What is the Qualifying Individual Program?
The Qualifying Individual Program (QI) is one of four Medicare Savings Programs. These programs assist low-income individuals with the costs of Medicare. Medicare Savings Programs are run through each state’s Medicaid program, although Medicaid eligibility is not a requirement for all Medicare Savings Programs.
Who is Eligible for the Qualifying Individual Program?
Medicare beneficiaries who meet certain income and resource limits are eligible for QI. The eligibility limits can change every year, but around $2000 or less monthly income should be near the eligibility limit, depending on the year, your resident state, whether you’re working, and whether you’re filing as an individual or married couple.
If you qualify for Medicaid, you are not eligible for the Qualifying Individual Program; you are probably eligible for a different Medicare Savings Program.
Automatic Qualification for
If you qualify for the QI Program, you will also automatically qualify for Extra Help, a program that assists with prescription drug costs. Extra Help may pay your Prescription Drug Plan premium and deductible, as well as set a maximum cost for each prescription, usually between $4-10, depending on whether they are generic or name-brand prescriptions.
Extra Help is run through the Social Security Administration.
Qualifying Individual Example Scenario
You have Medicare Parts A and B, plus a Part D prescription drug plan. You don’t pay a premium for Part A, but you do have premiums for Parts B and D. While on the Qualifying Individual Program:
· You do not pay a monthly Part B premium
· You do not pay a monthly Part D premium
· You continue to pay your usual deductibles, copay, and coinsurance
· You pay less for your prescriptions, just around $4 for the generic ones and around $10 for the name-brand prescriptions
What About Medicare Advantage Plans?
The Qualifying Individual Program works with Medicare Advantage (Part C) Plans as well. Because you continue to pay your Part B premium while enrolled in a Part C Plan, that cost will be covered while you are in the QI Program. The savings on prescription drugs will also carry over to a Medicare Advantage Prescription Drug Plan (MAPD).
If you pay a premium for your Part C Plan, you will continue to pay that while in the QI Program, as well as your usual deductibles, coinsurance, and copays, other than the ones related to prescription drug coverage.
How Do I Enroll in the Qualifying Individual Program?
To apply for the Qualifying Individual Program, contact your state’s Medicaid offices. It’s worth applying for the program even if you think you may not qualify. Due to differences in eligibility by state—based on your income, savings, properties, and your working situation—calculating your own eligibility can be difficult.
You must apply every year for the Qualifying Individual Program and acceptance is granted on a first-come first-served basis, prioritizing those who received QI benefits the previous year. You can always apply again if you haven’t been accepted in a previous year.
Frequently Asked Questions
The QI program covers Medicare Part B premiums.
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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