The California Department of Health Care Services has notified county Medi-Cal offices that the state will begin to cover the Part A premiums for certain low-income individuals. The premium for Part A of Original Medicare can be as high as $505 (2024) per month for people who don’t qualify for $0 premium Part A.
Part A Medicare Premium Maybe Paid by Medi-Cal
Most people who have worked 10 years and paid Medicare taxes receive Part A (hospital coverage) at no cost. Some individuals who have worked less than 10 years may have to pay $278 per month. Medicare beneficiaries with no work history may qualify under their spouse’s work history and not to have pay the Part A premium.
However, there are some individuals who have no work history or spouse and are subject to the full $505 a month Part A premium. You must have both Part A and Part B of Original Medicare to enroll in a Medicare Advantage plan or a Medicare Supplement.
Under the Medicare Savings Program, Medi-Cal will cover the Part B premium ($174.70 for 2024) for Qualified Medicare Beneficiaries and Specified Low-Income Medicare Beneficiaries. Medi-Cal did not cover the more expensive Part A premium.
Medi-Cal Low-Income Groups Eligible for Part A Premium Buy-In
The California Department of Health Care Services will now participate in a Part A Buy-In program with Centers for Medicare and Medicaid Services (CMS) and cover the premiums for Part A. Medicare beneficiaries eligible to have their Part A premiums covered are:
- Individuals with full-scope Medi-Cal
- Supplemental Security Income/State Supplementary Payment (SSI/SSP) recipients
- Medi-Cal recipients and deemed SSI/SSP Medi-Cal recipients
- Qualified Medicare Beneficiaries (QMB)
- Qualified Disabled and Working Individual (QDWI)
- Individuals in the Medically Needy group who meet their share of cost (SOC) in a month, for that month only
Medi-Cal can cover the Part A premium for eligibles individuals at any time of the year. It is not subject to any annual enrollment periods. In addition, if the Medicare beneficiary may have been subject to the Part A late enrollment penalty, those penalties will not apply while Medi-Cal is covering the premiums.
SSI Medicare eligible members will also be automatically enrolled in Part A buy-in by SSA who reviews Medicare eligibility for all SSI/SSP applicants. With Part A buy-in, the SSA will automatically enroll the individual in Part A and will notify DHCS. Other potentially eligible applicants will only be required to complete a Medicare Savings Program or Medi-Cal application with their county Medi-Cal office.
If you currently have Medicare and Medi-Cal, and you have to pay for Part A, contact your county Medi-Cal office to see if you qualify for the Part A premium coverage. If are over 65 and low-income, and don’t have Medicare Part A, contact your county Medi-Cal to see if you qualify for the Part A coverage.
