Most people can get Medicare Part A for free if they are 65 or older and have worked and paid Medicare taxes for at least 10 years (or if their spouse has). Some younger people with certain disabilities or serious kidney disease can also qualify.
However, if someone hasn’t worked enough to get Part A for free, they have to pay for it. The cost is either $285 or $518 per month, depending on how much they worked. This can be expensive, and some people might not be able to afford it.
But if you have clients with low income and qualify as a Qualified Medicare Beneficiary (QMB) through the Medicare Savings Program, then the state’s Medicaid program might help pay the cost. As an agent, it is important you know how to help your clients when they get assistance paying for Part A. The process needs to be done in a certain order to make sure Part A is paid for.
How to enroll in Part A when Medicaid will pay premium
Signing up for Medicare Part A is usually simple if you get it for free. If you already receive Social Security or Railroad Retirement benefits, you’re automatically enrolled, and coverage starts on the first day of your birth month.
But things get more complicated if you have to pay for Part A and need Medicaid to help with the cost. In this case, you have to go through a process called Conditional Part A Enrollment. This means you apply for Part A, but you only get it if your state approves your Qualified Medicare Beneficiary (QMB) application to cover the cost. If the state denies your QMB application, you won’t be enrolled in Part A at all.
This process is important because you must have Part A to qualify for QMB, but most low-income people who don’t get free Part A can’t afford to pay for it upfront. The conditional process makes sure you won’t be stuck paying for Part A if you don’t get help from QMB.
The time you can apply depends on where you live:
- Group Payer States – You can only apply between January 1st and March 31st. These states are: AL, AZ, CO, IL, KS, KY, MO, NE, NJ, NM, SC, UT, and VA.
- Part A Buy-In States – You can apply any time of the year. These include all states not listed above.
Steps to Apply for Conditional Part A. Follow these steps in order!
- Contact Your Local SSA Office
- You must apply for Conditional Part A through your local Social Security Administration (SSA) office—you cannot apply online.
- When you apply, be sure to say the magic words: “Conditional Part A.” This is very important because it ensures your application is correctly processed as conditional enrollment.
- Apply for the QMB Program Through Medicaid
- After applying for Conditional Part A at SSA, you’ll need to apply for the Qualified Medicare Beneficiary (QMB) program through your state’s Medicaid office.
- Let Medicaid know that you have applied for Conditional Part A and need help from the Medicare Savings Program to cover your Part A premium.
- Wait for Approval
- If Medicaid approves your QMB application, the state will pay your Part A premium, and your coverage will begin.
- If Medicaid denies your QMB application, you will not be enrolled in Part A.
Special Rules for Part A Buy-In States & People with Part B
- If you live in a Part A Buy-In State and already have Part B, your process is easier. You don’t have to go to the SSA office first—just apply for QMB through Medicaid, and if approved, they will automatically enroll you in Conditional Part A.
- If you live in a Group Payer State, you must follow all the steps above and apply at the SSA office first.
Once your client receives their Part A and QMB status, they will be eligible to enroll in a Dual Special Needs Plan (D-SNP) to receive extra benefits. You can help your clients determine if they qualify for QMB by checking their state’s income limits. Qualifying for QMB will give them a special election period to enroll in a D-SNP plan outside of the Annual Enrollment Period.
Need more agent training to better help your clients maximize their benefits and coverage? Give us a call!