Medicare Savings Programs (MSP) and the Medicare Improvement for Patients and Providers Act (MIPPA)
Frequently Asked Questions
What is MSP?
The Medicare Savings Program (MSP) helps with the costs of Medicare for eligible individuals. You may be eligible for help with the Medicare Part B premium, annual Part B deductible, coinsurance costs and Medicare Part A premiums, if any.
MSP consists of three federal programs; QMB, SLIB, and QI-1. You must have Medicare Part A to be eligible and meet the income and asset standards of the program. The income and asset standards change each year based on federal law. [return]
What is QMB?
Qualified Medicare Beneficiaries (QMB) are individuals with monthly countable income at or below 100% of the Federal Poverty Level (FPL). The income limit for 2009 is $903 for a single person, $1214 for a couple. Your countable assets must be at or below $6,600 for a single person or $9,910 for a couple.
QMB pays the monthly Medicare Part B premium, annual Part B deductible, coinsurance costs and Medicare Part A premiums, if any. If you have a Medicare Advantage Plan (Part C), the part of your B premium that you would be responsible for, the annual deductible and coinsurance will be covered. [return]
What is SLIB?
Specified Low-Income Medicare Beneficiaries (SLIB) are individuals with monthly countable income over 100% but at or below 120% of the FPL (up to $1083 monthly for a single person, and $1457 for a couple). Your countable assets must be at or below $6,600 for a single person or $9,910 for a couple.
SLIB pays the monthly Medicare Part B premium (or the part of your B premium that goes to your Medicare advantage plan). [return]
What is QI-1?
Qualified Individuals (QI-1) are individuals with monthly countable income over 120% but at or below 135% of the FPL (up to$1218 monthly for a single person, and $1639 for a couple). Your countable assets must be at or below $6,600 for a single person or $9,910 for a couple.
QI-1 pays the monthly Medicare Part B premium (or the part of your B premium that goes to your Medicare advantage plan). [return]
How do I apply for MSP?
The best way to apply for MSP is by mail. MSP applications are handled by the Illinois Department of Human Services (DHS).
There are 3 ways to apply directly for MSP:
You can find a local DHS Family Community Resource Center at www.dhs.state.il.us or by calling 1-800-843-6154 (TTY: 1-800-447-6404). [return]
- Online application Visit DHS and click on the Illinois Link hot button
- Mail-in application for MSP Visit Illinois Department Healthcare and Family Services, Medical Programs Forms and select HFS 2378M to download the Mail-In Application for Payment of Medicare Premiums, Deductibles and Coinsurance (PDF)
- Mail-in application for both a medical card and MSP Visit Illinois Department Healthcare and Family Services, Medical Programs Forms and select HFS 2378H to download the Mail-In Application For Medical Benefits (PDF)
How is MSP processing different under the MIPPA law?
The Medicare Improvement for Patients and Providers Act (MIPPA) allows individuals who apply through Social Security for "Extra Help" (also called the Low-Income Subsidy or LIS) to have that application information forwarded to the state to determine eligibility for MSP. The electronic file is sent to the Illinois Department of Human Services (DHS). The applicant is centrally sent an Illinois Department of Healthcare and Family Services (HFS) 267MSP1 Cover Letter, Extra Help with Medicare, and an HFS 267MSP Instructions to the Client for Help with Medicare Premiums, Deductibles and Coinsurance.
The form is printed with English on one side and Spanish on the other. You have 10 days from the mail date to complete and sign the 267MSP and return it to the DHS FCRC or your application will be denied. If you return the form within 10 days, the DHS FCRC will decide if you are eligible. Using this process may take longer than applying for MSP through the DHS office (see previous question) since Social Security must process the application first. You can file for Extra Help and do a MSP application both. [return]
What assets are counted?
The home you live in and one car is not counted. Include the value of assets on the day of application. There is no look-back period for MSP. The kinds of assets that may have to be counted:
- bank accounts
- stocks and bonds
- other property
- mutual funds
- life insurance with a cash value ($1,500 exempted)
- retirement accounts and IRAs
- other motor vehicles
- burial funds (plans worth over $1,500)
- annuity accounts
- certificates of deposit
- trust funds
- mineral/oil rights
What income is counted?
The only income that is usually NOT counted is Supplemental Security Income (SSI). Put you gross income (before any taxes or deductions) on the application. Most types of income are counted, such as:
- Social Security
- veteranís benefits
- work income
- unemployment insurance
- self-employment income
- railroad benefits
- rental income
- royalties, oil and mineral rights
- alimony and maintenance payments
What expenses and deductions are allowed?
A deduction is allowed for court-ordered support or alimony. Expenses that you pay so you can work can also be allowed, like taxes, self-employment business expenses, child care, and transportation costs to and from work. [return]
How long does it take to get an answer?
The Illinois Department of Human Services (DHS) office has 45 days to process your application. You will receive a notice when a decision is made if you are eligible. If you are ineligible because you failed to provide all the information needed, you can reapply at any time. If you are ineligible because your income or assets are too high, you can reapply when your income or assets change. [return]
When will benefits start?
Your approval notice will tell you when benefits begin.
For QMB, coverage will begin the month after your case is approved.
For SLIB and QI-I, coverage will begin up to 3 months before the month you applied as long as qualified for those months.
It will take Social Security 3-4 months to stop taking the Medicare premium out of your check. When they do, you will also receive a separate payment for the other months. If your SSA check has not gone up by the 4th month after you receive your approval letter, contact your Illinois Department of Human Services (DHS) caseworker.
After 12 months, you will receive a redetermination form to see if you are still eligible. You must complete it and return it to continue on MSP. [return]
What other benefits do I get as a person on MSP?
MSP means you are also a Full Benefit Dual Eligible for Medicare Part D. This means you will not have to pay:
You will only pay the low pre-prescription co-pay based on your income (from $1 to $6.30 for 2010). [return]
- the monthly premium for plans at or below the state plan average,
- the annual part D deductible,
- the 25% co-insurance,
- the coverage gap (donut hole), or
- the catastrophic coverage co-pay.
Does the state try to recover any of the money?
The state of Illinois does not recover benefits provided through MSP. MIPPA changed the law beginning 1/1/10, so that no recovery will be done on any MSP benefits. [return]