Medicare Savings Programs, or MSPs, can help Medicare beneficiaries save money on out-of-pocket expenses. Four different savings programs are available, and each one has slightly different eligibility criteria.
These programs are administered by state Medicaid offices. They help pay for Medicare premiums, and some even pay for deductibles, copays, and coinsurance. Since these programs are for low-income individuals, income limits apply to each program.
Keep reading if you think you might qualify for a Medicare savings program. We’ll give you all the details about them, including how they work, how you can be eligible, and what you need to do to apply for these benefit programs.
4 Types Of Medicare Savings Programs
There are four different types of Medicare savings programs for which you might be able to qualify. The rules are standard across all states, although some have slightly different qualifying rules. The reason is that the state Medicaid program offices administer these programs.
Another critical thing to remember is that qualifying for a savings program will automatically qualify you for the Medicare Extra Help program. Not only will you save money on your Medicare Part A and Medicare Part B expenses, but the Extra Help program will also cover most of your prescription drug plan costs. Here are the four savings plans available and what each one covers.
Qualified Medicare Beneficiary (QMB) Program
The Qualified Medicare Beneficiary program provides the highest level of benefit of any savings program. Qualifying individuals in the QMB program will have nearly the entire cost of Medicare paid for. The QMB program covers Medicare premiums (Part A and B), deductibles, copayments, and coinsurance amounts.
Add that to the fact that you also qualify for the Extra Help program, and you would essentially have zero out-of-pocket expenses after you enroll. We will discuss eligibility requirements in more detail in the next section, but the QMB program also has the lowest income limits of the four programs.
Specified Low-Income Medicare Beneficiary (SLMB) Program
The SLMB program is available to seniors on Social Security and adults with disabilities with limited income and who are on Medicare due to Social Security disability enrollment. While this program does not provide as much financial assistance as the QMB program, it can save participants around $2,000 annually.
The SLMB program covers your entire Part B premium, which is $174.70 in 2024. Enrollment in the SLMB program also automatically qualifies you for Extra Help Part D assistance, which can save you thousands more per year.
Qualifying Individual (QI) Program
The QI program is similar to the SLMB program mentioned above. This program also covers your Medicare Part B premium. The significant difference between the programs is that the QI program has slightly higher income limits. However, the QI program is available on a first-come, first-served basis.
It is funded through a block grant to the states, so once the money is gone, no one else can sign up for the program in that particular year. This program helps make available a little more money to help with Medicare expenses for individuals who make too much money to qualify for the SLMB program.
Qualified Disabled And Working Individuals (QDWI) Program
The Qualified Disabled Working Individual, or QDWI program, has the highest monthly income limits of any of the four Medicare savings programs. This program is for individuals under age 65 who have recently returned to work after receiving Social Security disability.
Since they no longer qualify for premium-free Part A coverage, the QDWI program will cover their Part A monthly premium. This program can be very helpful with Medicare costs and allow individuals to use more of their money for other expenses.
KEY TAKEAWAYS
- Medicare Savings Programs (MSPs) help Medicare beneficiaries lower their out-of-pocket costs by paying for Medicare premiums, deductibles, copays, and coinsurance.
- Four programs (QMB, SLMB, QI, and QDWI) are designed to support lower-income households. As such, you must meet strict income level limits to qualify.
- Qualifying for one of these MSPs will also qualify you for the Medicare Extra Help program that assists with prescription drug costs.
Medicare Income Limits For Savings Programs
As previously mentioned, each savings program has slightly different income limits for eligibility. You should also know that not all your income and resources are countable. This means some of your income or resources might be exempt from the calculation. When looking at your resources for eligibility purposes, the following items are countable: money in a checking account, savings account, stocks, and bonds.
However, your home, one car, furniture, household items, a burial plot, and up to $1,500 put aside for burial expenses are not countable toward the resource limit. Here are the limits of each program.
QMB Program
Since the QMB program provides the highest benefits, it also has the lowest income limits. To qualify, you must have an income below 100% of the Federal poverty level (FPL). You should also have resources of less than $9,430 for a single individual or $14,130 for a married couple. There are also monthly income limits that apply. A single individual can have no more than $1,275 in monthly income; that limit is $1,724 if you are married. The limits are slightly higher in Alaska and Hawaii. There is also a $20 monthly disregard for your monthly income. This means that $20 of your monthly income is not counted toward the limit.
SLMB Program
While this program does not offer the same level of medical assistance as the QMB program, the income limits are higher. To qualify for the SLMB program, you must have resources of no more than $9,430 for a single individual or $14,130 for a married couple. The resource limits for the SLMB program and QMB program are the same.
However, to qualify for SLMB, your income must be between 100% and 120% of the Federal poverty level. This means you can make up to $1,478 as a single individual or $1,992 if you are married. Again, Alaska and Hawaii have slightly higher limits. This is because the Medicaid services in those states have somewhat different qualifying rules. Likewise, there is a $20 monthly disregard for monthly income for the SLMB program.
QI Program
You will remember that the benefits provided by the QI program are the same as those offered by the SLMB program. However, the income limits are even higher. The resource limits are $9,430 for a single individual or $14,130 for a married couple. However, you can only earn between 120% and 135% of the federal poverty level to qualify for the QI program. This equates to a monthly income of $1,715 for a single individual or $2,320 for someone married. Alaska and Hawaii again have higher limits, and there is also a $20 monthly income disregard.
QDWI Program
The QDWI program has the highest income limits of the four available savings programs. The rules are set up this way to encourage those on disability receiving Social Security benefits from the Social Security Administration to return to work if possible.
While this program only covers your Medicare Part A premium for Medicare hospital insurance, the income limits are pretty high. Your income must be less than 200% of the Federal poverty level, and your resources must be below $4,000 for an individual or $6,000 for a married couple. Some additional monthly income disregards can almost double the monthly income limit to $5,105 for a single individual or $6,899 for a married person.
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How To Apply For A Medicare Savings Program
Now that you know how each program works, you might wonder how to apply. The process of applying is easy!
- You first need to contact your state Medicaid office.
- You must be enrolled or at least eligible for Medicare Part A.
- You should also ensure that your income and resources are below the limits mentioned in the section above.
If you meet those criteria, your state Medicaid office can help you apply for one of these programs. You should apply even if you are unsure but think you might qualify.
- Acceptance in one of these programs will automatically qualify you for help with your Medicare prescription drug plan or Medicare Part D.
Even if your income is higher than the amounts listed above, your state’s Medicaid office might still be able to help you. It is possible that they could find another program for which you could qualify, or you might be able to disregard some of your income. You could also research Medicare Advantage plans that offer a Medicare Part B Give Back benefit.
TIP
The state Medicaid department administers the Medicare Savings Program, so qualifications can differ slightly in each state. Alaska and Hawaii tend to have income limits that are different from those in the lower 48 states.
The Bottom Line
Medicare savings programs can be a great way to save monthly on your health care costs and have Medicare assist with your health expenses.
These programs cover many things, like monthly premiums, deductibles, copays, and coinsurance amounts. The program you can qualify for depends on your current situation — mostly your monthly income and total resources.
The programs are run through your state’s Medicaid office, so you should contact Medicaid services in your area to start your application today.
Frequently Asked Questions
There is no income or resource limit to enrollment in Medicare. However, if you are trying to qualify for a Medicare savings program, there are limits.
Most Medicare savings plans have resource limits of $9,430 for a single individual or $14,130 for a married couple. If you have more money in the bank than this, you will likely not be able to qualify for a savings program. There are some exceptions to countable resources, but money in the bank is almost always considered a countable resource.
The Medicare savings program helps save you money on your Medicare expenses. These programs will cover things like your monthly premium, deductibles, copays, and coinsurance amounts.
Some programs will cover all those items, while others might only cover your monthly premium. These programs are a great way for low-income individuals to save money on their health care expenses.
You can save your monthly premium amount by qualifying for one of the Medicare savings programs that will cover this cost. This means that you must have limited income and resources to qualify.
Even the program that offers the least benefits will at least cover your monthly Part A premium. You can learn more about the Medicare savings programs at Medicare.gov.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
