For Professionals: Low-income Help

State Stops Paying Medicare Part B Premiums for Beneficiaries with Any Share of Cost Medi-Cal

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Published Apr 20, 2011

Medi-Cal is no longer paying the Medicare Part B premium for any Medicare beneficiaries who have Medi-Cal with a Share of Cost (SOC), unless they meet their SOC in a given month. The change is the result of a budget trailer bill (Senate Bill 853) amending Welfare and Institutions (W&I) Code 14005.11, and is estimated to affect about 700 beneficiaries throughout California. It expands the policy change made in November 2008 when the state stopped paying the Part B premium for people with SOCs over $500. The recent change took effect April 1, 2011; for those affected, the Part B premium will be deducted from their Social Security checks beginning in May 2011.

If you are affected by this change and now have to pay the Medicare Part B premium, make sure your county Medi-Cal office screens you for other programs that pay the Medicare Part B premium. County Medi-Cal offices are required to screen all affected beneficiaries for programs such as the Medicare Savings Programs (MSPs) – Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI-1) – which pay the Medicare Part B premium as a benefit. Beneficiaries who currently have one of these 3 MSPs continue to have their Medicare Part B premiums paid, regardless of whether they also have Medi-Cal with a SOC.

If your income is too high to qualify for any of the MSPs, you may consider the California Working Disabled (CWD) program. The CWD program allows people with disabilities the opportunity to work, earn income up to 250% of the federal poverty limit (FPL) and still qualify for full Medi-Cal without a SOC. People who qualify for the CWD program pay a monthly premium for their full Medi-Cal benefits ranging from $20-$250 for an individual and $30-$375 for a couple. For most people who qualify for the CWD program, paying the monthly premium every month and getting full Medi-Cal benefits is better than having to meet their SOC every month before getting assistance from Medi-Cal. See our section on Medicare Savings Programs for more info on the MSPs and the 250% California Working Disabled program.

See the 6-page All County Welfare Department Letter (ACWDL no. 11-15) (PDF) for details about this change.

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