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
2020 Income and Resource Limits
Individual Monthly Income
Married Couple monthly income
Individual Resources
Married Couple Resources
Qualified Medicare Beneficiary (QMB) Program
$1,084
$1,457*
$7,860
$11,800
Specified Low-Income Medicare Beneficiary (SLMB) Program
$1,296
$1,744*
$7,860
$11,800
Qualifying Individual (QI) Program
$1,456
$1,960*
$7,860
$11,800
Qualified Disabled and Working Individuals (QDWI) Program
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.
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