Many Medicare Beneficiaries Under Age 65 Not Accessing Medicare Savings Programs

The Medicare Advocacy Project (MAP) believes that many Medicare beneficiaries under age 65 in Massachusetts are not able to access the Medicare Savings Program (MSP) benefits that they are legally entitled to. Unless eligible for MassHealth Standard, beneficiaries under age 65 do not receive MSP benefits. MAP is working to correct this problem and is looking for affected beneficiaries.

MassHealth does not advertise that MSP benefits are available to people under 65 who are not on Masshealth Standard. The MassHealth computerized eligibility determinations do not pick up on these cases.

The MassHealth regulations concerning the Medicare Savings Programs are contained in the sections of the regulations that apply to people 65 and over, creating ambiguity as to whether they apply to those under age 65.

The Law: There are three Medicare Savings Programs:

1. QMB (Qualified Medicare Beneficiary) covers Medicare deductibles, Medicare co-insurance and the Medicare premium(s). QMB has an income limit of 100% of the federal poverty level and an asset limit of $4000 - $6000.
   
2. SLMB (Specified Low Income Medicare Beneficiary) covers the Medicare premium(s) and has an income limit of 120% of the federal poverty level and an asset limit of $4000 - $6000.
   
3. QI (Qualified Individual) covers the Medicare premium(s) and has an income limit of 135% of the federal poverty level and an asset limit of $4000 - $6000.
   

The Law: SSI Income Counting Rules must Be Used:

Under federal law (42 U.S.C. § 1396d(p)(1), 42 U.S.C. § 1396a(a)(10)(E)(iii); 42 U.S.C. § 1396a(a)(10)(E)(iv)) countable income for these programs is supposed to be determined using SSI income counting rules. These rules are different from the rules that are used by MassHealth to determine MassHealth eligibility for disabled adults under age 65. While MassHealth uses a gross income test without deductions and counts the income of all household members including minor children in determining the adult's eligibility, SSI has deductions from countable income and does not count the income of a minor child in determining an adult's eligibility. This difference can be meaningful in individual situations.

Examples (using 2006 income and poverty level standards):

1. Single disabled adult with gross SSDI income of $1100 per month in 2006. Under MassHealth rules, this individual is over income for MassHealth Standard and thus would not have their Medicare premium paid by MassHealth. Under SSI income rules, countable income would be $1080 after the $20 disregard and thus the person would have countable income below 133% FPL and would be eligible as a QI for payment of the Medicare premium.
   
2. Disabled adult who is a single mother with gross SSDI income of $800 who has a child with dependants' benefits of $400 a month and child support of $300 a month. The gross monthly family income of $1500 is over the 133% for MassHealth Standard. However, under SSI income rules, the adults' countable income is only $800 which is below 100% of the Federal poverty level. Thus, although this person is not eligible for MassHealth Standard, she should be eligible for full QMB benefits which would pay Medicare deductibles and cost sharing as well as the Medicare premium.
   
3. Disabled adult with no income who has a working spouse grossing $2000 per month. Under MassHealth rules, this person is not eligible for MassHealth Standard as gross family income exceeds 133% of the Federal Poverty level. If SSI income deductions were applied, countable income would be $957 for a family of two and the person would be eligible for full QMB benefits which would pay Medicare deductibles and cost sharing as well as the Medicare premium.
   

If you have clients under age 65 who are not eligible for MassHealth Standard, but might be eligible for QMB, SLMB, or QI benefits under the SSI income rules, we would like to hear about them. Please contact Nancy Lorenz, nlorenz@gbls.org, or Sarah Anderson, sanderson@gbls.org.