For beneficiaries of Social Security Disability Insurance (SSDI), eligibility for Medicare begins 24 months after entitlement to cash benefits. Medicare is a health insurance program for people 65 years of age and older, disabled individuals under 65 years of age, and people with end-stage renal disease who are treated with dialysis or a transplant. After 24 months, SSDI beneficiaries are eligible to receive Medicare Part A and Part B. Part A is hospital insurance. Part B is medical insurance. Beneficiaries do not have to pay for Part A. However, most people have to pay monthly for Part B. For 2021, the standard Part B premium amount is $148.50.
Alabama Medicaid has 3 different Medicare Savings Programs for low-income individuals or couples who qualify for Medicare in order to help with the cost of the Part B premium. To be eligible for Medicare Savings Program, a beneficiary must :1) Be eligible for Medicare Part A, 2) Be living in Alabama, 3) Be a U.S. citizen or be in satisfactory immigration status, and 4) Have a monthly income below a certain limit.
The first Medicare Savings Program is the Qualified Medicare Beneficiary (QMB) Program. Under this program, Medicaid will pay the Medicare Part B premium, cover the Medicare deductible, pay the Medicare part A premium if certain conditions apply, and make agreements with providers who accept Medicaid so an individual will not have to pay the Medicare coinsurance (which is the 20 percent the individual would normally have to pay after Medicare pays its part). The income limit for the QMB Program is $1,094 per month (gross) for individuals and $1,472.00 per month (gross) for a couple.
The second Medicare Savings Program is the Specified Low Income Medicare Beneficiary (SLMB) Program. Under the SLMB Program, Medicaid pays only the Medicare Part B premium of $148.50 a month. The SLMB income limits are as follows: $1,094.01-$1,308.00 per month (gross) for individuals or $1,472.01-$1,762.00 per month (gross) for a couple.
The third Medicare Savings Program is the Qualified Individual-1 (QI-1) Program. Under the QI-1 Program, Medicaid mays the Medicare Part B premium only. The QI-1 Program income limits are as follows: $1,308.01-$1,472.00 per month (gross) for individuals or $1,762.01-$1,980.00 per month (gross) for a couple.
In order to apply for the Medicare Savings Program, a SSDI beneficiary would need to call 1-800-362-1504 and follow the prompts to request a Medicare Savings Program application. A beneficiary can also go to www.medicaid.alabama.gov and click “Apply for Medicaid” then “Applications and Forms” then “Form 211 (Medicare Savings Program).” The individual can download the form, print the application, and mail to the Medicaid District Office that serves the county in which the individual lives. Upon acceptance into the Medicare Savings Program, it will take Social Security 2 months to stop taking the Part B premium out of a person’s Social Security disability check. Once the premium is stopped, the beneficiary will get a refund of all the premiums that were taken out of his or her check for the months that he or she were deemed eligible for Medicare Savings Program.
For more information on the Medicare Savings Program and Social Security disability, contact an experienced Social Security disability attorney at Gardberg & Kemmerly, P.C. today at 251-343-1111 for a free case evaluation. Gardberg & Kemmerly, P.C. represents Social Security disability claimants in Alabama, Mississippi, Florida, and Louisiana at all levels of the disability process from initial application to appeals to Federal Court.