Medicare Savings Programs
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Medicare Savings Programs: Getting Help with Medicare Costs
- What are Medicare Savings Programs?
- Medicare Savings Programs - How can I qualify?
- Medicare Savings Programs - Qualified Medicare Beneficiary (QMB) program
What are Medicare Savings Programs?
Medicare Savings Programs help low-income individuals with some of the out-of-pocket costs for Medicare, including Medicare Part A and Part B premiums, deductibles, copayments, and coinsurance. Eligibility for certain Medicare Savings Programs automatically qualifies you for the Extra Help program as well, which helps beneficiaries with the cost of prescription drugs.
There are four types of Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individuals (QDWI) Program.
Benefits vary for each program, but all of them, with the exception of the QDWI Program, help pay for Medicare Part B premiums.
Medicare Savings Programs – How can I qualify?
To qualify, you must have or be eligible for Medicare Part A and have income and resources below a certain threshold. The income and resource requirements are different for each of the four Medicare Savings Programs and may change from year to year.
The following resources are counted when determining eligibility:
- Checking accounts
- Savings accounts
- Mutual funds
- Individual Retirement Accounts (IRAs)
The following resources are not counted when determining eligibility:
- Your home
- One car
- Burial plot
- Burial expenses (Up to $1,500, provided you have set aside that money)
- Household items
- Personal items
Because the programs are run by state Medicaid programs, some states may calculate income and assets differently, meaning you may be eligible even if your income and resources are above the listed limits. To see if you are eligible for a Medicare Savings Program, contact your state’s Medicaid office or State Health Insurance Assistance Program (SHIP).
To apply for the Medicare Savings Program, visit your local Medicaid office or check the Medicare website for a list of contact information.
The four types of Medicare Savings Programs are outlined below.
Medicare Savings Programs – Qualified Medicare Beneficiary (QMB) program
The Qualified Medicare Beneficiary (QMB) is a Medicare Savings Program that pays for the Medicare Part A (hospital insurance) premium and the Medicare Part B (medical insurance) premium. The program also pays Medicare cost-sharing expenses, including deductibles, coinsurance, and copayments.
If you qualify for QMB, you automatically qualify for the Extra Help prescription drug program to save on out-of-pocket expenses for your medications.
You must be eligible for or currently enrolled in Medicare Part A to apply for the QMB Medicare Savings Program.
This program uses the low-income subsidy asset test to determine eligibility. This amount may change each year. For the most up-to-date requirements, contact Medicare for more information at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week; for TTY assistance, call 1-877-486-2048.
Liquid assets that are taken into consideration include checking and savings accounts, stocks, and bonds. Items that aren’t counted when determining eligibility include your home, one car, personal items, and up to $1,500 in burial expenses (provided that you’ve set aside money for that purpose).
Medicare Savings Programs – Specified Low-Income Medicare Beneficiary (SLMB) Program
Those who earn a little more than the maximum QMB income requirement may qualify for the Specified Low-Income Medicare Beneficiary (SLMB) Program, which helps pay for Medicare Part B premiums. This Medicare Savings Program does not pay other cost-sharing expenses or Medicare Part A premiums, but it does allow you to have a higher income. Like QMB, if you qualify for the SLMB Program, you automatically qualify for the Extra Help prescription drug program as well.
Similar to the QMB program, you must meet income and asset requirements to be eligible. Eligibility criteria may change from year to year. . For the most up-to-date requirements, contact Medicare for more information at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week; for TTY assistance, call 1-877-486-2048.
Medicare Savings Programs – Qualifying Individual (QI) Program
The Qualifying Individual (QI) Program is another level of the Medicare Savings Program. If you don’t qualify for QMB or SLMB, you might try applying for the QI Medicare Savings Program instead. This program pays for Medicare Part B premiums and automatically qualifies you for the Extra Help prescription drug program. Be aware that you must reapply each year for these benefits. Also, program funding is limited, so benefits are available on a first-come, first-served basis, and priority is given to individuals who received QI benefits the previous year. If you qualify for Medicaid, you cannot receive QI benefits.
Medicare Savings Programs – Qualified Disabled and Working Individuals (QDWI) Program
The Qualified Disabled and Working Individuals (QDWI) Program is different from the other three Medicare Savings Programs. Unlike the other programs, QDWI only pays for Medicare Part A premiums. You may qualify for this program if any of the following apply:
- You returned to work and, as a result, lost your premium-free Medicare Part A coverage.
- You’re disabled, under 65, and currently working.
- You aren’t currently getting state medical assistance.
- You meet the income and resource requirements for your state.
Like all Medicare Savings Programs, the income and asset requirements for the QDWI program may change from year to year. To find out if you qualify, contact Medicare for more information (1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week; for TTY assistance, call 1-877-486-2048.).
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Medicare Part A
Part A of Medicare covers hospitalisation. Inpatient treatment, limited time in a licenced nursing facility, limited home health care services, and hospital care are all covered under Part A.
Medicare Part B
Non-hospital medical costs such as doctor's appointments, blood tests, x-rays, diabetes testing and supplies, and outpatient hospital treatment are covered by Part B benefits. For this component of the original health insurance, you pay a monthly fee.
Medicare Part C
In a health insurance plan, Medicare Advantage or Medicare Part C normally covers all forms of health insurance coverage. Private insurance businesses that have been contracted by the CMS to provide a medicare plan as an alternative to the original health insurance plan provide it.
Medicare Part D
Medicare Part D is a prescription medication coverage option. Part D health insurance is available as a stand-alone plan from private insurance firms, with monthly rates varying from one to the next. Depending on the plan you're registered in, you'll split the cost of your prescription medicines.
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- Initial Enrollment Period – Most persons can enrol in Medicare Part A, Part B, Part C, and/or Part D for the first time within a seven-month period: three months before, three months during, and three months after they reach 65.
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