Part B/SLMB Question

blech. I am concerned this is the case with a particularly challenging client who needs to be on a MAPD.

She was placed on-ex by another agent January 1, 2015 and was on that plan until June when she stopped paying her premium. They did ask her to prove that she wasn't on medicare. She says she sent the proof (not sure how she did that, when it appears she was actually Medicare eligible, at least starting in February) However, according to Medicare.gov she has been on Medicare since at least 2-1-2015. (she had it since 2004, then lost it and it was at least partially reinstated.) She has a part D plan at full extra help levels and was using that the whole time she was using her on-ex plan (with a different carrier) for low-cost doctor's visits.

So, she has at least Part A if she is on part D. She is not being charged anything for part B, but she wouldn't be if she was SLMB . She says she tried to go to the pharmacy to get a flu shot and they told her she wasn't in Medicare's system. That leads me to believe she doesn't have part B? The only way I can figure is to call Medicare to see.

She was paying $150 a month for a heavily subsidized on-ex plan. She doesn't make enough to file taxes, though (SSI only), so I don't know how they are going to recoup that subsidy.

What a mess. She was insisting the whole time she wasn't on Medicare.
 
blech. I am concerned this is the case with a particularly challenging client who needs to be on a MAPD.

She was placed on-ex by another agent January 1, 2015 and was on that plan until June when she stopped paying her premium. They did ask her to prove that she wasn't on medicare. She says she sent the proof (not sure how she did that, when it appears she was actually Medicare eligible, at least starting in February) However, according to Medicare.gov she has been on Medicare since at least 2-1-2015. (she had it since 2004, then lost it and it was at least partially reinstated.) She has a part D plan at full extra help levels and was using that the whole time she was using her on-ex plan (with a different carrier) for low-cost doctor's visits.

So, she has at least Part A if she is on part D. She is not being charged anything for part B, but she wouldn't be if she was SLMB . She says she tried to go to the pharmacy to get a flu shot and they told her she wasn't in Medicare's system. That leads me to believe she doesn't have part B? The only way I can figure is to call Medicare to see.

She was paying $150 a month for a heavily subsidized on-ex plan. She doesn't make enough to file taxes, though (SSI only), so I don't know how they are going to recoup that subsidy.

What a mess. She was insisting the whole time she wasn't on Medicare.






-If she has SLMB then the state is paying her part B premium.SLMB pays part B premium but not not part A so this indicates she does have part B....QMB pays both both A and B premium
 
I think it is possible for people to slip through the cracks. I have a client who is qmb with a current card to prove it who has never enrolled in part b.Complicated situation. Was working, deferred part b, left work to go overseas as a missionary, came back and never enrolled in b. It has been 3 years now.


Medicare will not let him on until July and he has to open enroll in January. I spent two hours with him last month and ss/medicare absolutely will not enroll him now. When he applied for qmb it was after March of this year and they told him he is s.o.l. basically until the next open enrollment.
 
I think it is possible for people to slip through the cracks. I have a client who is qmb with a current card to prove it who has never enrolled in part b.Complicated situation. Was working, deferred part b, left work to go overseas as a missionary, came back and never enrolled in b. It has been 3 years now.


Medicare will not let him on until July and he has to open enroll in January. I spent two hours with him last month and ss/medicare absolutely will not enroll him now. When he applied for qmb it was after March of this year and they told him he is s.o.l. basically until the next open enrollment.



yes like I said QMB will pay for part A and B premium- doesn't mean they have to have part B to have QMB.... and doesn't exclude them from the rules concerning when they can enroll in part B


PROGRAMS FOR PEOPLE with MEDICARE (Medicare Part B Premium $104.90 Part A free for most)

*QMB Pays Medicare premium, coinsurance & deductibles only
(100% FPL)

*SLMB Pays Medicare Part B premium only (120% FPL)

*QI1 Pays Medicare Part B premium only (135% FPL)

*WD (QDWI) Working Disabled Program; only Pays Medicare Part A
premium; Must have lost SSDI due to employment (200% FPL)
 
Yes, I am familiar with those programs.

So, you are saying that if SLMB, they are DEFINITELY enrolled in Part B? And WCMason is saying not necessarily.

I think I need a referee...
 
Yes, I am familiar with those programs.

So, you are saying that if SLMB, they are DEFINITELY enrolled in Part B? And WCMason is saying not necessarily.

I think I need a referee...

They can also have part B only and no part A. Had one one those awhile back. She was on part B, a part D drug plan and no part A.
 
Just got off the phone with Medicare regarding this lady.

She is NOT enrolled in Part B, yet is "SLMB". Will have to wait until July 2016 to enroll, get on a supplement, MAPD or whatever.

WCMason for the win!
 
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