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Do You Qualify for the Medicare Savings Program?

Lower-income households may qualify for extra Medicare assistance through the Medicare Savings Program (MSP). Medicare offers certain benefits for individuals and households below certain income and resource limits or who have other qualifications, such as working while disabled.

If you are looking for more affordable healthcare options, the Medicare Savings Program may be for you. In this post, we outline what the MSP is and how you can qualify for benefits.

What is the Medicare Savings Program?

Medicare Savings Programs are federally funded programs administered by every state. These programs help cover the costs of some Medicare premiums, deductibles, copays, and coinsurance for people with limited income and resources. In some instances, an MSP may also help pay for Medicare Part A and Part B if you meet certain conditions.

Medicare Savings Programs help low-income individuals with some of Medicare expenses, including Medicare Part A and Part B premiums, deductibles, and copays. The MSP is advantageous for seniors and younger adults with disabilities who may not qualify for full Medicaid. It allows you to save money on Medicare costs and automatically qualifies you for the Extra Help prescription drug program to save on out-of-pocket expenses for your medications.

The four Medicare Savings Programs

There are four different Medicare Savings Programs:

  • Qualified Medicare Beneficiary (QMB) Program
  • Specified Low-Income Medicare Beneficiary (SLMB) Program
  • Qualifying Individual (QI) Program
  • Qualified Disabled & Working Individuals (QDWI) Program

Each of these programs has different income level requirements and cover different ranges of Medicare Parts A and B and other expenses.

Qualified Medicare Beneficiary Program. QMB is an MSP that pays for the Medicare Part A (hospital insurance) premium and the Medicare Part B (medical insurance) premium. The program also helps cover Medicare expenses, such as deductibles, coinsurance, and copayments. If you qualify for QMB, you also automatically qualify for the Extra Help prescription drug program.

Specified Low-Income Medicare Beneficiary Program. If you earn a little over the limit for QMB, you may qualify for the SLMB Program. SLMB helps pay for Medicare Part B premiums. While this program does allow for a higher income, it does not pay other cost-sharing expenses or Medicare Part A premiums. As with QMB, if you qualify for the SLMB Program, you automatically qualify for the Extra Help prescription drug program.

Qualifying Individual Program. If your income is above the limits of both the QMB and SLMB Programs, you may qualify for the QI Program. QI pays for Medicare Medicare Part B premiums and, again, automatically qualifies you for the Extra Help prescription drug program. This program, however, is awarded on a first-come, first-served basis, and you must reapply each year. If you qualify for Medicaid, you cannot receive QI benefits.

Qualified Disabled & Working Individuals Program. Unlike the other MSPs, QDWI only pays for Medicare Part A premiums. While the income limit is much higher, to qualify for this program, one of the following must apply to you:

  • You’re a working disabled person under 65
  • You lost your premium-free Part A when you went back to work
  • You aren’t getting medical assistance from your state
  • You meet the income and resource limits required by your state

For more information on the income and resource limits of each program, please visit Medicare’s official Medicare Savings Program webpage.

Qualifying and Applying for the Medicare Savings Program

We have briefly discussed eligibility for the different Medicare savings plans. If you have or are eligible for Medicare Part A, your income is at or below the limits for any of the programs, and you have limited resources, you may qualify for the Medicare Savings Program.

As stated above, qualification for most of these programs comes down to your income limit. Qualification is determined by SSI-rated methodologies. The household’s net income is calculated and compared to the one- or two-person standard, depending on whether or not a spouse’s income is being considered. For more about qualification under Washington requirements, view this webpage.

If you need help with Medicare premiums, the MSP can save you money, where other programs may not. If you think you may be eligible for a Medicare Savings Program, even if you are not sure, talk to a Medicare representative. Once your eligibility is determined, you can apply for benefits online or with a Medicare agent.

The Medicare Policy Center is here to help you get the Medicare coverage you need.

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