Medicare & Medicare Savings Programs
Case Studies
Case Study 1: Veejay’s Continued Medicare Coverage
Veejay used his ninth Trial Work Period (TWP) month in May 2021. He worked off and on during his Extended Period of Eligibility (EPE). In July 2024, he worked at the SGA level and his SSDI was terminated. Veejay is still disabled and worries about how he will pay for medical care with only his wages of $2,000 gross per month.
Veejay is still disabled, and he now worries about how he will pay for medical care with only his wages of $2,000 gross per month.
Think about it. What needs to happen?
Veejay looks into the situation carefully. He discovers that he is entitled to an Extended Period of Medicare Coverage for at least 93 months after his TWP ended (until February 2029). In addition, his countable income makes him eligible for the Qualified Medicare Beneficiary (QMB) program. QMB will help pay his Medicare Part B premium, and the coinsurance and deductibles for Parts A and B. Enrolling in QMB will also give Veejay Medicare Part D Extra Help, paying his Part D cost-sharing expenses.
Learning this information and reviewing the steps of the QMB application process in his state makes Veejay feel much less worried—he now expects that he will be able to afford his medical expenses.
The takeaway
An SSDI beneficiary who is working should be aware that if their earning power causes their SSDI payment to terminate, there will be options for continuing Medicare.
Case Study 2: Ramona’s MSP eligibility
Ramona lives in a state that uses the federal income and resource guidelines for the Medicare Savings Program (MSP). She qualified for SSDI in 2022 at age 42. She first qualified for Medicare after the 24-month waiting period in 2024.
When Ramona first qualified for Medicare in February 2024, she was getting $1,120 per month in SSDI benefits. She had $250 in the bank and no other countable resources. Ramona was worried about having to pay the Medicare Part B premium of $174.70 per month and other Medicare cost sharing expenses.
Think about it. What needs to happen?
Ramona contacts a benefits planner. She learns how MSPs can help people like her afford Medicare.
To determine which MSP she qualifies for, Ramona does the math. She finds that her SSI countable income, after subtracting the $20 General Income Exclusion, is $1,100 per month and her countable resources are $250. Because her countable income and resources are within the Qualified Medicaid Beneficiary (QMB) limits, she applies for QMB and is accepted into her state’s QMB program.
The state Medicaid program begins paying the Part B premium and the deductibles and copayments for Parts A and B.
The takeaway
QMB will help Ramona with the Medicare Part A and Part B costs. In addition, she will be automatically eligible for help with Part D Extra Help when she enrolls in QMB.
Case Study 3: Ramona’s continued MSP eligibility
Continuing from the previous case study, in April 2024, Ramona starts working part-time and earns $665 gross per month. Her SSI total countable income changes, and she now uses the Earned Income Exclusion. Even though Ramona is grossing $665 per month, her SSI countable earned income is only $300 per month:
|
Explanation |
Calculation |
|
Unearned Income (SSDI payment) |
$1,120 |
|
Subtract the General Income Exclusion |
$1,120 - $20 = $1,100 |
|
Ramona’s SSI Countable Unearned Income |
$1,100 |
|
Explanation |
Calculation |
|
Gross earnings |
$665 |
|
Subtract the $65 Earned Income Exclusion (EIE) |
$665 - $65 = $600 |
|
Divide by 2 |
$600/2 = $300 |
|
SSI Countable Earned Income |
$300 |
When Ramona adds her countable unearned income of $1,100 to the $300 of countable earned income, she finds that her total countable income is $1,400 per month. This is more than the QMB income limit of $1,275 per month.
When Ramona realizes this, she almost panics. Then, she remembers that more than one MSP program is available.
Think about it. What needs to happen?
Ramona does the math. She learns that her countable income is less than the SLMB income limit of $1,526. Even after the $665 increase in Ramona’s gross income, she will be eligible for SLMB. This means the state Medicaid agency will pay the $174.70 per month Part B premium, but she will need to pay the deductibles and copayments for Parts A and B.
The takeaway
Ramona will be eligible for SLMB. Medicaid will continue to pay her Medicare Part B premium. In addition, Ramona will keep the Medicare Part D Extra Help.