The Qualifying Individual (QI
) program is one of four Medicare Savings Programs (QMB, SLMB, QI, and QDWI) established by Medicare. QI helps low-income Medicare beneficiaries pay their Medicare Part B premiums.
A Medicare beneficiary who qualifies for the QI program also automatically qualifies for the Medicare Part D Extra Help
program that provides financial assistance with Medicare Part D
prescription drug coverage (monthly premiums, deductibles, and drug costs).
You must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who had QI benefits the previous year. (You can't get QI benefits if you qualify for Medicaid).
What costs does the QI program cover?
For those who qualify for the QI program, this Medicaid program pays:
- Medicare Part B premiums only.
Since QI recipients also automatically receive Extra Help, the following prescription related costs would be covered through the Extra Help program:
- Medicare Part D prescription drug plan premiums (depending on the chosen plan), and
- Medicare Part D prescription drug plan deductible, and you would have lower drug cost-sharing.
If you qualify for the QI Medicare Savings Program, you could save a substantial amount of money
on Medicare Part B, and Medicare Part D prescription
Who is eligible for the QI program?
To be qualified for the QI program, you must be a Medicare beneficiary and:
- Have Medicare Part A (hospital insurance),
- Do not qualify for Medicaid benefits,
- Reside in a state or the District of Columbia, and
- Have limited income and assets or financial resources.
- Specifically, to qualify for the QI program you must have income and assets meeting 120-135% of the Federal Poverty Level (FPL). (You can click here to read more about the current Federal Poverty Level.)
QI income & resource limits in 2020:
monthly income limit:* $1,456
resource limit: $7,860
monthly income limit:* $1,960
resource limit: $11,800
*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.
Your financial resources or assets that count toward QI eligibility include: your checking accounts, savings accounts, and investments such as stocks, bonds, and mutual funds.
Some of your property will not count as resources (assets) when qualifying for the QI program, such as:
- Your primary home where you or your spouse lives,
- Your primary car,
- Furniture / personal items,
- A pre-paid burial plot, and
- A limited burial plan.
The Federal Poverty Level can (and usually does) change each year so the income and resource limits for the QI program can change each year.
Annual changes in the FPL mean that, even if you might not have qualified for QI last year, under the new FPL, you may be able to qualify this year.
How do you apply for the QI program?
To apply for the QI program, you will need to contact your local state Medicaid office. For more assistance, you may wish to contact your local State Health Insurance Assistance Program (SHIP).
As a note:
You may also wish to see if your state has a State Pharmacy Assistance Program (SPAP). SPAPs are state-funded programs that provide low-income and medically needy senior citizens and individuals with disabilities financial assistance for prescription drugs. We have SPAP information online here (note that the SPAP information is subject to change without notice): https://q1medicare.com/PartD-State-PharmacyAssistancePrograms.php
What are the other related Medicare Savings Programs?
If you do not meet the low-income financial requirements to qualify for the QI program, you still may have some of your Medicare costs covered by one of the other Medicare Savings Programs. The four Medicare Savings Programs include:
You can click here to learn more about Medicare Savings Programs: https://Q1FAQ.com/184.html
(primary source: Medicare.gov)