Some people qualify for both Medicare and Medicaid and are called “dual eligibles.” If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered. You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan.
Medicaid is a health insurance benefit for people with limited incomes. People who have Medicare can also receive Medicaid, if they meet their state’s eligibility criteria. These people are often called “dual eligibles” or “duals.” The Medicare Savings Programs are a specific sub-set of Medicaid benefits that help pay for the costs of Medicare.
Medicaid Savings Program
The Medicare Savings Programs use Medicaid funds to help eligible persons pay for all or some of their out-of-pocket Medicare expenses, such as premiums, deductibles or coinsurance. HHSC manages the Medicare Savings Programs, which consists of the following: Qualified Medicare Beneficiary (QMB) Program.
Unfortuantely, lack of awareness about these programs, the complexity of the applications and enrollment processes, and the reluctance to go to state Medicaid offices to sign up because of perceived welfare stigma all hinder participation, according to the analysts.
Only about one-third of those eligible for the QMB program are actually enrolled, and the figure is lower for the SLMB program.
If you are eligible for both Medicare and Medicaid (dually eligible), you can have both. They will work together to provide you with health coverage and lower your costs. Medicare Savings Programs (MSPs) lower those out of pocket costs.
Three Types of MSPs Programs
The Qualified Medicare Beneficiary (QMB) program is for those with incomes below the federal poverty line and covers Medicare Part A premiums and Part B premiums and other cost-sharing expenses such as deductibles, copayments, and coinsurance.
The Specified Low-Income Medicare Beneficiary (SLMB) is for those with incomes between 100 and 120 percent of the poverty line and pays for Part B premiums only.
The Qualifying Individual (QI) program is for those with incomes between 120 and 135 percent of the poverty line and also pays Part B premiums.
Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state's payment limit.
Depending on your income and assets, you may be able to find some assistance in paying health care costs associated with Medicare. Dial 2-1-1 or call 1-877-541-7905 for more information about Medicare programs and subsidies for people with low incomes in Texas.
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