What Are Medicare Savings Programs, and How Do I Qualify?

Fri, Aug 27, 2021 6:03 PM Medicare

Medicare Savings Programs (MSPs) are financial assistance programs that help you pay for your Medicare premiums and, in some situations, some of your out-of-pocket expenses such as Part A and Part B deductibles, coinsurance, copayments, and prescription medicines. Medicare Buy-In Systems or Medicare Premium Payment Programs are other names for these programs.

Medicare Savings Programs are divided into four categories. You may be eligible for one or more of the following programs, depending on your specific circumstances. But first, let's take a short look at the three general questions you must answer "Yes" to before you can even consider a Medicare Savings Program.

 

Before applying for Medicare Savings Programs, you must meet the following requirements

 

If all of the following apply to you, you can contact your state's Medicaid office to apply for a Medicare Savings Program.

 

• You don't go beyond the limit of your limited resources (see table below)

• You do not earn more than the maximum amount allowed (see table below)

• You have Medicare Part A or are eligible for it.

 

Let's take a look at the four different types of Medicare Savings Programs, what they pay for, and the financial eligibility requirements for each.

 

(QMB) Qualified Medicare Beneficiary Program

 

• Assists with premiums, deductibles, coinsurance, and copayments for Medicare Part A and Medicare Part B.

• Except for outpatient prescription medicines, you cannot be billed for services and commodities covered by Medicare under this program.

• Only apply if your income and resources are within the program's limits (see table below)

 

(SLMB) Specified Low-Income Medicare Beneficiary Program

 

• If you meet the income and resource limits (see table below) and have Part A, you can apply for this program.

• A state-funded program that assists with the payment of Part B premiums.

 

(QI) Qualifying Individual Program

 

• People who are eligible for Medicaid may not be eligible for QI benefits.

• If you meet the income and resource limits (see table below) and have Part A, you can apply for this program.

• A state-funded program that assists with the payment of Part B premiums.

• You must apply for QI benefits every year, and they are given out on a first-come, first-served basis.

 

Qualified Disabled and Working Individuals Program:

 

• Only pays for Medicare Part A premiums.

 

To be eligible for this program, you must:

 

• You meet your state's income and resource requirements.

• You're a disabled worker under the age of 65.

• When you returned to work, you lost your premium-free Part A.

• Your state does not provide medical assistance to you.

 

Important Information if you are eligible for the QMB, SLMB, or QI programs

 

You automatically qualify for Medicare Extra Help paying for Medicare prescription drug coverage if you qualify for one of the first three programs (QMB, SLMB, or QI). Important Information if you are eligible for the QMB, SLMB, or QI programs

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

 

Qualified Disabled and Working Individuals Program

 

• Only pays for Medicare Part A premiums.

• You are eligible for this program if you fulfill the income and resource limits (see table below) and if you match any of the following criteria:

• Your state does not provide medical aid to you.

• Your income and resource limits are both met (see table below)

• You're a disabled worker under the age of 65.

• When you returned to work, you lost your premium-free Part A.

 

Medicare Savings Program Income and Resource Limits

 

For each of the four Medicare Savings Programs, the table below displays the varied income and resource limits for individuals and married couples in 2021.

 

2021 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

 

 

Income is rather straightforward, but for information on how your resources are valued, read the list below for what is and is not “countable.”

 

Resources that can be counted include:

 

• Shares/Stocks

• Investments in bonds

• Cash in a bank account or a savings account

 

The following items are not countable resources:

 

• Up to $1,500 for burial costs if you have set up that amount.

• Home furnishings

• Other personal and home goods

• Your home

• A single-car, motorcycle, or motorhome (additional vehicles count as assets)

• Burial plot

 

Also Read: How To Qualify For Medicare Savings Programs?

 

It's never a bad idea to apply anyway

 

 

It's not a bad idea to apply even if you don't think you'll qualify or satisfy the requirements. The program will notify you if you are accepted or not, but income and resource constraints can alter at any time.  

 

 

 

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