Eligibility for Part A is primarily based on an individual’s age and work history. Most people qualify for premium-free Part A when they turn 65. This is because they paid Medicare taxes for at least 40 quarters or qualify under a spouse’s work history. However, some people do not have enough work history and have to pay a premium for Part A.
If you don’t qualify for premium-free but want Part A, then you will spend either $285 or $518 per month. The amount is dependent on how many work credits you have. This is a steep payment that can deter many people from enrolling in Premium Part A. But if you are low-income you may qualify for assistance to pay this premium. Your state’s Medicaid will pay if you qualify as a Qualified Medicare Beneficiary (QMB) under the Medicare Savings Program (MSP). Learn more about who qualifies for QMB in our previous blog.
How to Enroll in Premium Part A with QMB
Enrolling in Part A is normally straightforward for Premium-free beneficiaries. For those already receiving Social Security or Railroad Retirement Board benefits, enrollment is automatic. But this process becomes more complicated when you need to apply for both Premium Part A and Medicaid assistance to help with the premium. This involves a bit of back and forth between the Social Security Administration (SSA) office and your state’s Medicaid office. The is referred to as the Conditional Part A enrollment process.
The conditional enrollment process allows you to apply for Premium Part A pending approval from Medicaid. This means Part A coverage is dependent on your QMB approval, with Medicaid paying the premiums. If your state denies your QMB application, you will not be enrolled in Premium-Part A. The conditional enrollment process is necessary because you must first have Part A to qualify for the QMB Program. However, most low-income people cannot afford to pay the high Part A premium before obtaining QMB benefits. The conditional process addresses this by allowing them to enroll in Part A on the condition that the state approves their QMB application. Hence the name; Conditional Part A.
Due to the conditional process, you MUST FOLLOW THE STEPS BELOW IN ORDER. The date you can enroll in premium Part A depends on whether you live in a Part A Buy-In State or a Group Payer State.
In Group Payer States you can only apply for conditional Part A between January 1st and March 31st. These states include AL, AZ, CA, CO, IL, KS, KY, MO, NE, NJ, NM, SC, UT, and VA
In Part A Buy-in States you can apply for conditional Part A any time of the year. Part A Buy-in states include all other states that are not listed above.
Steps for Applying for Conditional Premium Part A:
- You must first contact your local SSA field office to apply for Conditional Part A. You cannot apply for this online. THE MAGIC WORD TO USE WHEN APPLYING IS “CONDITIONAL” PART A. It is very important that you tell SSA office “Conditional” Part A so the enrollment gets coded as conditional.
- Once you have applied for Conditional Part A with the SSA office, you will need to apply for the Qualified Medicare Beneficiary (QMB) program through your state’s Medicaid office. You will let Medicaid know that you enrolled in conditional Part A and need to apply for the Medicare Savings Program to pay for the Part A premiums.
- If you get approved for the QMB level of the Medicare Savings Program, then the state will pay your Part A premium and it will be active. If you get denied, then you will not be enrolled in Part A.
Note about Part A Buy-in States and current Part B: If you live in a Part A Buy-in state and already have Part B, then your steps for conditional Part A are slightly different. You do not need to go to the SSA office to apply for Part A first. You simply need to apply for QMB through your state’s Medicaid office and they will automatically enroll you in conditional Part A if approved. If you live in a Group Payer State, your enrollment will always require you to go to the SSA office first as listed above.
What other benefits do I receive as a Qualified Medicare Beneficiary?
Once you have QMB, you will be eligible to enroll in a Dual Special Needs Plan (D-SNP) to receive extra benefits such as dental, hearing, vision, healthy food card, over the counter benefits, prescription drugs, etc. You also receive assistance with Part A and Part B premiums, copays, deductibles, and coinsurance for your Medicare covered services. We can help you determine if you qualify for QMB and to find a Dual Special Needs plan in your area. Contact our office to get help from our friendly agents!
