Transitioning From Medicaid To Medicare | Help With Medicare Enrollment

One door closes and another door opens! Let us show you the way!

Everyone’s journey is different when it comes to Medicare, so let us take the time to understand your situation and give you informed advice about the next steps. We are here to help.

The Affordable Care Act (ACA) of 2010, made it possible for adults with limited income (below 138% of the Federal Poverty Line) to receive what is known as Expanded Medicaid (aka Obama Care). https://www.medicaid.gov/ This type of Medicaid considers income only and does not count resources. Once an individual qualifies for Medicare, whether through turning 65 or because of Disability, they cannot continue to receive Expanded Medicaid. At this point their income threshold for qualifying for full Medicaid is reduced from 138% to 74%, and resources are counted. Individuals can qualify for Medicare Savings Programs that help pay their premiums and Medicare cost share. However, because they require income and resource verification, these programs are not automatic. Senior Benefit Advantage helps our clients assess their eligibility for these programs. At our client’s request, we will serve as their designated authorized representative at their local Jobs and Family to help them apply for these programs. We also assist them in renewing their eligibility for the programs each year.

When you are turning 65 or have been on Disability for two years, you will qualify for Medicare. About 3 months before your Medicare starts, you will get a Medicare card and a letter from Social security notifying you that you must pay (in 2021) $148.50 for your Part B premium per month. In some cases, this might be more than 10-20% of your household income. Medicare is a big adjustment if you are coming from Medicaid. On Medicaid, everything has been free. There has been no premium. No copays or cost-share when going to the doctor. No hospital bills. Free dental and vision. And no cost for prescriptions. Medicare does not cover dental, vision and hearing.

Medicare has 4 parts, A, B, C and D. All the parts are moving, and are associated with deductibles, copays, and co-insurance. Prescriptions will now be covered through your Drug Plan (Part D) which has its own premium, deductible, and co-pays. If you are coming from Medicaid, where all of this was under one umbrella with no out-of-pocket cost, you might feel like you are suddenly standing on a cliff. In fact, this is a real phenomenon called- “The Medicaid Cliff.”

If you meet income and resource eligibility guidelines, you may qualify for Medicare Savings Programs, also called Medicare Premium Assistance Programs, to help you with your Medicare premiums and/or cost share.

Medicare Savings Programs may help pay your Medicare and Medicare Advantage premiums. Depending on your income and resources, a Medicare Savings Program may also pay hospital and medical insurance deductibles, copayments and coinsurance.

The QMB is the most comprehensive of the four Medicare Savings Programs. The QMB program may pay for Part A and Part B premiums as well as deductibles, coinsurance, and copayments. To be sure your provider knows you have QMB, show them both your Medicare and QMB (or Medicaid) card each time you visit.

When you have QMB status, Medicare providers are not allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments, except outpatient prescription drugs. Pharmacists may charge according to your level of Extra Help Eligibility for prescriptions purchased through Medicare Part D.

To make sure your provider knows you are 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 are in the QMB program and cannot be charged for Medicare deductibles, coinsurance and copayments.

The SLMB program pays Part B premiums only.

Like the SLMB program, the QI program is for Part B premiums only. You must apply every year for QI benefits and priority is given to people who got QI benefits the previous year.

If you qualify for the QMB program, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.

The QDWI program helps subsidize the Medicare Part A premium only. You may have to pay a Part A premium with a Medicare Advantage plan if you do not qualify for premium-free Part A. To qualify for QDWI you generally must be a working disabled person under 65 who lost your premium-free Part A when you went back to work. You also cannot be getting medical assistance from your state and you must meet income and resources limits set by your state.

All four programs have different income and resource guidelines that change each year. To get more information about this, feel welcome to visit http://www.medicare.gov

Senior Benefit Advantage specializes in assessing your individual situation. We are familiar with Medicaid and Medicare Savings Programs. We help you figure out where you fit in this very complex system. We make sure you have all the information available to make the most informed choices about your Medicare Plan options, and we continue to be your support throughout the year as your needs might change. As your local Medicare advisors, we help you navigate all the resources available to you to help you get the most out of your Medicare!

If you need affordable dental, vision and hearing coverage, you might want to consider a Medicare Advantage Plan option that provides for benefits beyond what Medicare covers. These plans usually cost $0 and provide extra benefits beyond Medicare such as Dental, Vision, Hearing, Transportation, Over the Counter Allowances, Emergency Response Systems, and more. For clients who qualify for both Medicare and Medicaid (Dual Eligible), you may qualify for a special Medicare Advantage Plan called a Special Needs Plan. Senior Benefit Advantage is certified with all the major carriers in your service area to be able to help you verify what kind of plan you are eligible for and help you determine which plan might be most suited to your needs.

Best of all – All our services are FREE!