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Medicare Savings Programs (help from Medicaid paying Medicare premiums)

What are Medicare Savings Programs?

Medicare Savings Programs use Medicaid funds to help reduce the out-of-pocket expenses for Medicare beneficiaries with limited income and financial resources.

More specifically, states have programs for people with limited income and financial resources that pay Medicare Premiums and, in some cases, may also pay Medicare Part A (inpatient hospital insurance) and Medicare Part B (outpatient medical insurance) Deductible and Coinsurance. These programs help millions of people with Medicare save money each year.

There are 4 kinds of Medicare Savings Programs:

  1. Qualified Medicare Beneficiary (QMB) Program—Helps pay for Part A and/or Part B premiums, deductibles, coinsurance, and copayments.
  2. Specified Low-Income Medicare Beneficiary (SLMB) Program—Helps pay Part B premiums only.
  3. Qualifying Individual (QI) Program—Helps pay Part B premiums only. You must apply every year for QI benefits and the applications are granted on a first-come first-served basis.
  4. Qualified Disabled and Working Individuals (QDWI) Program—Helps pay Part A premiums only. You may qualify for this program if you have a disability and are working.

Who qualifies for the Medicare Savings Program?

In most cases, to qualify for a Medicare Savings Program, a Medicare beneficiary must have:
  • Medicare Part A
  • Monthly income less than $1,595 and resources less than $13,110* in 2020 for an individual person
  • Monthly income less than $2,155 and resources less than $26,160* in 2020 for a married couple, living together.
*These limits do not include the $1,500 per person burial exclusion.

Note: The limit for income and financial resources may change each year. Many states calculate your income and resources differently, so you may qualify in your state even if your income or resources are higher than the amounts listed above. If you have income from working, you may qualify for benefits even if your income is higher than the limits above. Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs). Resources do not include your home, car, burial plot, burial expenses up to your state’s limit, furniture, or other household items. Some states do not have any limits on resources.

Individual states may have higher income and/or resource limits
The names of these programs and how they work may vary by state. Medicare Savings Programs are not available in Puerto Rico and the U.S. Virgin Islands.

Also, individual states may have higher income and/or resource limits. Check with your State Medical Assistance (Medicaid) office. Also, certain types of income and resources are not counted, so you should still apply even if you think your income and resources are above the limit.

How do I apply for a Medicare Savings Program?

Call your State Medical Assistance (Medicaid) office (see 1-800-MEDICARE Helpline). Since the names of these programs may vary by state, ask for information on Medicare Savings Programs. It is very important to call if you think you qualify for any of these programs, even if you aren't sure. Visit www.medicare.gov on the web, or call 1-800-MEDICARE (1-800-633-4227) to get the telephone number for your state. TTY users should call 1-877-486-2048.

(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)

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