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Take a Minute for Medicare

This month we will conclude the topic on Extra Help with Medicare Part D costs. We will focus on Medicaid eligibility and what it can do to help you with your Medicare and Part D costs. If eligible, you will pay the lowest costs for your Medicare Part D drugs and eliminate the coverage gap.

What is Medicaid?
Medicaid is a joint federal and state program that assists with the medical costs of people with low income, and low resources. Each state establishes its own eligibility guidelines, administers its own program, and determines the covered services. You can have both Medicare and Medicaid. If you are a dual eligible beneficiary –a person enrolled in both Medicare and Medicaid– Medicare pays first, and Medicaid pays second. Medicaid may cover services that Medicare does not, like some dental, vision and personal care. It can also help cover Medicare’s out-of-pocket costs, including deductibles, coinsurances, and copayments.

What is a Medicare Savings Program (MSP)?
Also administered by Medicaid are the Medicare Savings Program (MSP) which help pay for some of your Medicare health costs if you have limited income. There are three types of MSPs, and each helps pay your monthly Medicare Part B premium and one also helps pay Medicare costs like deductibles, copayments, and coinsurances. To qualify for a MSP, you must have Medicare Part A and meet the income and asset eligibility guidelines. If you’re unsure of whether you qualify, you should still apply because certain types of income and assets do not count when determining whether you qualify for a MSP.

Types of Medicare Savings Programs (MSPs) in Wisconsin:

Qualified Medicare Beneficiary (QMB) • Pays your Medicare Part A and Part B premiums, deductibles, copayments, and coinsurances.
• You can have both QMB and Medicaid.
• Coverage is not retroactive. Benefits begin on the first of the month after your eligibility is approved.
• Income eligibility at or below 100 percent of FPL.

Specified Low-Income Medicare Beneficiary (SLMB) • Pays your Medicare Part B premium.
• You can have both SLMB and Medicaid.
• Offers 3-month retroactive coverage prior to application date, as long as you were eligible during those months.
• Income eligibility set at 100 percent to 120 percent of FPL.

Specified Low-Income Medicare Beneficiary Plus (SLMB+) • Pays your Medicare Part B premium.
• You cannot have both SLMB + and Medicaid.
• Offers 3-month retroactive coverage prior to application date, as long as you were eligible during those months. However, coverage can only be provided within the current calendar year. For example, if you apply in January, you will not receive retroactive coverage.
• Income eligibility set at 120 percent to 135 percent of FPL.

For general Medicare questions, call DRW at 1-800-928-8778. For Medicare Part D questions, call the Disability Drug Benefit Helpline at 1-800-926-4862. You can also call 1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov to find out if Medicare covers your test, service, or item.