Social Service Coordinators

Medicare Savings Advantage™

SSC helps members identify and apply for State Medicare Savings Programs (MSPs) that can help pay their Medicare Parts A and B premiums, coinsurance, and deductibles. It may also pay some of the member’s health plan co-payments.

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Many people with Medicare have low incomes, but not quite low enough to qualify for full Medicaid. There are several MSPs 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)
Qualified Individual 1 (QI-1)
Qualified Disabled and Working Individual (QDWI)

Background

Congress first enacted the Medicare Savings Programs as part of the Medicare Catastrophic Coverage Act of 1988. The intent of the legislation was to expand protections for the elderly poor by relieving them of the need to share the costs of Medicare services. The programs were subsequently expanded by additional federal legislation—the Omnibus Budget Reform Act (OBRA) of 1990 and then the Balanced Budget Act of 1997 (BBA). These programs are sometimes called the Medicare Buy-In and the Medicare Premium Payment Programs.

The state and federal government fund the Medicare Savings Programs jointly. The administrative costs for three of the programs (QMB, SLMB, QDWI) are split between the federal and state government. QI-1 is a federal block grant and is fully federally funded. The state Medicaid office administers all of the programs.

The QMB and SLMB programs are entitlement programs. This means that anyone eligible for the benefit will be able to receive it. The QI -1 program is funded by block grants. A block grant program is different from an entitlement program. With a block grant, a specific amount of money is allocated to the state. Eligible beneficiaries receive benefits only up to the point where the allocation is exhausted. Thus the benefit is “first come-first served,” and contingent on the availability of funds.

The Qualified Disabled and Working Individual (QDWI) program was implemented as part of OBRA 1990. This program pays for the Medicare Part A premium only, not Part B. To be eligible, the applicant must be a disabled worker under age 65 who lost Part A benefits because of return to work. Historically, very few people have enrolled in QDWI.

Application Process

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. Some examples of these verifications are listed below:

Citizenship

If the member:	This type of verification may be needed
Was born in the United States or a U.S. Possession;	Birth Certificate U.S. Passport Baptismal Record Medicare Card
Was born outside the U.S. or a U.S. Possession, but has since become a Naturalized U.S. Citizen;	U.S. Passport Naturalization Certificate Medicare Card
Was born outside the U.S. or a U.S. Possession and is not a Naturalized U.S. Citizen;	Alien Registration Card Date of Entry into the U.S. Medicare Card

Note that citizenship verification for U.S. born individuals is only required in a few states. All states require citizenship verification for those individuals born outside the U.S.

Income

If the member has:	This type of verification will be needed
Social Security (RSDI) Pensions Survivor's benefits Permanent disability insurance	Recent award letter Recent cost-of-living increase notice from the SSA RSDI check or direct deposit slip Contact with SSA representative
Railroad retirement	Recent award letter from RR Board Contact with representative of RR Board Most recent check or direct deposit slip
Veteran's benefits Pension Compensation (disability) Subsistence allowance for education and on-the-job training Refunds paid to ex-servicemen (GI insurance premiums)	Current check or direct deposit slip Recent VA Award Letter
Private pensions (retirement benefits) Former employer Union Insurance company	Current check stub Letter from company
Civil service annuity (CSA)	Recent CSA increase award card Letter from CSA
Dividends Stocks Membership in associations	Recent check stubs or checks Letter from company making payments Recent statement from a brokerage house or the company issuing the stock to verify dividends
Earnings Wages Salary Commissions / Tips Piece-rate payments Cash bonuses Gross Income	Monthly gross income Copies of earnings statements (check stubs) Letter from Employer
Net income from self-employment	Most recent IRS Form 1040 (Income Tax Return) including all schedules.
Net rental income House, store or other property Boarders or lodgers	Most recent IRS income tax return Statements from client and renter Copy of lease or rent check
Net income from lease of mineral rights Gross royalty payments Yearly lease payments	Royalty interest statements (check stubs) Contact with representative of oil company Check stub from lease payments
Income from mortgages or contracts (notes) Negotiable and Non-negotiable	Copy of contract with the statement of terms of repayment and negotiability Amortization chart
Irrevocable trust funds	Trust agreement Letter from bank representative or financial institution managing trust Recent bank statement
Cash support payments from friends or relatives	Statement from contributor

Assets

Note: Some states have waived the asset requirements for Medicaid and/or one or all of the Medicare Savings Programs (Alabama, Arizona, Delaware, Connecticut, Mississippi, and New York).

If the member has:	This type of verification will be needed
Bank accounts, checking, savings, certificates of deposit (CD), money market	Current bank statement (and three prior months) Letter from the financial institution or bank Current savings statements Recent entry in a savings passbook
Bonds	For Savings Bonds, the U.S. Treasury Office or its publication that is used by banks (and is available upon request)
Real property	Tax bill or assessment notice
Revocable trust funds	Bank statement Trust agreement
Stocks	Recent statement from Brokerage House Issuing company Securities firm statement
Vehicles	Vehicle Registration "Blue" or NADA Book (gold) value