- Last Updated: 08 January 2016 08 January 2016
With the present implementation of the federal Affordable Care Act (the new federal health care law), it is useful to review and update some of the eligibility requirements for medical benefits under Medicare and, in Massachusetts, for Medicaid and the Health Care Safety Net.
Several of the eligibility cut-offs have been raised, so disabled patients may be newly eligible for health insurance benefits.
Mass. Health/Medicaid: This program provides coverage for hospital, doctor and prescription drug costs for disabled patients with a low income and minimal assets.
The current MassHealth/Medicaid program is being "expanded" as part of the federal Affordable Care Act program and the qualifying income limit is being raised. First, most of the different types of MassHealth programs are being eliminated and brought under one program. The new monthly income eligibility cut-off for MassHealth will be $1274. There will also be a ceiling on assets.
Medicare Savings Program—QMB: If you are receiving Medicare Part B (or wish to sign-up for it), and if your monthly income is less than $1333 if you are single, or $1790 if you are married and living together, then your Medicare part B premium will be paid for you. (Also, your income can be higher if your spouse works.)
To qualify for this program your resources (such as money in a bank, stocks or bonds) should not total more than $7,160 if you are single, or $10,750 if you are married and living together. (Some states allow you to have more.) Also, your house, car and up to $1,500 per person in burial expenses do not count as resources.
To apply for the Medicare Savings Program contact your State Medicaid Program. To find out how to contact your local Medicaid office, go to www.medicare.gov and select your State in the "Find someone to talk to" box.
Extra Help with Medicare Prescription Drug Costs: If your yearly income is less than $17,505 if you are single, or $23,595 if you are married and living together, then you can receive extra help to pay your Medicare prescription drug plan costs. Your income can be higher if you or your spouse works, other people live with you rely on you for support, or you live in Alaska or Hawaii. (To get this Extra Help you must be enroll in, or be enrolled in, a Medicare prescription drug plan.)
Your resources (such as money in the bank, stocks or bonds) should not total more than $13,440 if you are single, or $26,860 if you are married and living together. Certain things you own, like your house, car, life insurance, and up to $1,500 per person in burial expenses do not count as resources.
To get this Extra Help, contact the Social Security Administration. You can visit www.socialsecurity.gov/i1020 to apply online, or call the SSA at 1-800-772-1213. To apply for a prescription drug plan call 1-880-633-4227.
MassHealth Safety Net (formerly the Free Care/Low Cost Care Program): This Massachusetts program is available for those with limited income who have no medical insurance or only partial insurance, as well as for people with higher incomes who have large medical bills.
The Safety Net coverage only applies to Hospital Bills or to community health clinics associated with Hospitals. If the Hospital has a prescription drug dispensary, then the Safety Net can cover the prescription drug cost.
The Safety Net program has an income eligibility standard, but no asset standard (savings, property, etc.). Those with partial medical insurance come under the Health Safety Net Secondary Program. The Secondary Program includes Medicare recipients. The Safety Net annual income eligibility cut-off is $22,980.
There are some disqualifications for the Safety Net: If a person's income is low enough to qualify for MassHealth, but s/he did not enroll, then the Safety Net is not available; also, if a person had a MassHealth premium, but didn't pay it, then the Safety Net would not be available.
There is also a MassHealth Safety Net Partial for those with annual incomes from $22,980 to $45,960 if there are medical bills amounting to more than 10% of their income.
What about Medicare and the Affordable Care Act: The Affordable Care Act program functions under the "individual mandate" which requires that people obtain medical insurance. However, a person covered under Medicare is deemed to have "minimally acceptable coverage" and is not affected by the mandate or any penalties. Even those who have only Medicare Part A (Original Medicare) are deemed to have acceptable medical insurance and are not required to obtain additional coverage under the Affordable Care Act.
The Affordable Care Act does not offer Medicare supplement insurance (Medigap/Medex) or Part D (prescription drug) plans.