Medicaid Coverage of Premiums and Cost Sharing for Low-Income Medicare Beneficiaries

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March 2013

Medicare was originally designed to serve eligible individuals without regard to their income and includes beneficiary cost-sharing requirements such as premiums, deductibles, and copayments similar to private health insurance. From its earliest days, Medicaid covered some of the costs of medical care for low-income Medicare beneficiaries, but many persons eligible for this assistance did not enroll.

Out of concern that low-income individuals would forgo needed care when faced with cost-sharing requirements beyond their means, Congress enacted a series of provisions to make Medicaid’s role in paying for these costs explicit and to encourage greater enrollment. Today, there are four Medicare Savings Programs (MSPs), each with different income and asset-level requirements.

In addition to an examination of the MSPs, Chapter 4 of  the March 2013 report also includes the results of a MACPAC analysis of states’ Medicaid payment policies for Medicare cost sharing and interactions with Medicare bad debt policy. Read more about cost sharing under Medicaid and Medicare.

Publication Type: Reports to Congress

From: March 2013 Report to the Congress on Medicaid and CHIP

Tags: access, copayments, cost sharing, cross over claims, deductibles, dually eligible beneficiaries, elderly, Medicare, Medicare Savings Programs, people with disabilities, premiums, provider participation