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What is a Medicare Savings Program?

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Question: What is a Medicare Savings Program?

Answer: A Medicare Savings Program (MSP) is one of four different Medicaid programs (QMB, SLMB, QI, QDWI) available for people with limited financial resources and, depending on a person's income and assets, Medicare Savings Programs may pay monthly Medicare Part A premiums (for in-patient and hospital coverage) , as well as Medicare Part B (out-patient and medical coverage) premiums, deductibles, coinsurance, and co-payments.

Medicare Savings Programs and Medicare Part D Extra Help

A Medicare beneficiary who qualifies for either the QMB, SLMB, or QI program will automatically qualify for the Medicare Part D Extra Help program that provides financial assistance with Medicare Part D prescription drug coverage (premiums and drug costs).

Bottom line: If you qualify for a MSP, you could save a substantial amount of money on Medicare Part A, Medicare Part B, and Medicare Part D prescription drug coverage.

The four Medicare Savings Programs include:

Limits *
Qualified Medicare Beneficiary (QMB) Program 100% of FPL
QMB helps pay Medicare Part A premiums, Medicare Part B premiums, deductibles, coinsurance, and co-payments 
Specified Low-Income Medicare Beneficiary (SLMB) Program
100-120% of FPL
SLMB helps pay Medicare Part B premiums
Qualifying Individual (QI) Program 120-135% of FPL QI helps pay Medicare Part B premiums
Qualified Disabled and Working Individuals (QDWI) Program under 200% of FPL  QDWI helps pay Medicare Part A premiums

(* The FPL is the Federal Poverty Level and some portions of your income may not count toward reaching the income level - for instance, the first $20 of your monthly income).

Your assets or financial resources that are included to determine whether you qualify for a Medicare Savings Program include any money in your checking or savings account and investments (such as, stocks and bonds).

However, when determining whether you are qualified for a MSP, your total assets or resources will not include: your primary home, primary car, burial plot, minimal burial expenses ($1,500), furniture and other household / personal items.

Please remember that asset or resource levels needed to qualify for a Medicare Savings Programs can (and usually do) change each year.  For instance, as of May 2016, the resource or asset level for the MSPs are approximately:
  • QMB: Individual resource limit $7,280 and Married couple resource limit $10,930
  • SLMB: Individual resource limit $7,280 and Married couple resource limit $10,930
  • QI: Individual resource limit $7,280 and Married couple resource limit $10,930
  • QDWI: Individual resource limit $4,000 and Married couple resource limit $6,000 (Qualifying for QDWI also includes several other criteria: You must be under 65 and disabled, you do no longer have premium-free Medicare Part A when you went back to work, you are ineligible for your state Medicaid or medical assistance program.)
Applying for a Medicare Savings Program

To apply for a MSP, please contact your local state Medicaid office or State Health Insurance Program (SHIP) for more details and information on qualifying and applying for a MSP.

You may find that, even if your income or resources exceed the example limits stated above, you may still qualify for a MSP based on your state's specific rules (and Alaska and Hawaii usually have higher financial qualification limits).

(primary source: Medicare.gov)

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