Medicare Savings Program

Created on: 
Nov 06 2019

What is the Medicare Savings Program (MSP)?

MSP helps Medicare recipients pay for all or part of their Medicare premiums.

Who is eligible for the Medicare Savings Program (MSP)?

Medicare recipients who meet income and resources requirements may be eligible for MSP.  For additional information, see Apple Health eligibility manual - WAC 182-517-0100 Federal Medicare savings programs.

What are the Medicare Savings Program (MSP) Federal Poverty Levels (FPLs)?

In order to be income eligible for MSP coverage, an individual's MSP household must have net income that is less than or equal to the following FPL percentages.

  • Qualified Medicare Beneficiary Program (QMB) (S03)= 100% FPL
  • Qualified Disabled Working Individual (QDWI) (S04)= 200% FPL
  • Specified Low-Income Medicare Beneficiary Program (SLMB) (S05)= 120% FPL
  • Qualified Individual (QI-1) Program (S06)= 135% FPL

For updated income and resource standards for MSP programs, see the Standards Chart.

How does ACES determine eligibility for the Medicare Savings Program (MSP)?

ACES performs the existing SSI-Related income calculation to determine if a client meets MSP eligibility requirements.  If the client isn't eligible for MSP using the SSI-Related calculation, a second calculation is performed (if appropriate) to include additional household members.  This is called Alternate Methodology calculation.  If the household size increases using the Alternate Methodology, ACES then compares the Assistance Unit's (AU) gross income to a higher Federal Poverty Level (FPL).

For more information, see ACES User Manual - Qualified Medicare Beneficiary (QMB) (S03) - What if the client's countable income exceeds 100% of the Federal Poverty Level (FPL)?

How does the system determine household size requirements when using the Alternate Methodology calculation?

When the Alternate Methodology calculation is performed to include additional household members, the Medicare Savings Program (MSP) Assistance Unit (AU) must contain at least one dependent child who meets all of the following criteria:

  • Living Arrangement code is the same as the HOH,
  • Martial Status is Never Married (N),
  • Isn't receiving Temporary Assistance for Needy Families (TANF) or Tribal TANF, General Assistance, or SSI payments,
  • Age 17 or younger, or
  • Age 18 to 21 with the following:
    • Financial Responsibility code SSI Child/Child of SSI Related Parents/Child used to determine Family size (SC) and,
    • Student status code:
      • Half Time (HT)
      • Less Than Half Time (PT), or
      • Full Time (FT) with education level of Higher Educ (Half-Time or More) (HE).
NOTE:  If one of the adults (recipient or spouse) on the MSP AU is pregnant, then the number of the babies expected is included in the household size. 

How does the system display what Medicare Savings Program (MSP) income method was used to determine eligibility?

All MSP AUs have a system generated Income Qualification code, which is based on the rules to determine MSP eligibility.

The four types of MSP Income Qualification codes are:

  • SSI Recipient Methodology (K)
  • LTC Methodology (L)
  • SSI-related Methodology (M)
  • Alternate Methodology (N)

The Income Qualification field displays in the following locations:

  • ACES.online - Medical Eligibility Calculation section on the Assistance Unit Medical Eligibility page.
  • ACES 3G - Income Processing section on the Eligibility Details page.

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