If you or your loved one is eligible for Original Medicare but struggling to pay the costs, a Medicare Savings Program may be the answer! In this article, we’ll cover the types of Medicare Savings Programs, how to find out if you’re eligible, and the ways to apply for assistance. We’ll also provide the income and asset limits for each program. Read on to find out if a Medicare Savings Program can help relieve your out-of-pocket expenses.
What Are Medicare Savings Programs?
Medicare Savings Programs are federally funded programs managed by each state. These programs help people with limited income and assets pay for some (or all) of their Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) premiums, deductibles, copayments, and coinsurance. Older adults and individuals with disabilities who may not be eligible for full Medicaid may still have the option to enroll in a Medicare Savings Program.1
The Four Types of Medicare Savings Programs
There are four kinds of Medicare Savings Programs, each with its own specific benefits. The names of these programs and how they work may vary from state to state. Unfortunately, Medicare Savings Programs aren’t available in Puerto Rico or the U.S. Virgin Islands.2
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individuals (QDWI) Program
Money-Saving Tip: If you qualify for a QMB, SLMB, or QI Program, you’re automatically eligible for the Extra Help benefit. This benefit helps cover some of your Medicare Part D prescription drug costs.
Qualified Medicare Beneficiary Program
Over 7.7 million people participate in the Qualified Medicare Beneficiary (QMB) Program.3 The QMB Program provides Medicaid coverage of Medicare Part A and Part B premiums to low-income Medicare beneficiaries. QMB enrollees will not be billed for services and items Medicare covers, including coinsurance, deductibles, and copayments. You may be responsible for a small Medicaid copayment, if applicable. Covered prescriptions generally won’t cost you more than $4.30 each if you qualify for QMB.
Specified Low-Income Medicare Beneficiary Program
The Specified Low-Income Medicare Beneficiary (SLMB) Program helps cover your Medicare Part B premiums. These premiums go toward medically necessary care, including outpatient care, home health services, durable medical equipment (DME), and preventive services. You’ll also get extra help with your prescription drug payments.
Qualifying Individual Program
The Qualifying Individual (QI) Program pays your Medicare Part B premiums. This program is offered on a first-come, first-serve basis. Recipients must reapply each year, and those who received QI benefits during the previous year are prioritized.
Did You Know? If you qualify for Medicaid benefits, you are not eligible for the SLMB or QI Program.
Qualified Disabled and Working Individuals Program
The Qualified Disabled and Working Individuals (QDWI) Program helps pay for Medicare Part A premiums. You may qualify for the QDWI Medicare Savings Program if:
- You are currently a disabled individual under the age of 65 who is working.
- You lost your premium-free Medicare Part A benefit when you returned to work.
- You meet your state’s income and resource limits.
- You aren’t receiving medical assistance in your state.
Medicare Savings Program Income and Resource Limits
Each year, income and resources limits are set for all four Medicare Savings Programs.4
|Medicare Savings Program||Individual monthly income limit*||Married couple monthly income limit*||Individual resource limit||Married couple resource limit|
|Qualified Medicare Beneficiary (QMB)||$1,235||$1,663||$9,090||$13,630|
|Specified Low-Income Medicare Beneficiary (SLMB)||$1,478||$2,239||$9,090||$13,630|
|Qualifying Individual (QI)||$1,660||$2,239||$9,090||$13,630|
|Qualified Disabled and Working Individuals (QDWI)||$4,945||$6,659||$4,000||$6,000|
*Income limits are slightly higher in Alaska and Hawaii. If you have income from working, you may qualify for benefits even if your income is higher than the limits listed above.
What Counts Toward the Medicare Savings Program Resource and Income Limits?
Medicare Savings Program Countable Resources Limit
Countable resources (also known as assets) include:
- Money in a checking or savings account
- Money market accounts
- Mutual funds
- Certificates of deposit (CDs)
- Individual retirement accounts (IRAs)
Countable resources don't include:
- Your home
- One car
- Other household and personal items
- A burial plot
- Up to $1,500 for burial expenses if you have put that money aside
- Life insurance that has a cash value of less than $1,500
Medicare Savings Program Income Limit
Calculated income includes:
- Social Security benefits
- Supplemental Security Income (SSI)
- Railroad benefits
- Veterans benefits
- Public assistance
- Unemployment insurance
- Workers’ compensation
- Alimony payment
- Dividends and interest
- Rental income
Did You Know? Even if individuals or couples are slightly over the Medicare Savings Program income or resource limit, they still may qualify. States have some flexibility in excluding some income and resources.5
Who Is Eligible for a Medicare Savings Program?
To be eligible for a Medicare Savings Program:
- You must be eligible for or receiving Medicare Part A.
- Your income and resources must be at or below the limits for one or more of the Medicare Savings Programs.
Expert Tip: Enrolling in Medicare for the first time? Check out our comprehensive Medicare enrollment guide.
Looking for other ways to save? Prescription medication costs can wreak havoc on your wallet. In the video below, our editor-in-chief, Jeff Hoyt, shares the details on prescription assistance programs and how to save money on prescription drugs.
How to Apply for a Medicare Savings Program
Don’t miss out on potential savings! Even if you’re unsure about meeting the Medicare Savings Program qualifications, contact your local state Medicaid program office for guidance. A Medicare Savings Program application will be mailed to you (or you may be able to download it on your computer).
From the Pros: Medicare Savings Programs are administered by Medicaid. Head over to our Medicare and Medicaid health insurance guide to learn about the important insurance differences.