Medicare Part D and LowIncome Subsidy Program医疗保险和低收入补助计划.pptVIP

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Medicare Part D and LowIncome Subsidy Program医疗保险和低收入补助计划.ppt

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Medicare Part D and LowIncome Subsidy Program医疗保险和低收入补助计划

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Medicare Savings Programs Type Income Limit Asset Limit Benefits QMB 100% FPL 7,080 (I), 10,620 (C) Pays Part A B premiums, co-insurance, and deductibles SLMB 120% FPL 7,080 (I), 10,620 (C) Pays Part B premiums QI 135% FPL 7,080 (I), 10,620 (C) Pays Part B premiums MSP Application Process To qualify for QMB, must complete a full MassHealth application To qualify for SLMB or QI-1, completed either a full MassHealth application or a MassHealth Buy-In Application If an individual qualifies they will also be approved for Full Extra Help with Prescription Costs. Case Example David has an income of $1,100 a month and has $5,000 in the bank. David can complete a MassHealth Buy-In Application. If approved, his Part B premium would be subsidized He would also receive Extra Help, reducing his prescription premium, deductible, and copays. Commonwealth Care Health insurance coverage for uninsured adults Also for those on COBRA or those paying full non-group premium Must have income at or below 300% FPL Premiums and co-pays vary based on income and plan choice Note: Medicare beneficiaries are not eligible Medicare Appeals, Fraud and Abuse Medicare Appeals Beneficiaries have the right to a fair/efficient process for appealing decisions about healthcare payment or services Expedited appeals available in most situations Under Part D rules, beneficiaries have a right to a plan “Coverage Determination” concerning coverage or cost of a prescribed drug - this must be issued within 72 hours (24 hours, if expedited) All steps in the appeal process have specific time frames and other requirements – it is very important to be aware of time limits for appeals Appealable Events Medicare denies a request for a health care service, supply, or prescription Medicare denies payment for health care that the beneficiary has already received Medicare stops covering services that the beneficiary is already receivin