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What Happens After My Medicare Savings Program (MSP) Application is Approved

Fact Sheet for QMB (Qualified Medicare Beneficiary) Recipients

September 4, 2009

Author: Cathy Roberts

► Payment of your monthly Part B premium

QMB pays for your monthly Part B premium starting with the month after you applied for QMB. 

In a few months, the Social Security Administration (SSA) should stop deducting the Part B premium out of your monthly Social Security check and refund you any premiums you are owed. 

► Help with all other "cost sharing" for Part A and Part B

QMB pays your annual deductibles, your Part A premium (if you have one), and all other cost-sharing for Medicare Part A and B services.  You should not have to pay for any Part A or Part B services, either in original Medicare or in a Medicare Advantage plan.

NOTE:  Because QMB is a Medicaid program, your health provider must be enrolled in the Medicaid program in order to bill QMB.  However, once you are enrolled in QMB, your health provider cannot bill you directly for services even if they do not accept Medicaid. 

Ideally, you will want to seek medical care from providers who accept both Medicare and Medicaid. 

► The NYS Common Benefit Identification Card (CBIC)

You should receive this NYS Common Benefit Identification Card (CBIC) in the mail, unless you already have one:

If you don't get a CBIC in the mail, call your DSS/HRA caseworker and ask to be issued a new card.  Bring the CBIC, along with your Medicare card, when you go to your health provider.  Ask your health provider to bill both Medicare and QMB.

►  Automatic enrollment in Medicare Part D & the "Extra Help" program

If you are not already a member of a Medicare Part D prescription drug plan, you will be automatically assigned to a Part D drug plan, or you can sign up for one on your own.   Your QMB approval means you are automatically qualified for the Part D prescription drug program Low Income Subsidy (LIS), also known as "Extra Help."

The Extra Help program will pick up most of your Part D costs.  Your co-pay for your Part D drugs will be low, and you don't have to meet any deductible.  You will not have to pay a monthly drug premium if you are in a "benchmark" plan.  And there is no "donut hole" for people in Extra Help!

►  When will the "Extra Help" with Part D begin?

Extra Help should begin when your Part D coverage becomes effective, unless you already had Part D coverage when you were approved for QMB.  In that case, your Extra Help is effective the month of your QMB approval, and it may take awhile for your Extra Help status to show up in your pharmacist's computer system.  However, you don't have to wait in the meantime.  If you are being charged co-pays that are too high -- more than $3.20 per drug in 2009 -- contact your Part D plan immediately and give them a copy of your QMB approval letter.  (Your pharmacist may be able to help you with this.)  Your Part D plan should be able to adjust your co-pays to the Extra Help level.

Also:  Once you are in the Extra Help program, you can switch Part D or Medicare Advantage plans at any time.  You don't have to wait until the annual open enrollment period.

 





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