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Medicare Savings Programs

Medicare Savings Programs help pay some Medicare costs for eligible individuals. Each program provides benefits that help pay coinsurance or co-payments, costs of deductibles, and other costs of healthcare for seniors and certain disabled individuals that meet Medicare Savings Program qualifications. Benefits provided by these programs likely help some people cover a portion of their costs associated with senior care and senior living services. Take a moment to watch this video from the Senior Living YouTube Channel covering prescription drug costs and programs such as these that can help lower costs across the board for seniors.

If you or a loved one needs assistance with paying some of the costs of healthcare beyond what Medicare pays, determine which of the four programs is right for you and apply to start receiving your benefits.

What Are Medicare Savings Programs?

Medicare Savings Programs helps cover some of the costs of Medicare, depending upon the specific program and eligibility requirements. The Official Medicare website indicates that if you have income from working, you potentially qualify for one of the programs. If you now receive Social Security Disability or are retired after working most of your life, one of the programs potentially helps you pay some of the deductibles, co-pays, and coinsurance.

Medicare Savings Programs possibly offer a reduction in your prescription drug costs.

These programs are especially helpful for low-income seniors that need help paying their Medicare costs and that potentially need assistance with covering some costs of services provided through senior care or senior living options.

The income limits and countable resources potentially change each year, so you should always know what they are in advance. Individuals receiving benefits under each program receive written information about income and resource limits for the next year prior to the end of the current year.

What Medicare Savings Program Exist?

Each Medicare Savings program offers its own specific benefits to those enrolled in the program. The Medicare Learning Booklet, presented by the Centers for Medicare and Medicaid Services (CMS) explains that “Dual Eligible Beneficiaries” is the term used for people receiving both Medicare and Medicaid benefits, both Medicare Part A and Part B benefits and full Medicaid benefits or other assistance through one of the Medicare Savings Plans.

Learn whether you or your loved one potentially qualify for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI) or the Qualified Disabled and Working Individuals (QDWI) program.

If you qualify for QMB, SLMB or QI, you automatically qualify for the “Extra Help” benefit. This benefit helps pay some of your Medicare prescription drug costs after Medicare pays their share of your prescription coverage.

Qualified Medicare Beneficiary (QMB)

Qualified Medicare Beneficiary (QMB) helps pay your Part A and Part B premiums, deductibles, co-payments, and coinsurance if you meet all program qualifications. You are also enrolled in Medicaid when enrolled in the QMB program.

You likely do not receive all benefits under Medicaid because while many families or children receiving traditional Medicaid benefits have coverage for dental and vision care, Medicare does not typically pay for vision or dental care.

The CMS reveals that in 2015, more than seven million people on Medicare also received benefits under the QMB program.

Medicare suppliers and Medicare providers are not permitted to bill QMB recipients for deductibles, co-pays or coinsurance. Your state Medicaid program potentially pays at least some of these costs.

Federal laws allow states to place limits on how much the state pays Medicare for cost-sharing. It is crucial that you understand whether your state pays all or some of your Medicare costs under QMB.

You receive a monthly Medicaid card identifying you as a QMB beneficiary, different from the one card that you received when first eligible for Medicare. Make sure you carry your QMB card at all times, to all medical appointments, and when filling prescriptions.

Carry it when seeking any senior care or senior living services, including adult day care, skilled nursing facility care, assisted living, and nursing home care after a hospital stay or other senior care services.

Specified Low-Income Medicare Beneficiary Program (SLMB)

SLMB helps cover your Part B premiums if you are deemed eligible for the program. Individuals eligible for SLMB are eligible for Medicare Part A, have income greater than 100 percent of the federal poverty level (FPL) but less than 120 percent of the FPL guidelines.

A person receiving Specified Low-Income Medicare Beneficiary Program benefits has resources less than twice the limit for SSI eligibility each year. Eligible recipients are otherwise not eligible for Medicaid.

Qualifying Individual Program (QI)

The Qualifying Individual Program pays your Medicare Part B premiums. If you qualify for Medicaid benefits, you are not eligible for the QI Medicare Savings Program.

Recipients receiving Qualifying Individual program benefits are eligible for Medicare Part A and have income that does not exceed 135 percent of the federal poverty level (FPL).

This is a first-come, first-serve program. Recipients reapply every year, with priority given to those who received QI benefits during the previous year.

Qualified Disabled and Working Individuals Program (QDWI)

The Qualified Disabled and Working Program helps pay for Medicare Part A premiums if you are eligible to purchase Medicare Part A benefits under this program.

You potentially qualify for the QDWI Medicare Savings Program if you are currently a working, disabled individual under the age of 65 and lost your premium-free Medicare Part A benefit when you returned to work.

Other qualifications include that you meet income and resource limits in your state and are not eligible for Medicaid benefits in your state.

When you apply for a Medicare Savings Program, ask the agency representative if the program pays for senior living or senior care benefits for you or your loved one.

The four programs, designed to help cover some of the health care costs not covered by Original Medicare, created for eligible low-income people with limited resources and income also potentially assist eligible individuals that need help paying for costs associated with certain senior care services.

Written By

Jeff Hoyt

Editor in Chief

Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt

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