Medicare Entitlement

Medicare Entitlement A. An applicant or recipient entitled to Medicare Part A (Hospital Insurance) and Part B (Supplemental Medical Insurance) must apply and accept coverage under Parts A and B provided the Division of Medicaid will pay all associated premiums and cost-sharing expenses for persons in the category of eligibility under which the individual is applying or is eligible. 1. An applicant or recipient entitled to Medicare Part A with no premium payable (through work history of self or spouse), must apply and accept both Part A and Part B of Medicare as a condition of eligibility. 2. An applicant or recipient who is not eligible for free Medicare Part A is required to apply and accept Medicare as follows: a) If household income is equal to or less than the federal poverty level (100% FPL), the individual must apply and accept Medicare Part A under conditional enrollment, meaning Medicare will be accepted when Medicare is approved and Medicaid begins payment of the Part A premium. The individual must also apply for Medicare Part B at the same time. b) If household income is greater than the federal poverty level (100% FPL), the applicant/recipient will not be required to apply for Medicare Part A unless the only category of eligibility in which the individual qualifies is that of Specified Low Income Medicare Beneficiary (SLMB) or Qualifying Individual (QI). Both SLMB and QI require active Medicare Part A as a condition of eligibility. c) An applicant or recipient will not be required to apply for Medicare if the individual has previously applied for Medicare Part A and/or Part B and coverage for both or either parts of Medicare were refused, withdrawn or terminated due to non-payment of premiums. The Division of Medicaid will take appropriate action to have Medicare Part A and/or Part B reopened through the Medicare Buy-In process if household income is equal to or less than the federal poverty level (100% FPL). An individual whose household income is greater than the FPL will not be required to reapply for Medicare unless the only category of eligibility in which the individual qualifies is that of a Specified Low-Income Medicare Beneficiary (SLMB) or a Qualified Individual (QI), in which case reapplication for Medicare Part A is required as a condition of eligibility.