Medicare Premium Assistance Program 510-05-60

 

General Information (Medicare Premium Assistance Program) 510-05-60-05

(Revised 8/1/2023 ML #3745)

 

Individuals entitled to enroll in Medicare need to apply for Medicare through Social Security if they have not done so. The following are individuals who need to apply for Medicare with Social Security.

• Individuals turning 65

• Individuals who have been disabled for 24 months

• Individuals with End Stage Renal Disease (ESRD)

• Individuals with Lou Gehrig's Disease (ALS) 

 

All individuals eligible for Medicare should be tested to determine if Medicaid can pay the Medicare Premium.

Note: Medicare is not an earned right benefit. A Medicaid application or coverage cannot be denied for failure to apply for Medicare.

 

If the individual has applied for Medicare and has either Medicare Part A, Conditional Medicare Part A or Medicare Part B, they do not need to go to Social Security to apply again.

• A Medicare coverage start date will need to be added as of the date North Dakota can pay the Medicare premium for Medicare Part A or Part B. See job aid for Medicare details screen.

 

There are two ways an individual can receive assistance with their Medicare premiums and Medicare costs.

 

1. Medicare Savings Program (MSP)

• Is the primary coverage for individuals with free Medicare Part A or premium Medicare Part A.

• MSP is available to assist with Medicare premiums and cost sharing for people with Limited income and assets

• The program includes coverage of Qualified Medicare Beneficiaries (QMB), Specified Low-income Medicare Beneficiaries (SLMB), Qualifying Individuals (QI), Qualified Disabled Working Individuals (QDWI) and Medicare Part B-ID.

• Individuals eligible for MSP should not have their coverage closed unless:

  • They are over income; or

  • They are over assets; or

  • They are QI and requesting Medicaid coverage; or

  • They become eligible for Medicaid and have coverage as Part B-ID. The Part B-ID coverage needs to be close.

 

Note: An individual cannot voluntarily terminate from the Premium Assistance Program

 

Note: Medicaid should not be automatically closed when an individual becomes eligible for QMB or SLMB. They may have services not covered under Medicare that can be paid by Medicaid.

 

2. The SSI Buy-in Program

• SSI income eligible individuals who are eligible for Medicare Part B only

Note: An individual cannot be covered under SSI Buy-in and Medicare Savings Programs for the same time period.