MEDICARE SAVINGS PROGRAMS
What are They?
Medicare Savings Programs, also known as “MSP” Programs are specific programs that assist in paying premiums, deductibles, coinsurances, copayments, and prescription drug coverage costs. These programs may also assist in paying Medicare Part A which is hospital insurance and Medicare Part B which is medical insurance.
Medicare Savings Programs are Medicaid-administered programs for individuals who are on Medicare and have limited income and resources. Medicare Savings Programs are federally funded, but are administered by each state’s Medicaid office.Specific Guidelines Per State
State Medicaid offices either follow federal guidelines regarding income guidelines and asset limits, increase income and resource criteria, or place no limit onto the amount of resources/assets an individual has. In addition, several states use different naming for their programs. Individuals should refer to their specific state for eligibility rules.
The Social Security Administration (SSA) provides federal Medicare Savings Program Income limits which can be found at https://secure.ssa.gov/poms.nsf/lnx/0600815023. The National Council on Aging also provides a great resource chart titled MSP Eligibility Chart 2017 (link in sources/further reading below) which illustrates the income and asset guidelines by state and any important information to know regarding a specific state.
Types of Medicare Savings Programs
There are four types of Medicare Savings Program. Each of the programs have different income and resource eligibility limits/criteria. Below is a description of each type of Medicare Savings Program. The limits below are federal limits, each state differs.
Qualified Medicare Beneficiary (QMB):
Individuals may qualify if they have income less than 100% of the Federal Poverty Level (FPL) and resources under $7,730 if single, $11,600 if married. If eligible, QMB will cover the Medicare premiums (Part A, if applicable, and Part B), deductibles, copayments and/or coinsurance. Monthly income limits include a $20 general income disregard; Alaska and Hawaii have slightly higher limits:
- Residents of 48 states & District of Columbia: $1,061/$1,430 single/married
- Alaska: $1,320/$1,781 single/married
- Hawaii: $1,219/$1,642 single/married
Specified Low-Income Beneficiary (SLMB):
Seniors/adults with disabilities may qualify if they have income between 100-120% Federal Poverty Level (FPL) and resources under $7,7300 if single, $11,600 if married. If eligible, SLMB will cover the Medicare Part B premium ($144.60 in 2020). Monthly income limits include a $20 general income disregard; residents of Alaska and Hawaii have slightly higher income limits:
- Residents of 48 states & District of Columbia: $1,269/$1,711 single/married
- Alaska: $1,580/$2,133 single/married
- Hawaii: $1,458/$1,966 single/married
Qualifying Individual (QI):
QI is a limited program (block-grant to states), and is available on a first-come, first-serve basis. People with Medicare may qualify if they have income between 120-135% Federal Poverty Level (FPL) and resources under $7,730 if single, $11,600 if married. If eligible, QI will cover the Medicare Part B premium. Monthly income limits include a $20 general income disregard; Alaska and Hawaii have slightly higher limits:
- Residents of 48 states & District of Columbia: $1,426/$1,923 single/married
- Alaska: $1,775/$2,398 single/married
- Hawaii: $1,638/$2,210 single/married
Qualified Disabled Working Individual (QDWI):
Adults under age 65 and disabled but who recently returned to work and are no longer eligible for premium-free Part A may qualify for QDWI. Their income must be at or below 200% Federal Poverty Level (FPL) and their resources under $4,000 if single, $6,000 if married. However, there are additional earned income disregards that raise the income ceiling for QDWI. If eligible, QDWI will cover their Part A premium. Monthly income limits include a $20 general income disregard and other earned income disregards; Alaska and Hawaii have slightly higher limits:
- Residents of 48 states & District of Columbia: $4,249/$5,722 single/married
- Alaska: $5,285/$7,129 single/married
- Hawaii: $4,879/$6,572 single/married
Am I Eligible?
To be sure that you qualify or may be eligible for such programs the best action to take is to contact your State local Medicaid office for further information and guidance on how to apply for such programs.
DISCLAIMER: The information provided by CPT is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. CPT is not engaged in the practice of law or in rendering legal advice or counsel. No such legal advice or counseling is either expressly or impliedly intended. This form is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney. © 2017 CPT All rights reserved. Updated May 2020.