D.MSP Applications and the Extra Help program

Whenever a beneficiary phones and requests an MSP application (regardless of whether or not the beneficiary wishes to file an Extra Help application), inquire as to whether or not the beneficiary has computer access.

  • If so, explain that an application is accessible at SSA.gov in both English and ten additional languages, as well as in a combination of both. For example, people may either go down on the right side to “Additional Resources” and select “Medicare Savings Programs Model Application for Premium Assistance,” or they can browse down the middle and select “The Official Government Site for People with Medicare.” If the answer is no, or if the individual wishes to receive the application from the Social Security Administration, print the sample application from SSA.gov in the relevant language and mail it.
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In addition to English, Arabic, Chinese, French, Haitian-Creole, Farsi, Korean, Spanish, Tagalog, Russian, and Vietnamese are also offered as possible languages. Even if the state utilizes a different MSP application form than the model forms available on the Social Security Administration’s online sites, once the state receives the beneficiary’s completed MSP application form, the state will initiate the MSP application process.

E.Procedure on obtaining status inquiries on MSP Applications

If a beneficiary has any questions about the progress of their MSP application, they should contact their state Medicaid administration. Income Restrictions for Medicare Savings Programs (HI 00815.023) HI 00815.025, HI 00815.025 SSA Reaching Out to Low-Income Medicare Beneficiaries – Additional Assistance and Medicare Saving Programs HI 03001.001, Medicare Part D Prescription Drug ProgramDescription of the Medicare Part D Prescription Drug ProgramHI 03001.005, Medicare Part D Extra Help (Low Income Subsidy or LIS)HI 03010.005, Medicare Part D Extra Help (Low Income Subsidy or LIS)HI 03010.005, Medicare Part D Extra Help (Low Income Subsidy or LIS)HI 03010.005, Medicare Part D Extra Help (Low Income Subsidy In-person interviews for Medicare Part D Extra HelpHI 03010.010, and the submission of applications Hi 00801.131, Premium-HI EligibilityHI 00801.139, QMB ProvisionsHI 00801.170, Premium-HI for the Working DisabledHI 00801.170, Premium-HI for the Working Disabled Qualified Medicare Beneficiaries (QMB)TC 23001.050, Specified Low-Income Medicare Beneficiaries (SLMB)TC 23001.060, Qualifying Individual 1TC 23001.070, Qualifying Individual 2 (QI1) Medicare Query System (MSOM INTRANETMEDQ 001.001), often known as the Medicare Query System (MQS) (MEDQ)

State Health Insurance Assistance Program (SHIP)

SHIP is managed by ACL’s Office of Healthcare Information and Counseling (OHIC), which collaborates with state departments, local agencies, grantees, and community-based organizations. A community-based network of counselors is established by SHIP, who provide assistance in person and over the phone, give group presentations, and use a variety of media outlets to educate individuals about Medicare and its benefits. In order to help Medicare beneficiaries, their families, and caregivers make educated decisions about their care and benefits, SHIP provides one-on-one support, counseling, and education to them.

It is the goal of the SHIP to empower, educate, and support Medicare-eligible persons by providing objective outreach services, counseling, and training opportunities.

There are 54 grantees for the SHIP program (one in all 50 states, Puerto Rico, Guam, the District of Columbia, and the U.S.

Local Area Agencies on Aging and other community-based partners collaborate with State Units on Aging or State Departments of Insurance to provide SHIP services to the elderly and people with disabilities.

Additional to the services provided by SHIP, several grantees offer Senior Medicare Patrol (SMP) programs, which assist Medicare beneficiaries in protecting themselves against, detecting, and reporting healthcare fraud and abuse.

History

SHIPs were established as a result of the Omnibus Budget Reconciliation Act (OBRA) of 1990. In accordance with this part of the law, the Centers for Medicare and Medicaid Services (CMS) were permitted to provide funding to states in order to develop and sustain health insurance advisory service programs for Medicare beneficiaries. Medicare and Medicaid information, counseling, and assistance activities were supported using grant monies. Other health insurance alternatives were also considered, including: Medicare Supplement insurance, long-term care insurance, and managed care options.

As a result of the existing formal and informal connections between the SHIP programs and the networks that ACL supports, this transfer was made possible.

Funding

A formula is used to calculate state financing for SHIP on an annual basis, and it takes into account a variety of parameters, including the Medicare population. The amount of federal SHIP grant monies is shown in the following table. Many SHIPs enter into agreements with community-based organizations to deliver SHIP services to its members. For further information on the organizations with whom SHIPs have contracts, consult the yearly National SHIP Sub-Recipients Report:

Counseling and Outreach

SHIP recruits and trains team members who will work as volunteers or in-kind contributors to offer program services. Team members from the SHIP are highly trained and qualified to help people in acquiring coverage through a variety of alternatives, including Original Medicare (Parts AB and B), Medicare Advantage (Part C), Medicare Prescription Drug Coverage (Part D), and Medicare Supplement insurance (Medigap). Beneficiaries with low financial resources can also qualify for programs such as Medicaid, Medicare Savings Program, and Extra Help/Low Income Subsidy, which can assist them in paying for or reducing their healthcare expenses.

SHIP outreach assists in informing groups and people about Medicare benefits, coverage restrictions, written notices and forms, appeal rights and processes, and other topics related to health insurance coverage and coverage.

Performance Snapshot

SHIP delivered the following services in 2018:

  • A total of 2,694,135 Medicare beneficiaries, their families, and caregivers, including 330,737 persons under the age of 65 who have a disability, received individual health insurance counseling
  • And More than 4,238,927 people were reached through public presentations, enrollment events, health fairs, senior fairs, and other community activities
  • And

SHIP submits a report to Congress:

SHIP Technical Assistance Center (SHIP TA Center)

The SHIP TA Center acts as a clearinghouse for grantees, providing them with information, knowledge, and technical help. The TA Center disseminates information and best practices throughout the network through the creation of new products and technologies, as well as through one-on-one help to network members. Learn more about the SHIP TA Center by visiting their website.

Resources and Useful Links

The Volunteer Risk and Program Management (VRPM) Policies were established by ACL to help SMP and SHIP grantees in managing the programs they are funded to run on their behalf. In the policies, the governing principles and values that shape and guide Team Member involvement are described, as well as expectations for the management of volunteer programs, core expectations of SMP/SHIP Team Members are delineated, and what Team Members can expect from the SMP/SHIP is described in general terms. They are intended to improve the quality, effectiveness, and safety of SMP/SHIP services by providing advice and direction for SMP/SHIP employees and volunteers in accordance with established standards and procedures.

In order to help SHIP/SMP/MIPPA programs and their partner Community-Based Organizations (CBOs) in avoiding real and perceived Conflicts of Interest (COI) and mitigating risk, ACL has prepared a resource called “Conflict of Interest: Identification, Remedy, and Removal.”

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