Clarifying information
What do the Medicare Savings Programs (MSP) and Medicaid offer Medicare beneficiaries?
- The MSP pays some out-of-pocket Medicare expenses for Medicare beneficiaries who meet the MSP income tests. For example and depending on the category of MSP eligibility, MSP can pay:
- Part A and Part B premiums; and
- Deductibles, coinsurance, and copayments for Medicare Parts A, B, and C.
- The state notifies Medicare every month via an electronic interface about individuals with both Medicaid and Medicare. Medicare automatically assigns Medicaid individuals with Medicare and/or MSP to a Medicare Part D plan. Medicare notifies these individuals by mail about their Part D plan.
What expenses are not paid by the Medicare Savings Programs?
The Medicare savings programs do not pay for the following expenses:
- Medicare Part D premiums
- Medicare Part D prescription drug copayments
- Medigap policies
- Medicare Part C premiums
- Expenses incurred with a provider who is not contracted with Medicaid.
Automated screening of Medicare Savings Program
As part of the Medicare Modernization Act applications to Social Security for Limited Income Subsidy (LIS) are also to be considered an application for Medicare cost-sharing. To comply with this requirement ACES automatically sends an application for health care to any individual who has applied for LIS at SSA in the previous month. If the LIS recipient does not complete and return the application ACES will automatically deny the request. Procedures for processing the returned applications are below.
Worker responsibilities
- Determine eligibility for a Medicare Savings Program (MSP) and, if requested, all other health care programs.
- WA State SSI Related income and resource rules differ from SSA LIS income and resource rules so S03 cannot be opened without an application and eligibility determination.
- ACES sends a LTR 023-02 and a 13-691 application form.
- If the individual returns the application form eligibility is determined for all Apple Health programs.
- The Standard of Promptness (SOP) count begins from the date DSHS received the SSA/LIS input file. ACES is programmed to apply the correct SOP date.
- Denying automated MSP applications.
- ACES will auto-deny MSP applications with LTR 004-05 and reason code 230 after 30 days when an application is not returned.
- Do not deny for failure to provide information prior to the automated ACES denial.
Note: Estate Recovery rules do not apply to MSP.
For questions or issues about buy-in
For assistance with Medicare premium payment questions only, contact the HCA Medicare Buy-In Unit at 800-562-3022 Ext: 16129.
If you have an eligibility question or need assistance with an administrative hearing issue, please contact your area Medicaid eligibility policy representative at the Health Care Authority, Office of Medicaid Eligibility and Policy.
ACES procedures
See Medicare Savings Program