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Medicare Savings Program
Purpose: To describe programs to help individuals pay for Medicare premiums, deductibles, coinsurance charges, and copayments.
- Refer individuals with Medicare questions to Medicare at 1-800- Medicare (800-633-4227) or TRS through Washington Relay.
- Refer individuals with questions about Railroad Retirement (RRB) benefits to the Railroad Retirement Board at 800-808-0722.
- Railroad Retirement Medicare entitlement is NOT in SOLQ. The individual can present a Red, White, and Blue Medicare entitlement card or RRB approval or award letter that shows the individual's or dependent's Medicare coverage. RRB award letters do not provide entitlement dates for Part A and Part B. The RRB Red, White, and Blue cards do provide Medicare entitlement dates.
- Workers should call 877-772-5772 to request RRB Medicare entitlement dates.
- Update TPL screens, if not already updated by AUTO.
- Approve the appropriate Medicare Savings Program when an individual or dependent of a RRB individual has RRB Medicare coverage.
- Refer individual questions about the Medicare Prescription Drug Program (Medicare Part D) or specific drug plans to:
- Medicare 800-Medicare; or
- SHIBA HelpLine 800-562-6900.
- Refer individual questions about Extra Help Paying for Medicare Prescription Drug Costs to:
- Processing MSP cases in ACES includes adding and/or updating the TPL screens unless ProviderOne has already updated the ACES TPL screens.
- Medicare and Long-Term Care. This section provides more detailed information about Medicare Part D and post-eligibility determinations.
- 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, look to see if health care coverage if requested. If so, determine eligibility 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.