4 Types of Medicare Savings Programs and What They Cover

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