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2021 Medicare Savings Programs Eligibility

GOOD NEWS FOR LOW INCOME MEDICARE BENEFICIARIES: EFFECTIVE JANUARY 1, 2021, ELIGIBILITY FOR THE MEDICARE SAVINGS PROGRAMS IS BASED SOLELY ON INCOME.  IT IS NO LONGER NECESSARY TO SATISFY RESOURCE (A/K/A ASSETS) STANDARDS TO BECOME ELIGIBLE

The “Medicare Savings Programs” are Medicaid coverages that help low-income Medicare beneficiaries with out-of-pocket costs.  The three most important programs are called QMB (for “Qualified Medicare Beneficiary”); SLMB (for “Specified Low-Income Beneficiary”) and QI1 (for “Qualified Individuals”).  They are commonly referred to just by their initials.

Each program pays for its eligibles’ Medicare Part B premiums.  QMB also (1) pays for its eligibles’ Medicare Part A premiums (if needed),* and (2) insulates them from being charged for Medicare Parts A and B co-pays.  In addition, individuals who are eligible for any of these programs automatically qualify for “Extra Help” subsidies of their Medicare prescription drug coverage costs.  The federal Medicare agency reports that MSP eligibles can save as much as $4,500-$5,000 or more a year in out-of-pocket costs.

Prior to this year, in order to be eligible for any of these programs, individuals had to satisfy both income and resources eligibility standards (i.e., their countable** income and resources [a/k/a “assets”] had to be under specified amounts).  However, effective January 1, 2021, the resource standard has been eliminated, so applicants need only satisfy the income standard.

The New Mexico Human Services Department (HSD) proposed this elimination last Fall, and SCLO strongly supported the need for and value of the elimination.

The countable income eligibility standards for these MSPs through March 31*** are:

QMB:  $1,084/month for an individual; $1,457 for a couple

SLMB: $1,296/month for an individual; $1.744 for a couple
QI:        $1,456/month for an individual; $1,960 for a couple

[These dollar amounts include a standard $20/month income disregard]

 Since it will take at least until the end of January for HSD’s computerized eligibility system to be updated, MSP applicants (and beneficiaries whose eligibility is being recertified) should double-check that a resource standard is not being erroneously applied to them.

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* Most Medicare beneficiaries do not have to pay a monthly premium for Part A.

** “Countable” refers to the fact that some types and amounts of income and resources are disregarded (i.e., not counted) for eligibility purposes.

*** New MSP income eligibility standards, although based on the current year’s new federal poverty levels, are not implemented until April 1.  However, in determining MSP eligibility, the new year’s Social Security COLA amount is not counted from January through March.  

 

 

 

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