Frequently Asked Questions (FAQs)
Who is Social Service Coordinators®?
Social Service Coordinators® (SSC) is the nation's leading dual eligible outreach, advocacy and education company. Currently, SSC works with the largest Medicare Advantage Health Plans in the country to provide plan members with an assistance resource when applying for social programs for which they may qualify.
How can I learn more about SSC?
SSC Service Coordinators periodically sends a letter and an educational pamphlet to all our partnering health plans’ members introducing the company and the benefits of the Medicare Savings Programs. The letters provide the toll-free number health plan members can call to get more information on the Medicare Savings Program.
What is a Medicare Savings Program (MSP)?
A Medicare Savings Program (MSP) is a jointly funded (federal/state) and state administered program available to help lower income seniors and disabled individuals pay for some of their out-of-pocket medical expenses. They are:
- Qualified Medicare Beneficiary (QMB)
- Specified Low Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI-1)
- Qualified Disabled Working Individual (QDWI)
What are the benefits of a Medicare Savings Program?
Any member who enrolls into QMB, SLMB, or QI-1 will receive the amount of their Part B Premium in their Social Security check every month ($96.40), or $1156.80 annually.
The QDWI program pays the Part A premium only for those individuals under age 65 who are losing Medicare Part A because of earned income. Historically, there have been very few participants in the QDWI program.
How does a person qualify for a Medicare Savings Program?
To qualify for a Medicare Savings Program a member must be:
- Entitled to Medicare Part A;
- Meet all financial requirements;
- Meet Non-financial requirements.
- Cooperate in providing information needed for eligibility determination
- Have a Social Security Number
- Be a U.S. citizen or appropriate non-citizen
- Be a resident of the state of application
- Not be in a penal institution
- Apply for all potential benefits
What is the maximum income level to qualify for a Medicare Savings Program?
Single Individual: $1,123 (in most states) (Alaska, Hawaii, D.C., Connecticut, Maine, and Illinois have higher limits)
Married Couple: $1,505 (in most states) (Alaska, Hawaii, D.C., Connecticut, Maine, and Illinois have higher limits).
What is income?
Income means any payment from any source. Income can be a payment made on a one-time basis or on a recurring basis. Income can be earned, such as compensation received as a result of working, such as wages, tips, bonuses and commissions. Income can also be unearned, such as dividends, interest, and pension benefits. The most common examples of income are:
- Social Security (Gross)
- Monthly Pensions (includes Veteran’s Benefits, Railroad Benefits, Civil Service)
- Interest on Financial Accounts (some states exclude this income entirely)
- Wages (remainder after disregard calculation)
- Rental Income
- Worker’s Compensation
What is the maximum asset value allowed to qualify for a Medicare Savings Program?
Effective January 2011, the asset limits for MSP in most states that have an asset test increased to $6,680 for an individual / $10,020 for a couple. The asset limit in Minnesota is $10,000 for an individual / $18,000 for a couple.
*There are no asset limits for any of the MSP's in Alabama, Arizona, Connecticut, Delaware, the District of Columbia, Maine, Mississippi, New York and Vermont.
What is an asset?
In simplest terms, an asset is property of any kind. A resource may be “liquid” such as cash, or property that can readily be converted to cash. It may be “non-liquid,” meaning that it may not be easily converted to cash. Resources include both real and personal property, and tangible as well as intangible property. The most common examples of assets are:
- Checking & Savings Accounts
- C.D.s / Money Market Accounts
- IRA / 401(K) / Mutual Funds
- Stocks / Bonds
- Real Property
Are all assets and income taken into consideration when determining eligibility?
No. In determining an applicant’s eligibility for Medicaid, resources and income must be both countable and available.
What are non-countable assets and income?
These are examples of Non-Countable Assets and Income, not an all-inclusive list:
- Life insurance policies with an aggregate face value of $1,500
(in some states, this amount is much higher);
- A homestead and property connected to it;
- Qualifying burial or funeral plans, or trusts;
- An automobile;
- Clothing and personal effects; and
- Household furniture, appliances and equipment.
- Federal energy assistance payments;
- Food stamp coupons;
- Retroactive benefits under the SSI program and other lump sum payments from SSA; and
- The first $65 per month and half the remainder of any earned income.
By definition, if a resource or type of income is not disregarded or exempt, it is countable.
What are available assets and income?
Quite simply, if you can get your hands on it, it’s available. A countable asset or source of income will be treated as if you have it. Conversely, if you don’t have access to them, they are unavailable.
How can a health plan member apply for a Medicare Savings Program?
Members of health plans that are partnered with Social Service Coordinators® can apply for a MSP by applying directly at the state Medicaid agency or by contacting Social Service Coordinators® to help them with the application.
Why should health plan members use SSC?
When members use SSC to apply for a Medicare Savings Program, they receive personal assistance from an experienced caseworker to complete the application forms, to gather the required eligibility verifications, to represent them at any required interviews and to verify their approval by the state Medicaid agency.
The member also receives a complete Social Service CheckUp® to ensure that they are receiving any other social programs for which they might qualify. Instead of answering the enrollment questions five times on five different forms, the coordinator can document the member’s information once and complete multiple applications simultaneously.
If a member does not use SSC they will have to overcome all the governmental obstacles in order to receive a Medicare Savings Program or other private and public social programs.
How does the Medicare Savings Program application process work?
Verification requirements and eligibility limits differ by state. To begin the application for this benefit, a Social Service Coordinators® representative will interview the member and determine exactly which official forms and verifications need to be submitted in their state.
After completing the application as fully as possible, the Outreach Coordinator will send it to the member for his/her review and signature along with a list of the verifications that will be needed to prove his/her eligibility to the state Medicaid Administration.
Once the member returns the required documents, SSC’s Quality Assurance unit reviews the case to ensure that all eligibility factors have been adequately verified. The application is then submitted to the appropriate Medicaid eligibility agency for the member’s state and county of residence.
As the authorized representative for the member, the SSC Coordinator helps the member to obtain any other verification requested by the eligibility worker. Once SSC receives the approval notice, we capture the effective date of the benefit in our system and follow-up with the state if the Medicare Part B premium is still being deducted 90 days after the approval date.
How long does the application process take?
On average the entire application process can take about 45 days from the date the application is submitted to the Medicaid eligibility agency. The entire length of the application process is dependent on how quickly the member provides information to SSC, and how quickly the state Medicaid agency approves the application.
Once a health plan member is approved, how long before they receive the benefit?
On average, members begin to receive their Medicare Part B premium within 90 days after being approved by the state Medicaid agency. Additionally, members receive a separate check for the difference between when the Medicare Savings Program was effective and when their benefit appeared in their Social Security check. SSC will monitor approved applications to ensure that the payment of the Part B premium occurs as expected.
Is there a limit to how long I can receive the Medicare Savings Program benefit?
Yes. A member’s eligibility for a Medicare Savings Program must be re-determined every 12 months (some states perform QI-1 redeterminations in December. In those states, the member could be re-determined sooner than 12 months after the effective date of their benefit). Members must complete their re-determination paperwork in order to retain this benefit. As long as the member completes the required paperwork and continues to qualify an MSP, they will continue to receive the benefits.
Will SSC help health plan members re-apply?
SSC provides recertification services to those health plans that are contracted for such a service. In those cases, SSC will notify the member 60 to 90 days before the redetermination due date of their Medicare Savings Program and at that time SSC will assist the member with the redetermination paperwork so they can continue to receive the benefit.