This blog post reviews state programs that help eligible people with their Medicare costs. They are called Medicare Savings Programs (MSPs) and are also known as Medicare Buy-In programs.
First, let’s discuss what the Medicare Savings Programs (MSPs) offer.
MSPs are state programs that assist you with paying your Medicare Part A and B costs, especially Part B premiums. The Qualified Medicare Beneficiary MSP also pays for deductibles, coinsurances, and copayments for Part A and B and for Part A premiums, if you have any. Another kind of MSP is available to some Medicare beneficiaries who are under 65 and work. There are three main programs, each with different benefits and eligibility requirements.* The names of these programs and how they work may vary by state. You will be enrolled in the MSP that corresponds to your income, assets, and other application details.
To learn if you qualify for an MSP, contact your contact your state Medicaid agency or your State Health Insurance Assistance Program (SHIP). Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP. A SHIP counselor can help you find out if your income and assets are under your state’s limits for an MSP. SHIPs are experts on how Medicaid and Medicare work together.
*Note that a fourth MSP exists, called Qualified Disabled Working Individual or QDWI, which is available to some people eligible for Medicare under the age of 65 who work. Call your SHIP to find out more about this program.
There are some important additional benefits that come with an MSP.
One benefit of enrolling in an MSP is that it will allow you to enroll in Part B outside of the regular enrollment periods. This is important because you usually must wait for the General Enrollment Period (GEP) to sign up for Medicare if you did not sign up when you were first eligible. If you apply for and qualify for an MSP, it will enroll you in Part B outside of the GEP.
A second benefit is that enrolling in an MSP will eliminate your Part B late enrollment penalty if you have one. You will not have the penalty even if you later lose MSP eligibility. The QMB MSP will also eliminate your Part A late enrollment penalty if you have one.
Let’s now discuss how to apply for an MSP.
You will need to apply through your local Medicaid office or other state agency that receives MSP applications. Some states’ applications can be submitted online, while others are submitted through the mail. You will usually need to send in documentation with the application, such as copies of your Social Security card, Medicare card, birth certificate, and/or proof of income and assets. Your Medicaid office should respond in about 45 days. If you do not receive a notice, follow up with the office where you applied. If you are approved for the MSP, it can take up to three months for your benefits to start. You will be reimbursed for any premiums you paid during those months.
You can contact your local SHIP to learn how to apply or receive assistance with the application. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
Make sure to keep your MSP from year to year.
If you are approved, you will need to renew your MSP every year. This is called recertification. If you do not receive a notice in the mail reminding you to recertify, contact your local Medicaid office and ask what you need to do to make sure you receive your MSP benefits in the following year. Note that some states are automatically extending individuals’ MSPs through the COVID-19 public health emergency and are not requiring individuals to recertify to maintain their MSP. Contact your SHIP or local Medicaid office to learn how the current public health emergency may be affecting MSP recertification in your state.
And finally, make sure to know your MSP rights and protections.
First, MSPs are available to all eligible people with Medicare, not just those enrolled in certain private plans. Some Medicare Advantage Plans offer to assist beneficiaries with the MSP application, but this assistance should not be described as a supplemental benefit or a “premium-free” Medicare Advantage Plan. All people with Medicare can apply for an MSP and can contact their local SHIP if they need assistance applying.
Second, if you are enrolled in the Qualified Medicare Beneficiary (QMB) MSP, providers who accept Original Medicare or who are in-network for your Medicare Advantage Plan cannot bill you for any Medicare deductibles, coinsurance charges, or copayments. To do so would be considered improper billing. Providers who violate improper billing protections may be subject to penalties. If you have the QMB MSP and your provider bills you for services, remind them that you have a QMB MSP and should not be billed (unless you are in a state that imposes small Medicaid copayments). If a provider continually bills you despite your QMB MSP enrollment, call your local Senior Medicare Patrol (SMP). SMPs empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse. To find your local SMP, go to www.smpresource.org or call 877-808-2468
Still have questions?
Your SHIP is here for you! You can contact your SHIP for help with MSPs or any other Medicare-related question or concern. SHIP counselors are government-funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
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