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The Qualifying Individual (QI) program is one of the Medicare Savings Programs (MSPs) that helps individuals with limited income and resources pay for Medicare costs. Here’s a breakdown of what Medical Assistance pays for at each QI level:

  • Qualified Medicare Beneficiary (QMB) Program Coverage:
    Pays for Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments. This means that if you qualify for QMB, you should not be billed for Medicare-covered services when seeing Medicare providers.
  • Specified Low-Income Medicare Beneficiary (SLMB) Program Coverage:
    Pays for Medicare Part B premiums. This helps reduce the monthly cost of Medicare Part B, which covers outpatient care, doctor services, and preventive services.
  • Qualifying Individual (QI) Program Coverage:
    Pays for Medicare Part B premiums. This program is similar to SLMB but is available on a first-come, first-served basis due to limited funding. The main benefit is saving money by not having to pay the Part B monthly premium, which can be significant.
  • Qualified Disabled and Working Individuals (QDWI) Program Coverage:
    Pays for Medicare Part A premiums. This program is for individuals who are disabled and working, and who have lost their premium-free Part A due to returning to work.

These programs are designed to help reduce the financial burden of Medicare costs for individuals with limited income and resources. You can double check a person’s level by calling a carrier or by using a carrier tool like Jarvis provides on the UHC portal with a beneficiary’s Medicare number. QMB is the only full dual from the list, the rest are partial dual.

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LINET stands for the Limited Income Newly Eligible Transition Program. It's a Medicare initiative designed to provide immediate, temporary prescription drug coverage for individuals who qualify for Medicare Part D but do not yet have prescription drug coverage.

Here are some key points about LINET:

  • Eligibility: It is available to low-income Medicare beneficiaries who qualify for Medicaid or the Part D Low Income Subsidy (LIS), also known as "Extra Help". 
  • Coverage: LINET offers temporary coverage, usually for 1 to 2 months, allowing beneficiaries time to choose a Medicare Part D plan that best fits their needs.
  • Administration: The program is administered by Humana.
  • Retroactive Coverage: LINET can provide retroactive coverage for out-of-pocket expenses during eligible periods.

Learn more here:

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This year there has been a tremendous pull back in Medicare Advantage plans. To the untrained eye it could look worrisome, but I say, “it’s about time”!

When the Medicare Advantage (MA) market becomes saturated with too many plans offering rich benefits, it can lead to several potential issues:

  1. Consumer Confusion: With an overwhelming number of plans to choose from, beneficiaries might struggle to understand and compare the differences, leading to confusion and potentially poor decision-making.
  2. Administrative Burden: Healthcare providers and insurers may face increased administrative complexity in managing numerous plans, which can lead to inefficiencies and higher operational costs.
  3. Quality Dilution: The focus on offering rich benefits might lead to a dilution in the quality of care if plans cut corners to maintain profitability while offering extensive benefits.
  4. Market Instability: An oversaturated market can lead to intense competition, which might result in some plans exiting the market, causing instability and potentially leaving beneficiaries without coverage.
  5. Increased Costs: While rich benefits are attractive, they can drive up overall healthcare costs, which might eventually be passed on to consumers through higher premiums or reduced benefits in the future.

Learn more: https://www.marketwatch.com/story/medicare-open-enrollment-keep-these-three-things-in-mind-when-picking-your-2025-plan-34fad623?

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During the busy AEP period, we need to decide which clients need help before December 7th and which can wait until after. Who needs help first?

If a client’s Medicare Advantage plan ends this year, they have a Special Enrollment Period (SEP) until February 28th to choose a new Medicare plan. If they don’t select a new plan by December 31st, they’ll be automatically enrolled in Original Medicare starting January 1st. They also have a Guarantee Issue (GI) right to get a Medicare Supplement plan. The new policy will start on the first of the month after they apply.

There are several reasons why a Medicare Advantage plan might be ending: 

  1. Plan Withdrawal: The insurance company offering the plan may decide to stop offering it, either because it is no longer profitable or they are restructuring their plan offerings. 
  2. Service Area Changes:The plan might no longer be available in your area if the insurance company decides to reduce its service area. 
  3. Contract Termination: Medicare may terminate its contract with the plan if it fails to meet certain standards or requirements. 
  4. Non-Renewal: Medicare might choose not to renew its contract with the plan for the upcoming year. 
  5. Low Performance: Plans that consistently receive low ratings from the Centers for Medicare and Medicaid Services (CMS) may be discontinued. 
  6. Provider Network Changes: Sometimes, hospitals or healthcare providers may end their contracts with Medicare Advantage plans due to administrative challenges or payment issues. 

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