Question: I hear other people talk about benefits that pay their Medicare Part B premium. What is that and how do I get that?

Answer: The program I believe you are asking about is called the Medicare Savings Program (MSP). This is a Medicaid benefit administered by the Department of Social Services (DSS) in Chautauqua Co. Each year the income levels change, and this is new income information just released from the Federal Government.

Often our gross income is different than our Net income. (I remember the difference with a rhyme, “Net is what you Get”.) With regards to Social Security, most Americans have their Medicare Part B premium taken out before they receive their benefit. If someone’s Social Security benefit amount is $2,200 per month. Their net income is probably $2,026. (The amount deposited in their account.) That is because there is a Medicare Part B premium of $174.70 taken out before you are paid. This is true for pensions as well. Some individuals have taxes taken out of their pension. So your Net pension is less than your Gross pension. This can sometimes lead to confusion when people are trying to determine their eligibility for benefits. For most entitlement/benefits you apply for, you must count your gross income (the amount before deductions).

The application(s) for the following Medicaid (Medicare Savings Program-MSP) benefits can be obtained by going to the DSS office closest to you, Jamestown, Mayville, or Dunkirk. They can also be found on the www.mybenefits.ny.gov/ website. You can also call your local DSS office and request one be mailed to you.

The QI-1 benefit (entitlement) is part of the Medicare Saving Programs (MSP’s). This program pays your Medicare Part B premium, which means your SS benefit goes back to the gross amount that you receive in the bank. This benefit also could pay your Part D premium and reduces the cost of your medications at the pharmacy. The QI-1 benefit has an income cap (maximum) per household. The income cap for those over age 65 is $2,355 for a one-person household and $3,189 for a couple. This income includes all retiree income, (ie; Social Security, IRA’s, Pensions, Retirement Annuities, VA pension, etc.) There is NO resource test for this benefit. That means that the money in the bank, investments and stocks are not reviewed or included in this application process.

This entitlement does allow for some of your expenses to be deducted from your gross income. Those expenses include your Health Insurance Premiums, Dental Insurance Premiums and Long Term Care Insurance Premiums.

This reduction in your gross income could make a significant difference for some people. Some of these premiums could be significant. Medicare Supplement Insurance premiums have increased over the years, you may pay $250 monthly. This means that an individual with this monthly premium could make that much more in monthly income and still be eligible for the benefit ($2355 + $250 = $2605). This equation illustrates that higher income individual could be eligible for the QI-1 benefit.

Obviously this is just one of the deductions you can use as mentioned above. You can take that maximum income and review your own insurance premiums and determine if you are close to eligibility. Also remember this benefit does not count your assets (money you already have).

The next level of benefit is Qualified Medicare Beneficiary (QMB) Medicaid Benefit. This benefit also requires an Application be completed and filed with Department of Social Services (DSS). The income cap or highest amount an individual can make for this benefit is $1752 per month and for a couple $2371 per month. This is another benefit that does not have a resource test. This means you do not have to disclose your assets (money/property you already have).

The QMB benefit pays your Medicare Part B premium ($174.70) each month. This also can help pay for or pay in full your Health Insurance premiums. These premiums could be for a Medicare Advantage Plan or a Medicare Supplement Plan. If either of their insurance products require you to pay copays for your healthcare, this QMB benefit will pay those co-pays as well. This benefit also pays the copays and deductible for your health care.

Both of these benefits QI-1 and QMB benefit are what I call a ‘gateway’ benefit. Once you apply and are approved for this benefit, you also get the Low Income Subsidy (LIS) for your Part D plan, which pays the premium for your Part D coverage (up to $48.76) and reduces your co-pays at the pharmacy down to $4.50 for generics and $11.20 for brand name medications covered by your plan.

To apply for the QI-1, QMB or Medicare Saving Program benefits you must fill out an application for DSS. The application is usually a simplified application consisting of one piece of paper (two sides). When reviewing the income that an individual or couple has, DSS requires proof of income. This application and the required proof of income, expenses and identification can be mailed to DSS or dropped off at DSS.

You can apply for this benefit anytime during the year. You can also reapply for this benefit if you have been denied in the past, using these expenses listed above. You may then be eligible for this useful and extremely helpful benefit. I have seen this benefit make a significant difference in the households of many seniors.

Good luck and reach out with questions. Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.