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Browse the Medicare Part D "Medicaid & Extra Help & LIS" FAQs
If you still have questions, please contact us through our Online Help Desk.


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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:

MSP
Income
Limits *
 Benefit
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 135% 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, in 2015, 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.

Important:
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.

(primary source: Medicare.gov)

: : 2015 PDP-Finder - Medicare Part D Plan Finder
The 2015 PDP-Finder displays Medicare Part D plan information, including plan premium, deductible, type of gap coverage and if the plan qualifies for the $0 premium for those persons with a low income subsidy (LIS).

: : Sign-up for email reminders when the 2016 Medicare plan information is available.
: : Sign-up for our Medicare Part D Newsletter.
: : Still have a question? Click here to let us know.

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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.


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