Simplifying Medicare Part A Buy-In: What’s New in 2025 for Low-Income Enrollees

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Aired: April 11, 2025

About the Webinar
We were excited to partner with Justice in Aging to bring this exclusive webinar training to our community. Earlier this year, California implemented two new policies to simplify enrollment in Medicare Savings Programs and Part A for individuals who pay a monthly premium for Part A coverage. In this training, Justice in Aging covered the significant changes impacting how low-income individuals enroll in premium Part A and the Qualified Medicare Beneficiary (QMB) Program—a Medicare Savings Program that helps make Medicare more affordable for low-income Californians.

While most people do not pay monthly premiums for Part A, some individuals may owe up to $518 per month. QMB is currently the only Medi-Cal program that covers these premiums. This training discussed the policy changes, who was impacted, and how these updates help improve access for low-income older adults.

The webinar was hosted by Alcar Health’s Chief Growth Officer, Johanna Cazares, and featured expert training by Tiffany Huyenh-Cho, Director of California Medicare and Medicaid Advocacy at Justice in Aging.

About Tiffany Huyenh-Cho
Tiffany leads Justice in Aging’s efforts to improve the healthcare experience for Californians dually enrolled in Medicare and Medicaid. She works to strengthen Medicaid access and advocates for policies that support vulnerable older adults. Prior to joining Justice in Aging in 2021, she provided direct legal services to low-income individuals through legal aid in the Bay Area.

Transcript

Speaker 2 (05:36.558)

Good morning, everyone, and welcome. My name is Johanna Cazares and I'm honored to be here as your co-host and moderator for this important conversation brought to you in partnership by Alcar Health and Justice in Aging. Together, we're committed to equipping FQHC leaders like you with the equipment, knowledge, and tools to ensure that aging patients in your communities aren't left behind due to gaps in Medicare coverage. What inspired me to co-host this training

was what I see every day in the work that we do. Patients falling through the cracks simply because they do not have the right information or support at the right time. Whether it's confusion around enrollment or programs like the Part A buy-in, these gaps have often led to denied claims, delayed care, and unnecessary stress for aging patients. Today's training is about helping you and your teams turn that knowledge into action.

Now I'm thrilled to introduce our guest speaker from Justice in Aging, Tiffany Huyenh-Co Tiffany leads Justice in Aging's efforts to improve the experience of people who are duly enrolled in Medicare and Medicaid in California. She works to advance access to Medicaid and improve the policies and systems that affect how duly eligible individuals receive care. Tiffany brings a deep commitment to health equity

and regularly collaborates with federal, state, and local partners to make that vision a reality. She joined Justice of Aging in 2021, and before that, she served as a legal aid attorney in the Bay Area, providing direct legal representation to low-income individuals. We're excited to have her with us today as she shares her expertise in Medicare enrollment challenges, the Part A buy-in, and the opportunity for advocacy

for FQHC and their patients. Welcome, Tiffany.

Speaker 1 (07:39.31)

I appreciate the introduction and for having me here today to speak to all of you. So I appreciate all of you that are logging in early this Friday morning to join. Joanna said, might be muted.

You're muted.

Speaker 1 (07:59.534)

No one can hear me.

Speaker 2 (08:04.919)

No, you're good, Tiffany.

OK. Like Joanna said, my name is Tiffany Huyenh-Co, and I work at Justice and Aging. So I focus on people that are dually eligible for Medicare. You may also know them as duals or dual-eligibles. And today, I'm going to cover two pieces. are two new policies that started this year that are particularly relevant for this population.

Before I get into that, just a little background on justice and aging itself. We are a national organization. We use the power of law to fight senior poverty by securing access to affordable healthcare like Medicare or Medi-Cal, economic security, and the courts for older adults. We primarily focus our efforts on fighting for people who have been traditionally marginalized.

and excluded from justice such as women, people of color, LGBTQ plus individuals and people with limited English proficiency. We aren't a direct services organization. So I don't personally assist people that are duly eligible but we do more policy work within California and with the federal governments. And so we have a broad network of partners at legal aids,

at FQHCs, social workers, or health insurance counseling programs.

Speaker 1 (09:38.414)

We're committed to advancing equity for low income older adults in the areas of economic security, healthcare and housing and elder justice initiatives. And we do this by employing all of these tools here on this slide.

Okay, so here's our agenda today. I wanna make sure there should be time for questions at two parts. I will pause after we go through the first section and then at the very end of the training, I'll take time for questions. So feel free to use the Q &A function and I can get to those during today and anything I can't get to. So for today, again, I will be talking about part A buy-in and what that means in California, the benefits, the process, and why we are doing that in California. And then I'm also gonna talk about another policy that is specific to people that are on SSI or supplemental security income. And before we get into that, I'll do a background on

the Medicare Savings Program because that is the program that underlies both of these policies. So first, Medicare Savings Programs. These are Medicaid programs. They're administered by our Medi-Cal program and it makes Medicare more affordable. Medicare Savings Programs are the programs that pay for Medicare cost sharing.

paying for the co-pays, co-insurance, the monthly premiums that Medicare charges. All states have these. In California, we have these programs as well. But to qualify for a Medicare savings program, you do have to meet financial income limits. And I'll get into that in a bit. But Medicare savings programs matter because it helps pay for Medicare costs.

Speaker 1 (11:52.162)

Medicare is our federal health insurance program, as you all know, and it helps with that hospital care, routine checkups, et cetera. Medicare is vital for older adults because that is the primary program or healthcare program for people that are older and then people that are under 65 and who have a disability and receive social security disability benefits also access Medicare.

But although Medicare is comprehensive, comes at a cost. There are premiums, monthly premiums, deductibles, co-pays, and prescription costs. And then, as time goes by with inflation and everything else that is going on in the world, Medicare can be quite expensive. I think there was a statistic that says on average, Medicare enrollees pay around $8,000 a year for their coverage.

So because Medicare savings programs are vital and Medicare is not free, Medi-Cal does offer these Medicare savings programs to help pay for those costs. It's intended to make Medicare affordable. And there are four programs in California. The first three are those that are geared towards people that are lower income. And today we're gonna focus on the first one, the Qualified Medicare Beneficiary Program.

This is the Medicare savings program that will pay for your Part A premium, the Part B premium, and any cost sharing, deductibles, co-payments that come with using Part A or Part B costs. As you can notice on the slide, those three other programs that I have listed only pay for Medicare Part B premiums or Part A.

So QMB or Qualified Medicare Beneficiary Program is the most comprehensive program. And QMB is the only program that will pay for Part A premiums if you are low income. So these are really important in California itself and through other states. And to get onto these programs, you do file applications at the Medi-Cal office. They aren't administered.

Speaker 1 (14:14.21)

by Social Security, although they say Medicare, it is actually a Medi-Cal administered program.

Speaker 1 (14:24.302)

So for the Q &B program, this is again the most comprehensive of these Medicare savings programs. You have to be at or below 100 % of the federal poverty level in income. So that equates to about $1,305 a month as a single person. And you must be eligible for Medicare Part A or Part B, and Part B. People that...

are younger than 65 or don't qualify for Medicare yet, don't meet this program. This program is only for people that have Medicare and need help with the Medicare costs. And the Q and B program also beyond paying for Medicare cost also has enhanced protections. I'm sure you have all heard about improper billing for people that are duly eligible. So people with Medi-Cal and Medicare aren't responsible.

for their Medicare costs. QMB offers very strong protections under federal law so that they don't pay for these costs. And they'll also waive any late enrollment penalties. If someone enrolls into Medicare late, such as like a few years after they turn 65, Medicare will charge a late enrollment penalty. So you will see a higher monthly premium than the base premium. But if you're on the QMB program,

those late enrollment penalties are waived. The person is not paying for the actual premium or any late enrollment penalty. And then as of January, 2024, there are no longer any asset limits or asset test in our entire Medi-Cal program. People younger than 65 or people older than 65, it doesn't matter your age.

you do not have to prove your assets or keep your assets below a certain limit anymore.

Speaker 1 (16:25.314)

In the Q &B program, we find it particularly important because again, that is the only Medi-Cal program that will pay for the Part A premium. And Part A is Medicare's hospital insurance coverage. The vast majority of people have what we call free Part A. There is no monthly premium attached to enrolling into Medicare Part A. So while Medicare Part B always has a monthly premium,

Medicare Part A does not. And 99 % of people do not pay a premium for their Part A coverage, but some do. And the people that do are those that do not have enough work history in the US, meaning they haven't worked long enough in the US to pay the Medicare or Social Security taxes. So those people that don't have that work history

either on their own or through their spouse can buy into part A to get that Medicare hospital coverage, but they do face a premium for that. And it's up to $505 a month. So it's quite expensive. If you want part A and don't qualify for free, you will be charged up to $505 a month.

And so these folks that also must buy into premium part A, they have to affirmatively apply. Most people are automatically enrolled into Medicare part A or B when they turn 65 or after. Once you start receiving social security retirement, when you become Medicare eligible, you are automatically enrolled. Unless you say, I don't want to be enrolled.

But for those that have the premium part A, they are notified before and they have the option to enroll into premium part A or to decline it. And as you can imagine, a lot of people choose not to enroll into premium part A because it's expensive. $505 a month is really high. And then you're also gonna pay for your part B premium and any other Medicare costs. So the focus of our

Speaker 1 (18:42.753)

presentation today will be on these people, the people that have to buy into premium Part A. That is why we have Part A buy-in and for the qualified Medicare beneficiary program, these two pieces are really relevant to them because it makes enrollment into Part A easier and it can help pay for that Part A premium of $505 a month.

Speaker 1 (19:12.814)

Just for some demographics, like who are the people that pay for premium part A? Again, the vast majority of people don't pay a premium for part A. But for those that do, in California, the last data that we have is that as of 2021, about 181,000 people had that premium part A. And the vast majority are females. 69 % are female and the remainder are male.

They're also more likely to be a person of color in California and also across other states. And collectively, people that must pay a Part A premium owe collectively millions of dollars a year just for these Part A premiums. So the people that are most likely to have the premium Part A are older immigrants, people that immigrated into the US at an older age.

and thus didn't have the work history for free part A. It's about 10 years of full-time work to get free part A. So anyone that worked part-time might be more likely to have a premium for their part A coverage, as well as people that also just didn't enter the workforce. So women who were primarily family caregivers, and so they worked for free and did not get paid, did not pay.

into the Medicare or social security taxes or people with disabilities that maybe weren't able to work or could only find part-time work because of discrimination. So again, it's not the vast majority of people that have to pay the premium, but there is a significant population and the cost associated with premium part A are just really sky high.

So the impact is very substantial for these groups.

Speaker 1 (21:11.982)

So in 2025, there were two changes that changed the field for these people. First is the auto enrollment or automatic enrollment into QMB for anyone that is on SSI, Supplemental Security Income, and then Part A buy-in. And that's for people who are not eligible for that free Part A.

I'm going to cover these policies today, but we also created a fact sheet that was released late last year on these two policies that go into a lot more depth. I'll share the slides with everyone later, but you can also link and read more in that fact sheet as well. So first we'll discuss the automatic enrollment of SSI individuals into QMB.

This is a policy that came about under a federal law. It was a federal law that came about about two years ago. It's called the Medicaid Streamlining Rule. And basically it required states, all states to enroll supplemental security insurance people into QMB automatically. And SSI or Supplemental Security Insurance, I'm sure you know, but just as a refresher, that is a public benefit program.

It provides cash benefits to low income individuals and it's your lowest income individuals. To be on SSI, you have to have income below 100 % of the federal poverty level. And you'll notice that the SSI income limit is the same as the QMB income limit. They assist the people that are the lowest income in California.

People that get SSI are people that don't qualify for Social Security retirement. So it's also people that don't have the prior work history or a spouse also doesn't have the prior work history. It's geared towards low income people who are over 65 or people that are under 65 but have a disability. SSI benefits has their own income and their own asset limits.

Speaker 1 (23:25.282)

And if you get SSI in California, you automatically get Medi-Cal. There's no separate application for Medi-Cal if you are on SSI. You're automatically enrolled into Medi-Cal and you get Medi-Cal health benefits. But you are not automatically enrolled into QMB until this federal rule came about. So people on SSI, although categorically they qualify for the QMB program because the financial

Limits are exactly the same. You always had to apply. States did not regularly screen people, screen SSI individuals for QMB. So a lot of SSI individuals simply did not have it, even though it could have benefited them and even though they qualified. So the federal law, federal government made it required. And then as of January, 2025, all SSI individuals in California

will be automatically enrolled into the qualified Medicare beneficiary program if they are Medicare eligible.

This was actually a two phase process. The first phase started in October, 2024. But in October, 2024, not all SSI individuals were enrolled automatically. But now in January, everyone that is on SSI and qualifies for Medicare will be enrolled into QMB automatically. So what that means is,

California simply enrolls folks directly. Our Medi-Cal program gets the information from Social Security and they can directly enroll folks into the QMB program. There is no application at the county that is needed anymore and DHCS will do it at their state level system. So the counties also aren't doing this process anymore for SSI recipients.

Speaker 1 (25:32.27)

SSI recipients do not need to submit an application. There's no paper application for an SSI recipient for QMB. And again, this is because SSI recipients are financially eligible for QMB because the income limits are simply identical. But this means that people that don't have SSI, they are not automatically enrolled into the QMB program.

So those folks still have to apply, but any SSI individual, it will be done for them. So it just makes it a lot easier. If a person on SSI has premium Part A when they are enrolled into Q &B by the state, the state will also start paying for their Part A premiums because that is a feature of our Q &B program. There is no two-step process anymore.

I know a lot of you had helped a lot of people get into Medicare Part A and Q &B using the conditional Part A application where you had to go to the Social Security office to first conditionally apply for Part A and then go to the county to apply for Q &B. So for SSI recipients, that process is eliminated. They do not need to do anything really. The state

should be enrolling them directly and enrolling them into part A if it's needed. If you are seeing that this is not happening to your SSI patients, then let me know. So far, we've been assured that the process is going smoothly. I know that in January, there was several hundred thousand people that were successfully enrolled directly.

And that process will be ongoing. If you're on SSI and you age into Medicare, this will happen to you. If you're on Medicare and get onto SSI, this will also be the same process where they are automatically enrolled. So it's really great. It simplifies this piece, which as you know, is always very complicated. And this is the notice, a sample notice that the state Medi-Cal program sends out.

Speaker 1 (27:55.298)

to these members to let them know. So you may see these notices or hear of people getting them, but this is pretty much what it looks like. And the state actually, I don't know why I just checked this morning, but they used to have a page where they linked to these notices in a PDF file, but they took it down recently. So I'm not sure why I can try and find the PDF versions and send them out so you have a clearer view, but.

This is pretty much what it looks like. Anyone that is also enrolled into part A will get a separate notice from the social security office. And the social security office notice will say, you have been enrolled into part A. If someone is being enrolled into part A, they'll also get a new Medicare card from social security that also lists their new part A benefits.

All right, so the next piece is part A buy-in. The first piece I would say I think is more simple because it's clear. If you're of SSI, you're automatically enrolled into QMB and any Medicare that you need. But part A buy-in is a little bit more complicated, but under part A buy-in, this started in 2025 and it is focused on the way that California

Speaker 1 (29:52.93)

pays for these Part A premiums for people that need it. Part A buy-in is simply refers to the arrangement through which our Medi-Cal program pays the Part A premiums on behalf of eligible individuals.

Part B and other Medicare cost sharing is paid for under QMB and also through our other Medi-Cal categories. We actually have a very comprehensive Medi-Cal program and they'll pay for any Part B costs through like Aged and Disabled or any other Medi-Cal category. But Part A premiums again is only paid for through QMB. So you must have the QMB

program to get payment or help with your part a premiums. Otherwise you do have to pay that on your own. So under part a buy in California will directly enroll certain people into premium part a any time of the year and establish payment of those part a premiums via Q and B. This began January 1st, 2025 and it came about through.

Legislation that was passed a couple of years ago, it took a little bit to get implemented in January 2025, was the first date. And part A buy-in does not impact people that qualify for free part A. If you have free part A, you can enroll year round. When you turn 65, you are gonna be automatically put into free part A. But if you do not qualify for that free part A,

Those folks will have the option to enroll into premium part A. If you decline it, you have to wait until certain enrollment periods to enroll into Medicare. Like all other insurance, Medicare has restrictive enrollment periods. But if you are low income and qualify for our Q &B program, you can enroll year round through our part A buy-in program.

Speaker 1 (32:02.99)

And that's simply because the California or Medi-Cal program will do it directly. So prior to January 2025, we had a two step process to do this. You had to first go to Social Security and apply for conditional part A, but you could only do it between January to March. So if you enrolled outside of that three month window, you had to wait until the next year. And as you can imagine,

And as I know a lot of you experienced, people don't come back the next year to enroll. Or it's too confusing because you have to go to Social Security and then you have to go to the Medi-Cal office to apply for the Q &B application. So there are two applications at two different offices. And in our experience, both the Medi-Cal offices and Social Security workers were not necessarily very knowledgeable about this two-step process.

For most people, now that we are part A buy-in state, this two-step process has been eliminated.

And so why did we do this? The benefits of this are many. First, again, it simplifies enrollment for people who have to buy into part A. For most people, that two-step process is eliminated altogether. You can enroll year-round into premium part A. And it also eliminates the part A late enrollment penalties.

If California used to pay the late enrollment penalties to Social Security for anyone on QMB, but those are now eliminated, Social Security is waiving that for California. So it's actually saving the state money. It also, I think most importantly, helps people become fully, dually eligible with part A and part B. That means people who

Speaker 1 (34:03.894)

in the past maybe only had part B, you had a much more limited range of Medicare providers because Medi-Cal was paying for your hospital costs. So you had to go through the Medi-Cal network. But if you have part A and part B, you just have a much wider range of Medicare providers that are available to you. And that also means you have more Medicare enrollment options.

If you want to join a Medicare Advantage plan, the Part C plans, you have to have both Part A and Part B. So by becoming a full dual eligible, you now have access to those Part C Medicare Advantage plans, as well as the dual eligible special needs plans that are specifically catered to this group. So their benefits have been

Multi-fold state savings, but also on the individual, it's just much simpler. And then now you have help with your part A premiums and you don't have to jump through as many hoops. So it's been really great to see that this has happened in California. It's been a long time coming. We were one of, I think, 12 states that did not have this part A buy-in process.

So we were actually in the minority of states to just make it much more complicated than it really needed to be.

So what is the process today? There are two different processes for separate groups. Your first group is your SSI folks. For them, it's pretty much automatic. And then you have everyone else, people that don't qualify for SSI but are eligible for Medicare.

Speaker 1 (36:02.766)

So people that are on SSI, I've covered this before, but it's much easier. They're directly enrolled into both Q and B and then part A if needed. If they don't yet have part B, California also does that through our separate part B buy-in process that's been around for decades. And then this is an ongoing policy. Again, it's gonna apply to current SSI individuals and anyone that's newly eligible and that gets on.

in the coming months or years.

So here's a quick example. In December 2024, Lynn is 68. She receives SSI, SSP. She has SSI-linked Medi-Cal and Part B and Part D. She does not qualify for free Part A. And years ago, when given the chance, chose not to enroll. She could not afford the high cost.

Speaker 1 (36:59.31)

So in January, after we became a Part A buy-in state, California, our Medi-Cal agency, deems her eligible for QMB. She has SSI, she meets the income requirements for the QMB program. So they deem her eligible for both QMB and Part A, and in February, that is when the coverage starts. Your QMB effective date is always the first of the month following your application.

It's not immediate, so it's usually a month after. So that's why February 1st is when Lynn's Q &B coverage is effective and same with her Part A. She will not pay the premium for Part A, that's paid by the state. And then she will get the notices in the mail. She's been enrolled in Part A, Curriculum B, and she'll get a new Medicare card because now she has both A and B enrollment. Much simpler.

and much easier. But for people who don't have SSI, it's not gonna be as straightforward, unfortunately. For these folks, you do always have to apply for QMB to be evaluated. Not everyone is going to be income eligible for QMB because you have to have income at or below 1,305 a month. That's 100 % of the federal profit available.

And then for some people, just applying for Q and B alone is enough to be enrolled into premium part A, but not for everyone. And that is because you have to establish that you even qualify for Medicare. Our Medi-Cal program does not know if someone is eligible for Medicare or not. That is on the social security side because they will look at age and work requirements and whether someone has that work history.

There are two groups that fall into this non SSI automatic group. So there are those that are enrolled in part B now, but chose not to enroll into premium part A years ago. And then there are those that are not enrolled in either. They either just became Medicare eligible or for some reason has declined both premium part A and part B years ago.

Speaker 1 (39:23.79)

So the process for these two groups are going to be different under part A buy-in. If you're already enrolled into part B, you've established that you qualify for Medicare. So it's much simpler. They can apply for Q &B only, just like the SSI group. And if they qualify for Q &B, California will enroll them into premium part A and begin payment of their part A premiums. So for the...

group that's already enrolled in Part B and have established Medicare entitlement. It's simple, that two-step process is gone. You don't need to go to Social Security to apply for Part A. Applying for Q &B alone will be enough because you've already established Medicare entitlement through that Part B coverage. But if you're in Group 2 and you have not yet established that you qualify for Medicare, you do have to go to Social Security and apply.

and they have the choice of applying for part B alone. After they apply for part B, they'll be like the first group. They can apply for Q and B, California can evaluate them, and if they're eligible for Q and B, they're enrolled in part A.

You can also choose to apply for conditional Part A. That process is still an option, but it's not a requirement. And conditional Part A is the application telling Social Security that I am applying for Part A with a premium, but on the condition that I later qualify for Q &B so I get the state payment of my Part A premiums. These folks are applying for Part A conditionally.

because they don't want to be on the hook for those high Part A premiums if they won't get Medi-Cal help through the Q &B program. For the second group, you again have the option. I can't say what is a better option if they want to apply for Part B and conditional Part A to establish the Medicare entitlement or only apply for Part B alone.

Speaker 1 (41:38.062)

I know that you can do both. It may be easier to do the part B and conditional part A just so you have it in one bucket. I'd be curious to know if you have any experience with people that have tried this and what their experience have been. But in all cases, this group still has to, after they've applied for Medicare at Social Security, then file an application for Q &B at the Medi-Cal office.

So this group still has a two-step process, but hopefully there's few and fewer people on group two and most people have part B, so that if you're a group one, you only have to do one application. We still advise that folks that apply for Medicare and Social Security keep copies of that application so that when they go to the Medi-Cal office, they have proof of that just in case it's needed.

So here's an example. Mr. Ko is 67 and enrolled in part B. He has aged and disabled Medi-Cal and his income is 1,160 a month. Mr. Ko has worked part-time jobs for most of his life and does not have the work credits for free part A. So he decided not to apply for premium part A when he turned 65 and does not have Q and B.

I will say that also when someone applies for Medi-Cal, you are supposed to be screened for the Q and B program. So Mr. Koh should have been screened for Q and B when he got on the Aged and Disabled program and was Medicare eligible. I don't think we always see that the counties are screening folks uniformly for like your Aged and Disabled and Q and B. Some counties do, some counties don't.

But so that's why we were also talking about having to apply for QMB, even though the counties really should be screening people when they become Medi-Cal eligible, when they turn 65 onto Medicare or as they go through their renewal processes. But I can't say that that has always happened. So for Mr. Koh, he's only has Part B and the aged and disabled Medi-Cal.

Speaker 1 (44:03.886)

program. He does not have QMB or premium part A. So in January, he learns that Medi-Cal will pay his part A premium. He hears about this QMB program. So he goes to Social Security to apply. But because Social Security does not handle the QMB applications because it's a Medi-Cal program, he's directed to go to the county Medi-Cal office. So he does so and he submits his QMB application on January 5th.

The county reviews it, it's approved in January, and he's enrolled in premium part A.

His application was submitted in January, but by state and federal law, QMB effective date is not the same as your application date. So his QMB effective date is February 1st and so is his Part A, the same month as his QMB. So that means February 1st and ongoing, he will get state payment of his Part A premiums. He is a QMB person and he also has

all of the federal protections against improper billing now apply to him as a QMB.

Here's another example. Mrs. Lee immigrated to California in 2011 at age 57. She came to care for her disabled adult daughter who lived in the U.S. She does not have the work credits for free part A because she was unpaid. She is uninsured and has recently started needing medical care. She does have a part-time job earning $1,100 a month. So Ms. Lee applies for Medi-Cal and is directed to apply for Medicare.

Speaker 1 (45:52.174)

when she turned 65. She cannot afford the monthly Part A premium because she hasn't been in the US long enough to have that 10 years of work history. If she did sign up for Part A with a premium, the premiums alone would take up more than 50 % of her income. Again, she only earns $1,100 a month, so that is not feasible.

She applies for QMB2 but is rejected because she has not established that she is eligible for either Medicare Part A or B. She has gone without any health coverage while she has been here. So what steps does she need to take next?

So first, again, she does not have any sort of Medicare, Part B or Part A. So she has to establish that she even qualifies. So she goes to Social Security and applies for Part B. She is enrolled. And after that, she can apply for QMB. She should keep a copy of her Part B enrollment with Social Security so that she can bring it to the county office.

She is approved for the Q and B and so California is also going to enroll her into premium part A and pay the premium. She did not apply for conditional part A at Social Security and she did not have to. Her part B application was enough. But that does mean she's going to see some delays in her part A effective date because she only applied for part B only after she applies for part A.

for part A and for Q and B with Medi-Cal, will that part A enrollment date start?

Speaker 1 (47:40.942)

So for this group and part a buy in there's also multiple notices that have been sent out. The Q and B approval notice of action will be sent and then Social Security on their end will send folks a notice that they've been enrolled into Medicare and a new Medicare ID card if it's needed.

And then we have the Q &B approval date again.

Sample notice. This is the one that Social Security looks like that says California is going to pay your Part A premiums. This notice says October 2024, because that is the first date that this started. But obviously people that have been applied at a later date will get different notices, a different notice date on theirs. And I don't have a copy of what

the ID, the notice that comes along with someone that gets a new ID card that has not been shared with us, but we do have a copy of at least the notice saying that you have part A.

Speaker 1 (48:52.302)

So key takeaways from all of this, if you're on SSI, it's simple. You are automatically enrolled into both QMB and if needed premium part A. That group should not be asked to submit any application for QMB or part A. If you are hearing otherwise, let me know, because that means education needs to be done or there's some problems. If you don't have SSI,

you will not be automatically apply enrolled into QMB or part A, and you may still need to go to Social Security to apply for Medicare. But if you have part B already, you only have to submit one application, and that's for QMB to get QMB and payment of your part A premiums. And then people that are already enrolled into any of these programs, if you're already in QMB, if you already have part A or part B,

This does not apply to this group, to those groups. All of what I have talked about today are only for people who are on SSI or people who are not yet enrolled into premium part A, but are eligible for state help or state payment of those part A premiums. So if you see problems in any of these areas,

Let me know. Although I don't do direct services, we have a lot of contacts with the local legal aides in each county that do provide those direct services. We can elevate issues to the Medi-Cal office. They did a lot of work on the back end to make sure that the enrollment processes went smoothly. And so far, I've only heard good things. I haven't heard of any hiccups. If you do hear of hiccups though, please let me know because we can.

immediately escalate those and fix issues. Or if you hear of counties that are also giving out incorrect information, we want to hear that as well. It is a new policy. It's pretty complicated. And even, you know, the past two part conditional part a process was already not well known and a lot of incorrect information was given out. So I can only imagine that it may be the case with

Speaker 1 (51:16.878)

the new updated policies, even if they're meant to make things easier.

And then there's some other updates. The Medi-Cal, DHCS, our Department of Health Care Services, they oversee our Medi-Cal health coverage in California. They told us last year that they are looking into increasing the QMB income limit. So this is not set in stone. It is not concrete. I don't have a date when this will happen. And we do need federal approval to do this. One second.

Speaker 1 (51:54.961)

But DHCS is exploring increasing the current limit, which is at 100 % of the federal poverty level to 138 % of the federal poverty level. As you know, Medi-Cal for older adults, the income limit in our Aged and Disabled program is set at 138%. So by increasing the QMB limit to match the Aged and Disabled limit,

we would open up the benefits of QMB to more people, really to help pay for the part eight premiums. That is gonna be the big difference for those people that are low income, but not low income enough that they are at 100 % of the federal poverty level, because that is very low. 1305 a month gross is what 100 % of the federal poverty level is. So this is still ongoing.

The state is evaluating whether to do this, what it would cost. If it happens, we would have to get federal approval and there would be some implementation steps before it would occur. And if we do it, we will put it all over our listserv so you would be notified. And then of course, I'm sure most of you have heard of this, but there are potential funding threats to our Medicaid program in California.

California right now is going through a budget shortfall. And then in the federal government, there are talks to reduce the federal spending. And if the amount of money that California gets from the federal government to fund our Medi-Cal program in California goes through, we anticipate that California will have to make hard decisions and make funding cuts or cut some services in California.

There's been many different expansions. We have increased access to Medi-Cal for undocumented immigrants. We've also increased our income limit for aged and disabled to 138. That is not what it has always been. We have services like IHSS or dental. Those are optional. California is not required to provide those services under federal law, but they do so. They have chosen to do so.

Speaker 1 (54:15.63)

But in past budget deficits, California has rolled back dental to adults. They have cut IHSS hours. So there's a lot that could happen in California if because of any federal funding cuts, it would impact our Medi-Cal program today. So is there a lot of advocacy that is going on to fight against any Medicaid cuts if you are?

signed up for our listserv. There's a lot of opportunities on there to engage in advocacy or just to get up to date news on what's happening.

I have a bunch of resources listed here. When I share the PowerPoint, you'll be able to link those if you're interested. And then anyone is always free to also contact me directly if you have questions about what I covered today or anything else really that is Medicare or Medi-Cal related. We do answer questions from folks like you that work directly with people to try and resolve any issues or connect you to who

who may be able to help you fix certain problems.

Speaker 1 (55:50.19)

So question is, if you have part B and submit an application for QMB to get part A coverage, what happens with your part D coverage? Well, that's a good question. Nothing happens with your part D coverage. That is completely separate. People that are Medicare eligible or have Medicare because they're age 65 or younger but have a disability, once you

Get onto Medicare. Medi-Cal cannot pay for your prescription coverage. Medicare is considered primary. So Medicare will pay for any dual-eligibles Part D prescription coverage. So what I talked about today will not impact someone's access to Part D. They probably already had Part D because Medi-Cal has required that folks...

that are on Medicare or Medicare eligible have already signed up for Part D because they simply are prohibited, Medi-Cal is prohibited from paying for a dual eligible's prescription cost except for in some very rare circumstances, but that's why most, if not all dual eligibles are getting most of their prescription drugs covered under the Medicare Part D program.

So Q and E or the part A applications will not impact someone's part D.

And if that didn't answer your question, feel free.

Speaker 2 (57:45.646)

I'll go ahead and close this out. First of all, thank you all for joining us today. And a huge thank you to Tiffany who actually did simplify such a complicated process. So thank you so much, Tiffany, and your wisdom, your insights and your expertise really shined and I couldn't thank you more than for making it very clear.

I hope this session gave everyone practical ways to better support your Medicare and Medicaid or Medi-Cal patients, specifically when it comes to enrollment and the Part A buy-in. I, As FQHCs, you all play a critical role in closing these coverage gaps and ensuring that the patient has access to care as well as resources. So we're exceptionally thankful that you guys all joined today. We'll be sharing some follow-up materials.

And we encourage you to bring this back to your teams and just start the conversation. Thank you again from all of us at Alcar Health and Justice in Aging. We appreciate the work that you do and we're very grateful to be in partnership with you all. Take care.