Medicare is a federal program that provides medical and health insurance to people who are 65 or older, certain disabled individuals of any age, and those with end-stage renal disease. There are several Medicare Savings Programs available for eligible Medicare recipients. These programs can help you reduce your out-of-pocket expenses during Medicare coverage periods.
This article will talk about the four Medicare Savings Programs involved in Medicare, what each has to offer, and who is eligible for them.
What is the Social Security Medicare Savings Program?
Medicare Savings Programs (MSP) are federally funded programs that are administered by individual states. They may be utilized by individuals with restricted income and resources to assist in paying some or all of their Medicare premiums, deductibles, copayments, and coinsurance.
Let’s discuss each of the four programs in more detail.
1. Qualified Medicare Beneficiary (QMB) Program
The Qualified Medicare Beneficiary program pays for Medicare Part A and B premiums and deductibles, as well as any copayments, except on prescription medications. According to the Centers for Medicare and Medicaid Services (CMS), one out of eight people enrolled in Medicare were also in the QMB program as of 2017. That makes a total of 7.5 million people.
Rules outlined in the QMB program forbid Medicare providers from billing QMB enrollees for Medicare cost-sharing. These enrollees are not obligated to pay the deductibles, coinsurance, or copays associated with Original Medicare. This does not apply to services that are not covered by Medicare.
Errors in billing QMB program members are frequent. To help prevent these errors, members should be sure to show their QMB card each time they receive care. You may also issue them a copy of your Medicare Summary Notice (MSN) which shows that you are in the program and should not be billed. If you need a copy of this yourself, you can access it under your MyMedicare.gov account.
If your provider continues to bill you or involves a collection agency, you can call Medicare directly at 1-800-633-4227) and inform them of the situation. They will be able to contact your provider or collection agency to resolve the issue. If you have already paid for services that you should not have paid for, you will be issued a refund from your provider.
Those who qualify for this program automatically qualify for Extra Help for prescription drug coverage.
QMB Eligibility Requirements
Eligibility requirements may change each year, but as of 2021, these are the requirements:
- An individual monthly income maximum of $1094
- A married couple monthly income maximum of $1472
- An individual resource maximum of $7970
- A married couple resource maximum of $11,960
2. Specified Low-Income Medicare Beneficiary (SLMB)
The Specified Low-Income Medicare Beneficiary program does not offer as much assistance as the QMB program. The SLMB pays for the Medicare Part B premiums only.
Those who qualify for this program automatically qualify for Extra Help for prescription drug coverage.
SLMB Eligibility Requirements
Eligibility requirements may change each year, but as of 2021, these are the requirements:
- An individual monthly income maximum of $1308
- A married couple monthly income maximum of $1762
- An individual resource maximum of $7970
- A married couple resource maximum of $11,960
3. Qualified Individual (QI-1) Program
The Qualified Individual program is similar to the SLMB program in that it also pays for the Medicare Part B premium. Members in this program must reapply every year, and applications are approved on a first-come, first-served basis. Priority is given to those who were in the QI-1 program the prior year. Those who receive Medicaid benefits are not eligible for this program.
Those who qualify for this program automatically qualify for Extra Help for prescription drug coverage.
QI-1 Eligibility Requirements
Eligibility requirements may change each year, but as of 2021, these are the requirements:
- An individual monthly income maximum of $1469
- A married couple monthly income maximum of $1980
- An individual resource maximum of $7970
- A married couple resource maximum of $11,960
4. Qualified Disabled Working Individual (QDWI) Program
The Qualified Disabled Working Individual program pays for the Medicare Part A premium.
QDWI Eligibility Requirements
There are more requirements to apply for this program. Eligibility requirements may change each year, but as of 2021, these are the requirements.
First, one of the following must apply to you:
- You are under 65, disabled, and working;
- You no longer have Social Security disability benefits or Medicare Part A because you are now working; OR
- You are not receiving state medical assistance.
In addition to those requirements, you must not exceed any of the following:
- An individual monthly income maximum of $4379
- A married couple monthly income maximum of $5892
- An individual resource maximum of $4000
- A married couple resource maximum of $6000
If you need help deciding if you qualify for one of these programs, ask yourself these questions:
- Are you enrolled in Medicare Part A, or are you eligible to enroll?
- Is your current income below any of those listed above as program eligibility requirements?
- Do your resources fall below the maximums listed above?
You may contact your state’s Medicaid program if you need help determining your eligibility. Your state department can also assist you in filing your application.