What Are Medicare Savings Programs, and How do I Qualify?

Medicare Savings Programs help individuals with low income or limited resources pay for their Medicare costs. Medicare beneficiaries can apply for these supportive benefits to save on premiums. Some programs even assist with deductibles, copays, and prescription drugs.

There are four types of Medicare Savings Programs:

  • Qualified Medicare Beneficiary (QMB) Program
  • Specified Low-Income Medicare Beneficiary (SLMB) Program
  • Qualifying Individual (QI) Program
  • Qualified Disabled and Working Individuals (QDWI) Program

If you qualify for QMB, SLMB, or QI, you can also enroll in Extra Help, which regulates prescription drug expenses.

When you apply for a Medicare Savings Program, you must specify the resources you (and your spouse, if you’re married) have on hand. To calculate whether your resources meet or exceed the resource limit, your state government will consider the value of money in a checking or savings account, stocks, and bonds. Assets like a single car, your home, furniture, household items, and burial plots or savings for burial expenses (up to $1,500) are not included.

Alongside the resource limit, there is also a monthly income limit. If your monthly income is at or below the amount specified for a program, you are encouraged to apply. Let’s break down each type of Medicare Savings Program and review how you can check your eligibility.

Qualified Medicare Beneficiary Program

The Qualified Medicare Beneficiary (QMB) Program helps individuals pay for Medicare Part A and Part B premiums, as well as deductibles, coinsurance, and copayments. Receiving QMB benefits automatically qualifies you for Extra Help.

Below are the resource and monthly income limits for the QMB Program.

Medicare Savings Program: Qualified Medicare Beneficiary

Specified Low-Income Medicare Beneficiary Program

The Specified Low-Income Medicare Beneficiary (SLMB) Program assists with Medicare Part B premiums. Receiving benefits from SLMB also qualifies you for Extra Help aid for prescription drugs.

Below are the resource and monthly income limits for the SLMB Program.

Medicare Savings Program: Specified Low-Income Medicare Beneficiary

Qualifying Individual Program

The Qualifying Individual (QI) Program also helps cover the cost of Medicare Part B premiums and gives you access to Extra Help. However, with this program, individuals must reapply every year to continue receiving benefits. Benefits are distributed on a first-come, first-serve basis. Depending on your state, priority is typically given to individuals who received QI benefits in the previous year.

In addition to resource and income limits, you are only eligible for QI if you do not qualify for Medicaid. Below are the resource and monthly income limits for the QI Program.

Medicare Savings Program: Qualifying Individual

 

Qualified Disabled and Working Individuals Program

The Qualified Disabled and Working Individuals (QDWI) Program helps pay for Medicare Part A Premiums. You may be eligible to receive aid from this program if you:

  • Are a working disabled person under age 65
  • Lost your premium-free Medicare Part A when you returned to work
  • Are not receiving other medical assistance from your state
  • Meet the income and resource limits required by your state

Below are the resource and monthly income limits for the QDWI Program.

Medicare Savings Programs: Qualified Disabled and Working Individuals

Extra Help (Prescription Drug Coverage)

As an added benefit to the QMB, SLMB, and QI Programs, Extra Help regulates the cost of prescription drugs for low-income Medicare beneficiaries. This program also helps cover premiums, deductibles, and coinsurance associated with your Medicare Part D prescription drug plan.

However, you can qualify for Extra Help even if you are not enrolled in a Medicare Savings Program. Read more about Extra Help here.

To receive Extra Help or check your level of Extra Help coverage, send any of these documents to your drug plan provider:

  • Purple notice from Medicare saying you automatically qualify for Extra Help
  • Yellow or green automatic enrollment notice from Medicare
  • Extra Help “Notice of Award” from Social Security
  • Orange notice from Medicare saying your copay will change next year
  • Award letter from Social Security as proof of Supplemental Security Income

Your plan provider must accept any of these documents as proof of your Extra Help eligibility. As part of Extra Help, you will pay no more than the Low Income Subsidy (LIS) drug coverage cost for each of your prescriptions. In 2020, that was $3.60 for generic drugs and $8.95 for brand name drugs.

Checking Your Eligibility

Receiving assistance from any of these programs (including Extra Help) means you’ll have an extra card to show, in addition to your Medicare card, when you visit the doctor’s office or hospital.

You can apply for Medicare Savings Programs through your state government or your local Medicare office. To apply or determine your eligibility for a Medicare Savings Program, visit a Medicare office or select your state from this webpage. You can also find application instructions at these links if you live in Ohio, Kentucky, or Indiana.

If you still have questions about Medicare Savings Programs, applying for benefits, or how to find the right options for your needs, RetireMEDiQ would love to help. To request information about RetireMEDiQ, call 1-866-407-5180 or visit https://www.retiremediq.com/schedule/.

RetireMEDiQ simplifies Medicare by providing guidance, evaluating your plan options, and helping you enroll in the right health care plan. Over 50,000 individuals have trusted them to deliver peace of mind.

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