Medicaid Table

Owned by Megan Hutton (Unlicensed)
Jun 04, 2022
2 min read

Medicaid/Medicare Savings Programs Table

Notes

Medicaid is a state run program. Every state has different ID Cards, income limits, benefit levels, ancillary benefits, etc. Some states even call Medicaid by a different name.

When a Medicare beneficiary receives Medicaid, Medicaid WILL NOT pay anything for prescription drugs. Medicare beneficiaries receive a different type of Medicaid than everyone else. This is why LIS/Extra Help exists. Most people with Medicaid also receive LIS/Extra Help, but it is not automatic.

IMPORTANT: Medicare Beneficiaries can have LIS without Medicaid. They can have Medicaid without LIS. They are totally separate programs. Medicaid is state program. LIS is Federal program.

 

Level

  • FBDE (Full Benefit Dual Eligible)

    • Medicaid pays:

      • Part A premiums, if they have any.

      • Part B premiums, ($170.10/month in 2022).

      • A & B cost-sharing (co-payments and coinsurance for doctor’s visits, lab work, hospital stays, etc. as long as the doctor accepts Medicaid and Medicare).

      • Ancillary Coverage, if the state program provides any (Dental, Vision, Hearing).

  • QMB (Qualified Medicare Beneficiary)

    • Medicaid pays:

      • Part A premiums, if they have any.

      • Part B premiums, ($170.10/month in 2022).

      • A & B cost-sharing (co-payments and coinsurance for doctor’s visits, lab work, hospital stays, etc. as long as the doctor accepts Medicaid and Medicare).

  • QMB+ (Qualified Medicare Beneficiary + Ancillary)

    • Medicaid pays:

      • Part A premiums, if they have any.

      • Part B premiums, ($170.10/month in 2022).

      • A & B cost-sharing (co-payments and coinsurance for doctor’s visits, lab work, hospital stays, etc. as long as the doctor accepts Medicaid and Medicare).

      • Ancillary Coverage, if the state program provides any (Dental, Vision, Hearing).

  • SLMB (Specified Low-Income Medicare Beneficiary)

    • Medicaid pays:

      • Part A premiums, if they have any.

      • Part B premiums, ($170.10/month in 2022).

  • SLMB+ (Specified Low-Income Medicare Beneficiary + Ancillary)

    • Medicaid pays:

      • Part A premiums, if they have any.

      • Part B premiums, ($170.10/month in 2022).

      • Ancillary Coverage, if the state program provides any (Dental, Vision, Hearing).

  • QDWI (Qualified Disabled Working Individuals)

    • Medicaid pays:

      • Part A premiums, if they have any.

  • QI (Qualified Individuals)

    • Medicaid pays:

      • Part B premiums, ($170.10/month in 2022).

IMPORTANT: SLMB, SLMB+, QDWI, and QI levels have to pay their copays. If we put them on a D-SNP plan that says 0-20%coinsurance they will be paying 20% coinsurance. It is very important to keep this in mind, when reviewing plans for these people. In most cases, a regular MAPD plan with low copays will benefit them more than a D-SNP, but it all depends on their preferences/needs and what’s available in their area. Please, do not ignore MAPD plans when talking with people with SLMB, SLMB+, QDWI, and QI levels of Medicaid. ALWAYS open the Summary of Benefits for DSNP plans to make sure that you are stating accurate copays/coinsurance.

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