Medicare Savings Programs are a resource offered through state Medicaid programs to help Medicare beneficiaries with the costs of Medicare Parts A and B. There are four types of Medicare Savings Programs with different eligibility requirements and varying levels of assistance. The Medicare Savings Programs will still work if you have additional Medicare coverage like a Part C (Medicare Advantage) Plan, Part D Prescription Plan, or Medicare Supplement Plan (Medigap).
These programs pay directly for Medicare costs like premiums, deductibles, or copayments. They are not programs you have to pay into, like a Health Savings Account (HSA) or a Flexible Spending Account (FSA).
Many individuals who qualify for a Medicare Savings Program also automatically qualify for Extra Help, a program that assists with the costs of prescription drug coverage. You will probably be enrolled when your Medicare Savings Program application goes through, but if you have any questions about Extra Help, you can contact the Social Security Administration.
Types of Medicare Savings Programs
Qualified Medicare Beneficiary (QMB) Program: covers Medicare Part A and B premiums, deductibles, copayments, and coinsurance.
Specified Low-Income Medicare Beneficiary (SLMB) Program: pays Medicare Part B premiums.
Qualifying Individual (QI) Program: pays Medicare Part B premiums. Medicaid recipients are not eligible for the Qualifying Individual Program. You must apply for QI benefits each year and they are granted on a first-come first-served basis, with priority given to the previous year’s QI recipients.
Qualified Disabled and Working Individuals (QDWI) Program: helps pay Medicare Part A premiums and is available if you were previously receiving Medicare coverage with your disability benefits, but have now returned to work and lost your disability coverage.
Income & Resource Limits
Each Medicare Savings Program determines eligibility based on your income and resources. The exact amount for these limits can change every year, but the top monthly income amount for an individual is usually in the range of $1,000 – $1,700. Income limits for couples are listed separately. If you receive income from working, you may still be eligible at an amount higher than the listed limit.
The resource limit is based on your assets, including money in the bank, investment accounts, real estate, and stocks all count against your resource limit. However, a lot of household resources don’t count toward your resource limit.
The following resources do not count toward your resource limit:
- Your home
- Your car (1)
- Household items
- A burial plot
If you qualify for a Medicare Savings Program, it’s important to obtain all of the information regarding how to stay eligible and what may affect your eligibility status.
Applying for a Medicare Savings Program
You can apply for a Medicare Savings Program through your state’s Medicaid office. You will probably be able to find the application online, but if you’re having trouble, you can call in for help. We recommend applying even if you’re not certain whether you’re eligible. The exact details of how income and resources are calculated can get complicated; it’s better to apply than potentially miss out on assistance you could be receiving.
For your Medicare Savings Program application, you will need more paperwork than applying for a Medicare plan. Gathering these items before you call or fill out the application is a good idea:
- Social Security Card
- Medicare card
- Investment statements
- Tax returns and Life insurance policies
- Payroll slips and Pension letters
- Recent balance statements from banks, credit unions etc.
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
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