Medicare Savings Programs
Ca Health Advocates.org (SHIP)
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualified Individual (QI)
- Qualified Disabled Working Individual (QDWI)
- 250% California Working Disabled (CWD)
- How to Apply
Categories of dual eligible beneficiaries
and out-of-pocket costs that must be paid by Medi-Cal – Medicaid:
Medicare Savings Programs (MSP’s) ⇒ CA Health Advocates
Qualified Medicare Beneficiary (QMB)
- Medicare Part A and Part B premiums; ♦ cost sharing for Part A & Part B benefits.
- QMB Plus – Medicare Part A and Part B premiums; cost sharing for Part A & Part B benefits; Full Medicaid benefits.
- SLMB (only) (Specified Low-Income Medicare Beneficiary) – Medicare Part B premium.
- SLMB Plus – Medicare Part B premium; Full Medicaid benefits.
- QI (Qualifying Individual) – Medicare Part B premium.
- Other FBDE (Full Benefit Dual Eligible) – Medicare Part B premium; Full Medicaid benefits.
- QDWI (Qualified Disabled & Working Individual) – Part A premium. (AHIP Training * Medicare & You * CA Health Advocates)
|Medicare Savings Programs 2 minutes|
Specified Low Income SLMB
Q I Qualified Individual
Qualified Disabled Working Individual QDWI
What Medi-Cal Covers
Can have MAPD
Share of Cost
Full Medi-Cal – pays Part A
How to apply for Medi-Cal?
Dual Demonstration Project – Cal Medi Connect
Can get MAPD too – stability, committement, qualify products – quality medical groups –
Plan 1 all UHC
Plan 2 – Health Care Partners – lower co pays
Plan 3 transportation, full network, ancillary benefits look a like plan, includes transportation
How to verify between Cal Medi Connect shows pcp and Medi-Cal Plan – no MD show
Show MAPD card, then don’t have to show Medi-Cal card
Medi-Cal picks up co pays
Share of Cost vs Fully qualified
Can no longer dual SNP – look a like plans are OK