A. Benefits for MCSP and Part B-ID MCSP
SLMB pays the Medicare Part-B and Part B-ID premium only.
B. TPL
TPL process is only required for Medicare Part B-ID MCSP
C. SLMB and Other Medicaid Programs
Members may receive SLMB and other Medicaid programs at the same time. Explain to members that SLMB only pays the Part B premium. SLMB does not pay the Medicare Part B deductible or co-payments.
If the member becomes eligible for Medicaid by paying a spenddown, Medicaid will pay the Medicare deductibles and co-payments. Medicaid may also cover medical services that Medicare does not cover.
D. SLMB Medicare Part B-ID MCSP and Other Medicaid Programs
SLMB QI-1 members who are eligible for other Medicaid programs, Marketplace insurance, employer insurance, etc. which cover immunosuppressant drugs are not eligible for the Medicare Part B-ID MCSP programs.
E. Benefit Effective Date
The benefit effective date for coverage is the first day of the application month or the first day of any of the 3 retroactive months in which the individual meets all the requirements for SLMB. See 705-1 to determine the retroactive period. Always review eligibility for the retroactive months.
F. Benefit Effective Date for Medicare Part B-ID MCSP
The effective date for SLMB coverage is the first of the month of the application month. There is no retroactive coverage.