Medicare Secondary Payer
MSP is the term generally used when the Medicare program does not have primary payment responsibility – that is, when another entity has the responsibility for paying before Medicare.
How does Medicaid work with Medicare?
When someone has Medicare there is the possibility that they may also be eligible for a form of Medicaid often referred to as QMB – Qualified Medicare Benificary.
QMB is actually a level of assistance under the Medicare Savings Program.
Other levels are:
- SLMB (only) (Specified Low-Income Medicare Beneficiary) – Pays Medicare premium only
- QI1 (Qualifying Individual) – Pays Medicare premium
And a few others that we will not expand on here. These levels are the most common and the level most people will fall into.
So what do all these levels really mean to anyone?
In short, QMB recipients get premiums, Part B (and Part A if they have a Part A premium), Deductibles, and coinsurance covered. It is actually prohibited for Medicare providers to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments, except outpatient prescription drugs.
QMB Income and Resource Limits in 2019:
Individual income/mo limit* – $1,061
Married couple income/mo limit* – $1,430
Individual resource limit – $7,730
Married couple resource limit – $11,600
Program helps pay for:
- Part A premiums
- Part B premiums
- Deductibles, coinsurance, and copayments
Note: Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments, except outpatient prescription drugs. Pharmacists may charge you up to a limited amount (no more than $3.80 in 2019) for prescription drugs covered by Medicare Part D.
An important note: Prescriptions are not covered under Medicare Savings Program. Prescriotion assistance, when qualified, is done through a Federal Program known as Extra Help also known as Low income Subsidy (LIS) and administered with your Private Part D plan. Part D is required to get prescriptions when on Medicare either in the form of a Stand Alone Part D or in a Medicare Advantage Plan that includes Part D.
To make sure your provider knows you’re in the QMB program, show both your Medicare and Medicaid or QMB card each time you get care. If you get a bill for medical care Medicare covers, call your provider or plan about the charges. Tell them that you’re in the QMB program and can’t be charged for Medicare deductibles, coinsurance and copayments. If this doesn’t resolve the billing problem, visit medicare.gov to get help paying costs.
SLMB and QI1 recipients only receive help paying their PART B PREMIUM only. No part A, and No Coinsurance nor deductibles.
Medically Needy Program
If you are seeking extra help with large bills, you may find what you are looking for under another program called the Medically Needy Program.