How Do I Qualify for a Medicare Savings Program?

Medicare offers several savings programs for people with lower retirement income. These programs may make it easier to get good healthcare as you grow older. They’re run by Medicaid in the state where you live.

How do I know if I qualify for a Medicare savings program?

These four Medicare savings programs are funded by the federal government but operated by Medicaid in each state:

• Qualified Medicare Beneficiary (QMB) program
• Specified Low-Income Medicare Beneficiary (SLMB) program
• Qualifying Individual (QI) program
• Qualified Disabled and Working Individual (QDWI) program

Income requirements for Medicare savings programs

Medicare savings program	Individual monthly income limit	Married couple monthly income limit	Individual resource limit	Married couple resource limit	Helps you pay
QMB	$1,084	$1,457	$7,860	$11,800	Part A premiums, Part B premiums, deductibles, copays, coinsurance
SLMB	$1,296	$1,744	$7,860	$11,800	Part B premiums
QI	$1,456	$1,960	$7,860	$11,800	Part B premiums
QDWI	$4,339	$5,833	$4,000	$6,000	Part A premiums

Other facts to know about the savings programs

• Healthcare providers may not bill you. If you are in the QMB program, your healthcare providers aren’t allowed to bill you for the care you receive — Medicaid will pay them directly. If you are wrongly billed for a healthcare service, make sure the doctor knows you’re in the QMB program. Then, contact Medicare to let them know you’re being billed for the service.
• You must qualify. To qualify for the QDWI program, you must be disabled, working, and under 65 years old. If you went back to work and lost your premium-free Medicare Part A coverage, and if you’re not getting medical help from your state right now, you may be eligible for the QDWI program.
• You must enroll each year. If you’re enrolled in Medicaid, you won’t be able to get QI benefits. If you apply for the QI program and you’re accepted, you’ll need to reapply every year.
• There may be a delay before benefits begin. Once you’re accepted, it can take a couple of months before Medicaid begins paying your premiums. Medicaid will reimburse you for any premium payments you made while Medicaid was supposed to be paying.

Extra Help with prescription drugs

If you qualify for the QMB, SLMB, or QI programs, you’ll automatically be enrolled in the Extra Help program, too. This program will help you pay all the premiums, deductibles, and coinsurance for a Medicare Part D prescription drug plan.

If you have Extra Help, you’ll always pay either your Extra Help copay or your Part D cost for your prescriptions, whichever is less.

It’s possible to get partial support from Extra Help. People with partial Extra Help pay lower premiums, deductibles, and copays. Plus, they pay just 15 percent of the cost of prescription medications until they meet their annual out-of-pocket limit.

Medicare Part D plans are offered by private insurance companies. Each insurer will have different requirements for which documents you need to provide to show your eligibility.

Some examples of the kinds of documentation you might be asked to provide include:

• notice from Medicare saying you’re qualified (purple)
• Extra Help notice of award from Social Security
• Medicare automatic enrollment notice (green/yellow)
• notice from Medicare about a change in your copay (orange)
• proof that you have Medicaid

For a list of documents your plan can accept as proof of your eligibility, visit the Medicare website.

What does Medicare consider my resources?

For the purpose of determining your eligibility for these savings programs, Medicare considers your resources to include money you have in checking or savings accounts, stocks, and bonds.

Resources do not include your home, one car, any burial plots, your household furnishings, personal belongings like your clothes and jewelry, or up to $1,500 for burial expenses.

If I think I might be eligible, how do I apply for these programs?

If you’re eligible for Medicare and your income and resources are at or below the limit for a Medicare savings program, you can apply by contacting the Medicaid office in your state.

You should receive an update on the status of your application within 45 days. If Medicaid denies your application, you may be able to file an appeal.

Are there other ways I can lower my healthcare Medicare costs?

Medigap (Medicare supplement)

Medigap plans are private insurance policies that help you pay your Medicare costs, including copays, coinsurance, and deductibles. You can choose from among 10 plans, and each plan offers the same coverage nationwide.

Starting in 2020, though, you won’t be able to enroll in a Medigap plan that pays your Part B premiums as a new enrollee. To take a look at the different costs and coverage options, you can use Medicare’s plan compare tool.

Medicaid

This program is a health safety net jointly run by federal and state agencies. It offers the same services as Medicare, plus some additional benefits like nursing home care and personal care.

PACE

The Program for All-inclusive Care for the Elderly (PACE) can get you the medical care you need at a PACE center in your area, in your home, or in your community, so you don’t have to go to a nursing home.

Here are just a few of the services PACE beneficiaries may receive:

• adult day care
• dentistry
• home care
• hospital care
• lab work
• physical or occupational therapy
• social work counseling
• meals
• medical specialty services