Medicare Savings Programs (MSPs), and in particular the Qualified Medicare Beneficiary (QMB) program, provide essential financial support in covering a number of Medicare’s out-of-pocket costs for those who qualify. During the COVID-19 public health emergency (PHE), Medicaid offices were required to keep people enrolled in their Medicaid programs, such as the MSPs. They were barred from terminating or reducing coverage. Yet, some people still lost their Medicare Savings Program, or were moved to a different MSP with less coverage during the PHE. This meant that some people who were enrolled in QMB, which covered their Medicare Part A premiums ($506/month), Part B premiums ($164.90/month), deductibles and co-insurance, now had significant out-of-pocket costs.
Last month, however, California restored 40,810 beneficiaries back to their original Medicare Savings Program (MSP) — the program they had before the change — due to the court order in the case Carr v. Becerra. This is great news. These beneficiaries should have received a letter from the Department of Health Care Services (DHCS) notifying them of this change and that no action is needed on their part. They will be able to remain in their original MSP until their next annual review.
Below is some helpful information for advocates to know as shared by our partners at Justice in Aging:
- Individuals were reinstated to their original MSP tier retroactive to the date of the original change in their MSP coverage.
- Individuals who paid Part A premiums due to the loss of QMB status will receive a reimbursement from the Social Security Administration. This will happen automatically.
- Individuals who paid Medicare deductibles, co-payments, and co-insurance because they lost QMB status can submit a claim for reimbursement through the Conlan process.
- Reimbursements received as a result of the MSP restoration are not countable as income and will not affect Medi-Cal and/or MSP eligibility.
- Individuals will remain in the restored MSP tier until their Medi-Cal renewal, at which time they will be reassessed for MSP eligibility.
Some additional resources for information include:
- Justice in Aging Practice Tip explaining the Carr v. Becerra ruling and what it means for people dually enrolled in Medicare and Medicaid and how advocates can help.
- Advocate Guide: The Nationwide Preliminary Injunction in Carr v. Becerra and What It Means for Medicaid Enrollees in Your State
- Dept. of Health Care Services Medi-Cal Eligibility Division Letter 23-07 and 23-18
