What Brokers Need to Know!
We’re thrilled to share some important news for California residents that will help increase access to healthcare for low-income individuals. Starting January 1, 2025, California will officially become a Medicare Part A Buy-In state under a new agreement with the Centers for Medicare & Medicaid Services (CMS). This initiative is a game changer for eligible individuals who don’t qualify for free Part A due to insufficient work history, offering a chance to have their Medicare Part A premiums covered by state funding.
What Does This Mean for California Residents?
This program is designed to support full-scope Medi-Cal members who meet specific eligibility requirements, enabling them to gain access to comprehensive healthcare coverage. Here are some of the key benefits:
- Dual eligibility for Medicare and Medi-Cal: Eligible individuals can benefit from both programs, expanding access to a wide range of healthcare services.
- State-covered Medicare Part A premiums, coinsurance, and deductibles: State funding will cover these costs, providing significant savings for individuals who qualify.
- Primary hospitalization and inpatient care coverage under Medicare: Medicare will take over for Medi-Cal for these services, ensuring smoother healthcare access.
Who Is Eligible?
To be enrolled in Medicare Part A under this new program, individuals must meet the following criteria:
- Be a full-scope Medi-Cal member
- Be enrolled in Medicare Part B
- Qualify for the Qualified Medicare Beneficiary (QMB) program
For recipients of SSI/SSP, enrollment is automatic if they meet these criteria. Non-SSI/SSP Medi-Cal members can apply for the QMB program through their local county office to access this benefit.
Key Questions for Brokers
As a broker, you can play a crucial role in helping your clients access this important benefit. Here are some key questions to guide your conversations and determine eligibility:
- Are you currently enrolled in full-scope Medi-Cal?
- Do you have Medicare Part B coverage?
- Do you qualify for the Qualified Medicare Beneficiary (QMB) program?
- Have you ever been denied Medicare Part A due to insufficient work history?
- Did you know that the state may now cover your Part A premium?
Why This Matters
This new program is an excellent opportunity for brokers to help their clients improve access to vital healthcare benefits. By working with Medi-Cal members who meet the eligibility criteria, you can provide valuable guidance in navigating this new benefit. Stay tuned for more updates and resources to help you support your outreach efforts!
Let’s work together to ensure more individuals in California have access to the healthcare they need.
If you have any questions about this program please contact us at agents@taia.us.