Medicare Part B for MA-EPD Enrollees

Medicare Eligibility

People enrolled in Medical Assistance for Employed Persons with Disabilities (MA-EPD) must enroll in Medicare if eligible.

If not enrolled in Medicare at the time they apply for MA-EPD, Medicare eligible people must apply for Medicare during the next available Medicare general enrollment period (January-March of each year), to continue MA-EPD eligibility.

Payment for Medicare Part B Premiums

MA-EPD enrollees may have their Medicare Part B premiums paid for or reimbursed with an effective date of MA-EPD eligibility for enrollees who meet one of the following:

• Meets the requirements for Qualified Medicare Beneficiary (QMB) or Service Limited Medicare Beneficiary (SLMB) programs. See EPM section 4.2 Medicare Savings Programs for more information.
• If not eligible for QMB or SLMB, has income at or below 200% FPG using the MA-EPD income methodology.

For the eligible MA-EPD enrollees not eligible for QMB or SLMB with income at or below 200% FPG, Medicare Part B premium reimbursements must be processed and reimbursed by the county or tribal servicing agency at application, renewal, or when an enrollee reports a change that makes them eligible for reimbursement. DHS reimburses Medicare Part B premium reimbursement payments made to an eligible MA-EPD enrollee by the county or tribal servicing agency.

MA-EPD enrollees who become newly eligible for agency reimbursement of their Medicare Part B premiums must receive the Eligible for Manual Reimbursement for Medicare Part B Premiums for MA-EPD Enrollees Form (DHS-8555).

MA-EPD enrollees who become newly ineligible for agency reimbursement of their Medicare Part B premiums must receive the Ineligible for Manual Reimbursement for Medicare Part B Premiums for MA-EPD enrollees Form (DHS-8556).