Medicare Savings Programs: Lower Your Healthcare Costs
If you have Medicare but struggle with premiums, deductibles, and copays, Medicare Savings Programs can help. These state-run programs pay some or all of your Medicare costs.
Types of Programs
- QMB: Pays Part A & B premiums plus deductibles and copays
- SLMB: Pays Part B premium
- QI: Pays Part B premium for slightly higher income levels
- QDWI: Pays Part A premium for disabled workers
Who Qualifies?
Income and asset limits vary by program and state. Generally, you may qualify with income up to about 135% of poverty level. Qualifying for a Medicare Savings Program also automatically qualifies you for Extra Help with prescription drug costs.
How to Apply
Contact your state Medicaid office or your local State Health Insurance Assistance Program (SHIP) for help applying. You can find your SHIP at ShipHelp.org.
Four Medicare Savings Programs Explained
Medicare Savings Programs are state-administered programs funded jointly by the federal and state governments that help people with limited income and resources pay for Medicare costs. There are four distinct programs, each with different income limits and benefits. The Qualified Medicare Beneficiary program, known as QMB, covers the Part A premium, the Part B premium, and all deductibles, coinsurance, and copayments. This is the most comprehensive of the four programs and is available to individuals with incomes at or below 100 percent of the federal poverty level.
The Specified Low-Income Medicare Beneficiary program, or SLMB, covers only the Part B premium and is available to individuals with incomes between 100 and 120 percent of the poverty level. The Qualifying Individual program, known as QI, also covers the Part B premium and serves individuals with incomes between 120 and 135 percent of the poverty level. Finally, the Qualified Disabled and Working Individuals program, or QDWI, pays the Part A premium for disabled individuals who lost their premium-free Part A benefits when they returned to work.
Income and Resource Limits
Each Medicare Savings Program has its own income and resource limits, which are updated annually. Income limits are based on the federal poverty level and vary depending on whether you are an individual or a couple. Resource limits, which include savings accounts, stocks, and bonds but generally exclude your home and one vehicle, are set by each state. Some states have eliminated the resource test entirely, making it easier for people to qualify based on income alone.
When calculating income for MSP eligibility, certain deductions and exclusions may apply. For example, some states disregard a portion of earned income or do not count certain types of irregular income. This means your countable income for MSP purposes may be lower than your gross income. It is always worth applying even if you think your income is slightly above the limit, because the exclusions and deductions could bring you within the eligible range.
How to Apply
You can apply for a Medicare Savings Program through your state Medicaid office. Applications are available online, by mail, or in person in most states. You will need to provide proof of identity, proof of Medicare enrollment, income documentation such as Social Security benefit statements or pay stubs, and information about your financial resources. Processing times vary by state, but most applications are reviewed within 30 to 45 days.
An important benefit of enrolling in a Medicare Savings Program is that you are automatically entitled to Extra Help, also known as the Low-Income Subsidy, which significantly reduces the cost of Medicare Part D prescription drug coverage. Extra Help can save you thousands of dollars per year on premiums, deductibles, and copayments for medications. Your local State Health Insurance Assistance Program, known as SHIP, can provide free one-on-one counseling to help you understand your options and complete the application process. Find your SHIP at shiphelp.org or by calling 1-877-839-2675.
Four Medicare Savings Programs Explained
Medicare Savings Programs are state-administered programs funded jointly by the federal and state governments that help people with limited income and resources pay for Medicare costs. There are four distinct programs, each with different income limits and benefits. The Qualified Medicare Beneficiary program, known as QMB, covers the Part A premium, the Part B premium, and all deductibles, coinsurance, and copayments. This is the most comprehensive of the four programs and is available to individuals with incomes at or below 100 percent of the federal poverty level.
The Specified Low-Income Medicare Beneficiary program, or SLMB, covers only the Part B premium and is available to individuals with incomes between 100 and 120 percent of the poverty level. The Qualifying Individual program, known as QI, also covers the Part B premium and serves individuals with incomes between 120 and 135 percent of the poverty level. Finally, the Qualified Disabled and Working Individuals program, or QDWI, pays the Part A premium for disabled individuals who lost their premium-free Part A benefits when they returned to work.
Income and Resource Limits
Each Medicare Savings Program has its own income and resource limits, which are updated annually. Income limits are based on the federal poverty level and vary depending on whether you are an individual or a couple. Resource limits, which include savings accounts, stocks, and bonds but generally exclude your home and one vehicle, are set by each state. Some states have eliminated the resource test entirely, making it easier for people to qualify based on income alone.
When calculating income for MSP eligibility, certain deductions and exclusions may apply. For example, some states disregard a portion of earned income or do not count certain types of irregular income. This means your countable income for MSP purposes may be lower than your gross income. It is always worth applying even if you think your income is slightly above the limit, because the exclusions and deductions could bring you within the eligible range.
How to Apply
You can apply for a Medicare Savings Program through your state Medicaid office. Applications are available online, by mail, or in person in most states. You will need to provide proof of identity, proof of Medicare enrollment, income documentation such as Social Security benefit statements or pay stubs, and information about your financial resources. Processing times vary by state, but most applications are reviewed within 30 to 45 days.
An important benefit of enrolling in a Medicare Savings Program is that you are automatically entitled to Extra Help, also known as the Low-Income Subsidy, which significantly reduces the cost of Medicare Part D prescription drug coverage. Extra Help can save you thousands of dollars per year on premiums, deductibles, and copayments for medications. Your local State Health Insurance Assistance Program, known as SHIP, can provide free one-on-one counseling to help you understand your options and complete the application process. Find your SHIP at shiphelp.org or by calling 1-877-839-2675.
