The Qualified Individual (QI) program is one of the Medicare Savings Programs which help Medicare beneficiaries with lower incomes pay some out-of-pocket costs. Specifically, the QI program pays the Medicare Part B premium for Medicare beneficiaries with incomes between 120% and 135% of the Federal Poverty Level (FPL) and who meet the asset limit.
Unlike the other Medicare Savings Programs (MSPs), which are permanent, the QI program is not. In recent years, Congress has extended this program from year to year as they blocked cuts to physician payment required by the Sustainable Growth Rate (SGR). Congress’ short-term approach to physician payment and the QI program does not ensure stability or predictability.
In December 2013, Congress extended the QI program until March 31, 2014. If Congress does not extend the QI program again, about half a million Medicare beneficiaries in the QI program will have to pay the Part B premium ($104.90 in 2014) on their own or drop Part B. The Part B premium is at least 8.2% of the monthly income of Medicare beneficiaries who are currently in the QI program. If they cannot afford to pay the premium and drop Part B, they would have no insurance for outpatient medical services like doctor visits, lab tests, and therapy services. Medicaid (Medi-Cal in California) is not available for most of them because they are not poor enough to qualify for Medicaid. Nor do they qualify for expanded Medicaid, also called MAGI Medi-Cal, if they are 65 years or older or are eligible for Medicare. Many will probably forego these services if they cannot pay for them, putting their health in jeopardy.
While we are hopeful that Congress’ efforts will result in a physician payment system that is fair and sustainable, we and other beneficiary advocacy organizations strongly urge Congress to make the QI program permanent for lower-income beneficiaries.
Please join us in contacting your Congressional people and urging them to take this action. Your voice counts. Legislative staff take the voice of their constituents seriously and every phone call makes a difference.