State of Wisconsin
Release 20-02 February 20, 2020
32.1.1 Medicare Savings Programs Introduction
32.1.2 Medicare Savings Programs Fiscal Test Group
32.1.3 Medicare Savings Programs Benefits
32.1.4 Low Income Subsidy Requests
32.1.5 Part B Enrollment Via the Medicare Savings Programs Buy-In Program
Medicare is the health insurance program administered by CMS Centers for Medicare and Medicaid Services. It administers the Medicare program and works in partnership with states to administer Medicaid and other programs. Formerly known as HCFA. for people 65 years old, people determined disabled for two years or more, or people with end-stage renal disease (permanent kidney failure requiring dialysis or transplant). People who receive Medicare are referred to as Medicare beneficiaries.
Medicare is divided into four types of health coverage:
Medicare charges monthly premiums, and Medicare beneficiaries are responsible for deductibles and coinsurance payments to providers. These out-of-pocket charges are generally referred to as Medicare cost-sharing.
Wisconsin Medicaid may pay some or all of the member’s Medicare cost-sharing for certain Medicare beneficiaries participating in the following programs:
These programs are called Medicare Savings Programs (MSP). (They may also be referred to as Medicare Premium Assistance or Medicare Buy-In programs.)
When determining eligibility for MSP, IM workers should use the same rules for determining financial eligibility as are used for Medicaid with the exception of using the MSP asset limits in Section 32.6 Medicare Savings Programs Asset Limits and the MSP income limits in Section 39.5 Federal Poverty Level Table. Nonfinancial eligibility is available as follows:
QMB members will receive a ForwardHealth card even if the member is not eligible for any other subprograms of Medicaid since Medicaid pays the Medicare copayments and deductibles for members enrolled in QMB.
The FTG fiscal test group size is two when a couple is living together in the community, unless one of the spouses is an SSI Supplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind, or disabled. recipient. If one spouse is applying for MSP and the other spouse is an SSI recipient, the SSI recipient spouse is not included in the other spouse’s FTG. If both spouses are living in the same nursing home, each person is an individual FTG.
See Section 2.6.4 Low Income Subsidy Program of Medicare Savings Programs for information on LIS Low Income Subsidy of Medicare Part D. This is also called "Extra Help" by the SSA. It helps people with limited resources pay for a portion of Part D costs. Requests for MSP Medicare Savings Programs. Assistance to help pay coinsurance, premiums, and deductibles for Medicare beneficiaries who are also one of these types of Medicaid recipients: QMB, SLMB, SLMB+, or QDWI. This has also been called "Medicare buyin," "buy in," or "Medicare Premium Assistance (MPA)." DHS is using the term "MSP" to refer to this type of assistance..
Members receiving Medicare Part A coverage who chose not to enroll in Part B may be eligible to enroll in Part B via the MSP process with the state. The MSP eligibility should be determined in CWW. If the member is eligible for MSP, the worker must contact the ForwardHealth Medicare buy-in analyst by phone at 608-224-6126 or by filling out a Medicaid/BadgerCare Plus Eligibility Certification form (F-10110) stating when the member will begin their Medicare buy-in eligibility. The Medicare buy-in analyst will create a manual transaction to send to CMS with the appropriate MSP information. Once CMS processes the record, the member should be enrolled into Part B with coverage beginning the first month of MSP eligibility.
Example 1: In January, the member applies for QMB benefits and is only receiving Part A Coverage. The case worker determines the member qualifies for QMB starting February. After the confirmation is done in CARES in January, the worker contacts the ForwardHealth Medicare buy-in analyst to report the enrollment. The buy-in analyst creates a transaction with the QMB information. This transaction is sent to CMS in February.
Once CMS processes the record and bills the state, the member will show Part B coverage starting in February.
This page last updated in Release Number: 18-01
Release Date: 04/13/2018
Effective Date: 04/13/2018