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What is a Medicare Savings Program?



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FAQ 8 of 37 in this Category
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Question: What is a Medicare Savings Program?
Category: Extra Help - LIS - Medicaid

Answer: A Medicare Savings Program (MSP) is one of four different Medicaid programs (QMB, SLMB, QI, QDWI) available for people with limited financial resources and, depending on a person's income and assets, Medicare Savings Programs may pay monthly Medicare Part A premiums (for in-patient and hospital coverage), as well as Medicare Part B (out-patient and medical coverage) premiums, deductibles, coinsurance, and co-payments.

Medicare Savings Programs and Medicare Part D Extra Help

A Medicare beneficiary who qualifies for either the QMB, SLMB, or QI program will automatically qualify for the Medicare Part D Extra Help program that provides financial assistance with Medicare Part D prescription drug coverage (premiums and drug costs).

Bottom line: If you qualify for a MSP, you could save a substantial amount of money on Medicare Part A, Medicare Part B, and Medicare Part D prescription drug coverage.

The four Medicare Savings Programs include:

MSP
Income
Limits *
 Benefit
Qualified Medicare Beneficiary (QMB) Program 100% of FPL
QMB pays Medicare Part A and Part B premiums, deductibles, coinsurance, and co-payments

CMS: "Qualified Medicare Beneficiaries (QMBs) without other Medicaid (QMB Only) - These individuals are entitled to Medicare Part A, have income of 100% Federal poverty level (FPL) or less and resources that do not exceed twice the limit for SSI eligibility, and are not otherwise eligible for full Medicaid. Medicaid pays their Medicare Part A premiums, if any, Medicare Part B premiums, and, to the extent consistent with the Medicaid State plan, Medicare deductibles and coinsurance for Medicare services provided by Medicare providers. Federal financial participation (FFP) equals the Federal medical assistance percentage (FMAP)."
Qualified Medicare Beneficiary Plus (QMB+) (QMB Plus)
100% of FPL**
QMB+ (QMB Plus) has full Medicaid benefits and pays Medicare Part A and Part B premiums, deductibles, coinsurance, and co-payments

CMS: "QMBs with full Medicaid (QMB Plus) - These individuals are entitled to Medicare Part A, have income of 100% FPL or less and resources that do not exceed twice the limit for SSI eligibility, and are eligible for full Medicaid benefits. Medicaid pays their Medicare Part A premiums, if any, Medicare Part B premiums, and, to the extent consistent with the Medicaid State plan, Medicare deductibles and coinsurance, and provides full Medicaid benefits. FFP equals FMAP"
Specified Low-Income Medicare Beneficiary (SLMB) Program
100-120% of FPL
SLMB pays Medicare Part B premiums

CMS: " Specified Low-Income Medicare Beneficiaries (SLMBs) without other Medicaid (SLMB Only) - These individuals are entitled to Medicare Part A, have income of greater than 100% FPL, but less than 120% FPL and resources that do not exceed twice the limit for SSI eligibility, and are not otherwise eligible for Medicaid. Medicaid pays their Medicare Part B premiums only. FFP equals FMAP. "
Specified Low-Income Medicare Beneficiary Plus (SLMB+) (SLMB Plus)
100-120% of FPL**
SLMB+ (SLMB Plus) has full Medicaid benefits and pays Medicare Part B premiums and cost-sharing

CMS: " SLMBs with full Medicaid (SLMB Plus) - These individuals are entitled to Medicare Part A, have income of greater than 100% FPL, but less than 120% FPL and resources that do not in exceed twice the limit for SSI eligibility, and are eligible for full Medicaid benefits. Medicaid pays their Medicare Part B premiums and provides full Medicaid benefits. FFP equals FMAP."
Qualifying Individual (QI) Program 120-135% of FPL QI pays Medicare Part B premiums

CMS: "Qualifying Individuals (1) (QI-1s) - This group is effective 1/1/98 - 12/31/02. There is an annual cap on the amount of money available, which may limit the number of individuals in the group. These individuals are entitled to Medicare Part A, have income of at least 120% FPL, but less than 135% FPL, resources that do not exceed twice the limit for SSI eligibility, and are not otherwise eligible for Medicaid. Medicaid pays their Medicare Part B premiums only. FFP equals FMAP at 100%.

Qualifying Individuals (2) (QI-2s) - This group is effective 1/1/98 - 12/31/02. There is an annual cap on the amount of money available, which may limit the number of individuals in the group. These individuals are entitled to Medicare Part A, have income of at least 135% FPL, but less than 175% FPL, resources that do not exceed twice the limit for SSI eligibility, and are not otherwise eligible for Medicaid. Medicaid pays only a portion of their part B premiums ($2.23 in 1999). FFP equals FMAP at 100%. "
Qualified Disabled and Working Individuals (QDWI) Program under 200% of FPL  QDWI pays Medicare Part A premiums

CMS: "Qualified Disabled and Working Individuals (QDWIs) - These individuals lost their Medicare Part A benefits due to their return to work. They are eligible to purchase Medicare Part A benefits, have income of 200% FPL or less and resources that do not exceed twice the limit for SSI eligibility, and are not otherwise eligible for Medicaid. Medicaid pays the Medicare Part A premiums only. FFP equals FMAP. "
Medicaid Only Dual Eligibles (Non QMB, SLMB, QDWI, QI-1, or QI-2) Program   CMS: " Medicaid Only Dual Eligibles (Non QMB, SLMB, QDWI, QI-1, or QI-2) - These individuals are entitled to Medicare Part A and/or Part B and are eligible for full Medicaid benefits. They are not eligible for Medicaid as a QMB, SLMB, QDWI, QI-1, or QI-2. Typically, these individuals need to spend down to qualify for Medicaid or fall into a Medicaid eligibility poverty group that exceeds the limits listed above. Medicaid provides full Medicaid benefits and pays for Medicaid services provided by Medicaid providers, but Medicaid will only pay for services also covered by Medicare if the Medicaid payment rate is higher than the amount paid by Medicare, and, within this limit, will only pay to the extent necessary to pay the beneficiary's Medicare cost-sharing liability. Payment by Medicaid of Medicare Part B premiums is a State option; however, States may not receive FFP for Medicaid services also covered by Medicare Part B for certain individuals who could have been covered under Medicare Part B had they been enrolled. FFP equals FMAP. "

* The FPL is the Federal Poverty Level and some portions of your income may not count toward reaching the income level - for instance, the first $20 of your monthly income.  Remember, the FPL can change every year.
** In addition to meeting the income requirements, qualifying individuals have resources that do not in exceed twice the limit for SSI eligibility, and are eligible
for full Medicaid benefits.

Zero Cost Share Dual Eligible Member means a Dual Eligible Member that is not responsible for paying any Part A or Part B cost sharing.

WellCare provides an excellent summary of Medicare Savings Program (MSP) benefits:

Medicare Savings Program (MSP) Assistance FFS Part A Premium Covered? FFS Part B Premium Covered? Premium Covered? Part A & B Cost Sharing Covered? Full Medicaid Benefits Provided?
Qualified Medicare Beneficiary (QMB) YES YES YES NO
QMB Plus (QMB+) YES YES YES YES
Specified LowIncome Medicare Beneficiary (SLMB) NO YES NO NO
SLMB Plus (SLMB+) NO YES YES YES
Qualifying Individual (QI) NO YES NO NO
Qualified Disabled Working Individual (QDWI) YES NO NO NO
Full Benefit Dual Eligibles YES YES YES YES
QMB, QMB+, SLMB+ and FBDE beneficiaries are considered “zero cost share” dual eligibles since they pay no Part A or Part B Member Expenses.


Medicare Savings Programs and Asset Limits

As noted above, the four different MSPs have their own income limits - plus each program has an asset or resource limit.  Your assets or financial resources that are included to determine whether you qualify for a specific Medicare Savings Program include any money in your checking or savings account and investments (such as, stocks and bonds).  However, when determining whether you are qualified for a MSP, your total assets or resources will not include: your primary home, primary car, burial plot, minimal burial expenses ($1,500), furniture and other household / personal items.

Please remember that asset or resource levels needed to qualify for a Medicare Savings Programs can (and usually do) change each year.  For instance, in 2018, the resource or asset level and income levels for the MSPs are approximately (can vary in Alaska and Hawaii):
  • QMB: Individual resource limit $7,560 and Married couple resource limit $11,340
  • SLMB: Individual resource limit$7,560 and Married couple resource limit$11,340
  • QI: Individual resource limit $7,560 and Married couple resource limit $11,340
  • QDWI: Individual resource limit $4,000 and Married couple resource limit $6,000 (Qualifying for QDWI also includes several other criteria: You must be under 65 and disabled, you do no longer have premium-free Medicare Part A when you went back to work, you are ineligible for your state Medicaid or medical assistance program.)
Applying for a Medicare Savings Program

To apply for a MSP, please contact your local state Medicaid office or State Health Insurance Program (SHIP) for more details and information on qualifying and applying for a MSP.

Important:
You may find that, even if your income or resources exceed the example limits stated above, you may still qualify for a MSP based on your state's specific rules (and Alaska and Hawaii usually have higher financial qualification limits).

(primary source: Medicare.gov)


FAQ 8 of 37 in this Category
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