Inside Medicare | NYS is no longer paying my Part B premium, what do I do?

Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Share this...

• Facebook
• Linkedin

Question:

I just received a document from the Chautauqua County Department of Health & Human Services stating that New York State is no longer paying my Medicare Part B Premium. Now what do I do?

Answer:

There are many programs under the umbrella of Department of Health & Human Services (DHHS), just one of them being Medicaid. There are also many types and levels of Medicaid. Without looking at the letter, I would guess that you had previously applied for one of the Medicare Savings Programs – DHHS jurisdiction and under the classification of Medicaid. We call them, QI-1, QMB (Qualified Medicare Beneficiary) or Medicaid.

All three levels pay your Medicare Part B Premium, which is $185 for most Medicare enrollees. That Medicare Part B premium is usually taken out of your Social Security check each month before you get it. Some letters actually say, “During the previous year, you or a member of your household was eligible to have the Medicaid Program pay the Medicare Part B Premium.” Some letters say, “During the previous year, you or a member of your household were eligible for Medicaid.”

This letter is saying that at some time in the last year, or prior to that time, you applied for a benefit that would have paid that Medicare Part B premium and now you no longer have it. It usually states a date such as ‘as of August 1’, or ‘September 1’. This benefit is called the QI-1 benefit, or the Medicare Savings Program (MSP). This benefit, like many others, needs to be recertified (or re-applied for) each year. The DHHS office sends out the annual re-certifications time of year. I have heard from many individuals with this same question in the last few weeks.

Sometimes when individuals get the annual recertification letter, they don’t complete it, and therefore lose the benefit. Sometimes individuals complete the recertification and then are denied because their situation has changed, more income, or lower premiums. Sometimes an individual forgets to include information that is required and therefore they get denied.

That means your Social Security will go down by $185, because you will be paying the Medicare Part B premium again. You can also consider talking with the worker who is listed on the letter, and asking if they could help you understand the decision.

I consider this type of benefit a “gateway” benefit. Once approved, there are many other benefits that you are automatically approved for, such as the Low Income Subsidy (LIS) from Social Security, to help with Medicare Part D costs.

Your loss of the Medicare Savings Program does NOT mean that the LIS benefit ends right away. The LIS benefit is going to continue for the remainder of the calendar year. That means your low prescription drug costs and your lower Part D premium will continue for 2025, but will likely end starting January 1, 2026.

This QI-1 benefit allows an individual to have monthly income of up to $2446 or two persons up to $3299 per month. This benefit does not consider the money you have as assets, (ie: in the bank or investments) only the income you receive. This benefit also allows for a reduction to your income by the amount you pay in insurance premiums. Not all insurance premiums, but premiums for health insurance, prescription drug coverage insurance, dental insurance, and long-term care insurance. So, if you have dental insurance for $34 per month and health insurance for $209 per month, your income could be up to $2689 per month and you would still be eligible for this benefit. The same is true for couples. If you both have dental, and that same health insurance premium, your income could be closer to $3785 per month and still be eligible. So, there are many individuals and couples who may be eligible for this benefit in our community.

This benefit is one of the many programs that require an annual recertification. This simply means you have to inform them of your financial situation again, including your income, your expenses and for some, your assets. Some of these programs are: QI-1 (the one we talked about above), EPIC, SNAP (Food Stamps), HEAP, and Low Income Subsidy (LIS), to just name a few. For the time it takes to complete the annual form, you get a year’s worth of benefits. For most this is a very good deal.

I would also consider looking into this benefit again with someone who can help you re-evaluate your eligibility. Maybe something was left off the form, or information was misinterpreted or misrepresented. You can always reapply for this Medicare Saving Program (MSP) benefit anytime you qualify.

I also want you to know that you have a Special Enrollment Period (SEP) to change your insurance coverage because you lost this MSP benefit. Now may be a good time to evaluate your insurance coverage overall to see if something fits better based on what you need right now. This SEP lasts for 60 days from your end of MSP eligibility, so don’t put it off.

I am always cautious about advising to complete and mail forms back to someone without understanding what it is and why, so I am glad you asked. Always call for more information if you are unsure about the requests. If you are not comfortable with this answer or are still unsure, review it with family, the Office for the Aging, or a professional in the field.