4 Types of Medicare Savings Programs and What They Cover

Published by: Medicare Made Clear

Medicare Savings Programs (MSP) are programs that help pay Medicare premiums and, in some cases, some of your out-of-pocket expenses like your Part A and Part B deductibles, coinsurance, copayments, and prescription drugs. These programs are also sometimes known as Medicare Buy-In Programs or Medicare Premium Payment Programs.

 

There are four types of Medicare Savings Programs. Depending on your individual circumstances, you may qualify for one or more of the following programs. But before we go any further, let’s quickly look at the three overall questions you must answer “Yes” to before even being eligible to explore a Medicare Savings Program.

 

 

You Must Meet the Following Qualifications Before Applying for Medicare Savings Programs

 

You can reach out to apply for a Medicare Savings Program with your state’s Medicaid office if all the following are true for you.

 

  • You have or are eligible for Medicare Part A
  • You do not exceed the maximum income requirements (see table below)
  • You do not exceed the maximum limited resources requirements (see table below)

 

Now, let’s look at the four types of Medicare Savings Programs and what each pays for and then the specific financial eligibility conditions for each.

 

 

Qualified Medicare Beneficiary Program (QMB):

 

  • Helps pay for Medicare Part A and Part B premiums, deductibles, coinsurance and copayments.
  • In this program, you can’t be billed for services and items Medicare covers, except outpatient prescription drugs.
  • Apply to this program if you are within the income and resource limit amounts (see table below)

 

 

Specified Low-Income Medicare Beneficiary Program (SLMB):

 

  • State program that helps pay for Part B premiums.
  • Apply to this program if you are within the income and resource limit amounts (see table below) and have Part A.

 

 

Qualifying Individual Program (QI):

 

  • State program that helps pay for Part B premiums.
  • You must apply every year for QI benefits, and applications are granted on a first-come, first-serve basis.
  • People who qualify for Medicaid may NOT get QI benefits.
  • Apply to this program if you are within the income and resource limit amounts (see table below) and have Part A.

 

 

Qualified Disabled and Working Individuals Program:

 

  • Covers Medicare Part A premiums only.
  • To qualify for this program:
    • You're a working disabled person under 65
    • You lost your premium-free Part A when you went back to work
    • You aren't getting medical assistance from your state
    • You meet the income and resource limits required by your state
  •  

 

Important Note If You Qualify for QMB, SLMB or QI Programs

 

If you qualify for one of the first three programs (QMB, SLMB, or QI) you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.

 

 

Qualified Disabled and Working Individuals Program:

 

  • Covers Medicare Part A premiums only.
  • Apply to this program if you meet the income and resource limits (see table below) and if any of the following apply to you:
    • You’re a working disabled person under 65
    • You lost your premium-free Part A when you went back to work
    • You aren’t getting medical assistance from your state
    • You are within the income and resource limit amounts (see table below)

 

 

Medicare Savings Program Income and Resource Limits

 

The below table shows the different income limits and resource limits for both individuals and married couples for 2020 for each of the four Medicare Savings Programs.

 

 

2020 Individual and Married Couple Income and Resource Limits

 

2020 Income and Resource Limits Qualified Medicare Beneficiary (QMB) Program Specified Low-Income Medicare Beneficiary (SLMB) Program Qualifying Individual (QI) Program Qualified Disabled and Working Individuals (QDWI) Program

Individual Monthly Income

$1,084

$1,296

$1,456

$4,339

Married Couple monthly income

$1,457*

$1,744*

$1,960*

$5,833

Individual Resources

$7,860

$7,860

$7,860

$4,000

Married Couple Resources

$11,800

$11,800

$11,800

$6,000

*limits are slightly higher in Alaska and Hawaii

Source: Medicare.gov

 

 

Income is pretty straight forward, but for how your resources are valued, please see the below for what may or may be “countable.”

 

Countable resources include:

 

  • Money in a checking or savings account
  • Stocks
  • Bonds

 

Countable resources don’t include:

 

  • Your home
  • One car, motorcycle or motorhome (additional vehicles count as assets)
  • Burial plot
  • Up to $1,500 for burial expenses if you have put that money aside
  • Furniture
  • Other household and personal items

 

 

It Never Hurts to Apply Anyways

 

If you think you may not qualify or quite meet the limits above, it can’t hurt to still try to apply. The program will let you know if you do or don’t get accepted, but sometimes income and resource limits change. Furthermore, if you live in Alaska or Hawaii, the limits listed in the table above will be higher for you.

 

 

Source for all above information and 2020 financial limitations: https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs

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