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The original item was published from 5/22/2020 4:06:22 PM to 6/23/2020 12:00:04 AM.

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Office for Aging

Posted on: May 22, 2020

[ARCHIVED] Enrolling in Medicaid or a Medicare Savings Program in New York

2020 MSP-Info-Sheet-(NY)_Page_1

If you live in New York and have a limited income, you may be able to get assistance with your health care costs through a Medicare Savings Program (MSP) or Medicaid. MSPs, also known as Medicare Buy-In programs or Medicare Premium Payment Programs, help pay your Medicare costs if you have limited income and savings. Medicaid is health coverage for certain people with limited income and assets.

1. Qualifying Individual (QI)

• Pays for your Part B premium

• May receive up to three months retroactive reimbursement for Part B premiums (Note: only for premiums paid up to three months before your MSP effective date, and within the same year of that effective date)

• You cannot have both QI and Medicaid

2. Specified Low-Income Medicare Beneficiary (SLMB)

• Pays for your Part B premium

• May receive up to three months retroactive reimbursement for Part B premiums

• You can have both SLMB and Medicaid

3. Qualified Medicare Beneficiary (QMB)

• Pays for Medicare premiums

• Providers are prohibited from charging you for Medicare cost-sharing (deductibles, coinsurance, and copayments). This means you should not be billed for any Medicare-covered services you receive from Original Medicare providers or providers in your Medicare Advantage Plan’s network

• You can have both QMB and Medicaid

4. Medicaid

• Health coverage for certain people with limited income and assets

• For services covered by Medicare and Medicaid, Medicare will pay first and Medicaid may cover your Medicare cost-sharing, including coinsurance and copayments

• May cover services that Medicare does not, such as dental and/or vision

• You may also qualify for QMB, which will pay for your Part B premium

• To apply, contact your local Medicaid office

• If you need Medicaid coverage and your income is above the income guidelines, you may be eligible for the Medicaid spend-down. Contact your local Medicaid office for more information.

Note: If you receive a denial and are told that you do not qualify for an MSP, you have the right to request a fair hearing to challenge the decision.

Note: New York disregards/excludes the cost of certain health insurance premiums from your income. For example, if you are over the income limit for an MSP but pay a premium for a Medigap or other secondary health insurance, you may deduct the premium from your gross monthly income to qualify. Sometimes a portion of your Part D premium can also be deducted from your income. The Part B premium ($144.60 deducted from your Social Security award) cannot be used as a disregard.

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