Medicare health insurance has two parts -- Part A (hospital insurance) is premium free for Social Security recipients. Part B (medical insurance) has a 2011 monthly premium of $115.40. In California, the Medicaid program -- called Medi-Cal in California -- provides needs-based health insurance benefits to more than 7.2 million state residents. Over 1.1 million of these recipients also have Part B of Medicare. Their Medi-Cal benefits help pay the Part B premiums.
Part B Buy-In Program
Medi-Cal considers it cost-effective to pay the Part B Medicare premiums. Ensuring that beneficiaries have full Medicare coverage reduces the liability for medical costs for the Medi-Cal program. Recipients with full Medicare coverage can choose doctors who accept Medicare rather than confining their choices to doctors who accept Medi-Cal -- only patients. The process by which the state pays for premiums is called "state buy-in" and Californians can qualify for premium buy-in through several state assistance programs.
Eligible Public Assistance Categories for Buy-in
Recipients of certain California public assistance programs automatically qualify for the state to pay their Medicare Part B premiums. The programs include beneficiaries Supplemental Security Income, a cash benefit for low-income individuals at least age 65, blind or disabled administered by the Social Security Administration. Family members receiving Temporary Assistance to Needy Families also qualify for Medi-Cal. Other state-aid programs such as Refugee Assistance and Cash Assistance Program for Immigrants also qualify recipients for Medi-Cal and Medicare buy-in benefits.
Qualified Medicare Beneficiaries
A Californian with Medicare who does not qualify for cash assistance because his income and assets exceed allowable levels may still receive help paying her Part B Medicare premium. She must meet the requirements of for the Qualified Medicare Beneficiary program. As of 2011, an individual qualifies if his income is at or under $10,830 annually. A member of a couple could qualify if the combined couple income does not exceed $14,470 annually. The first $20 monthly of income does not count toward the income limit. Assets such as cash, investments, bank account balances and non-home land or property must be at or under $6,600 for an individual or a total of $9,910 for a married couple.
Some possessions are excluded from countable assets, including usual home furnishings and personal possessions, one vehicle and a home that is the principle place of residence. Although Qualified Medicare Beneficiary recipients do not receive cash assistance, having the state pay Part B premiums saves beneficiaries $115.40 monthly. Eligibility also qualifies recipients for help with Medicare co-payments and deductibles.
SLMB
An additional program -- the Specified Low-Income Medicare Beneficiary program -- pays the Medicare premium for individuals whose income is too high for cash assistance or the Qualified Medicare Beneficiary program. Recipients who meet only the Specified Low-Income Medicare Beneficiary criteria receive help only with paying the Part B premium -- Medi-Cal does not help with Medicare co-payments and deductibles.
The 2011 income limits for the Specified Low-Income Medicare Beneficiary program are $1,083 monthly for an individual or $1,457 monthly combined income for a married couple. As with Qualified Medicare Beneficiary applicants, the state ignores the first $20 monthly of income. The resource limits are the same as for Qualified Medicare Beneficiary-eligible recipients.
Tags: Medicare Beneficiary, Qualified Medicare, Beneficiary program, Medicare Beneficiary program, Part Medicare, Qualified Medicare Beneficiary
