The Medicare Savings Programs
If you or your loved one is eligible for Original Medicare but is struggling with out of pocket costs, a Medicare Savings Program may be the answer! In this article, we’ll cover the types of Medicare Savings Programs, how to find out if you’re eligible, and the ways to apply for assistance. In addition, we’ll also provide the income and asset limits for each program. Read on to find out if a Medicare Savings Program can help relieve your out-of-pocket expenses.
What are the Medicare Savings Programs?
The Medicare Savings Program, or MSP, is a program designed to assist eligible seniors with their Medicare-related costs. It is administered by the Centers for Medicare & Medicaid Services (CMS) and operates at the state level. The MSP provides financial assistance for Medicare premiums, deductibles, coinsurance, and copayments, making healthcare more affordable for qualified individuals. This is a huge way for seniors to save money on Medicare. It is essentially Medicaid, for people on Medicare.
Who is eligible for the MSP?
Eligibility for the Medicare Savings Program depends on factors such as income, assets, and residency. Each state sets its own eligibility criteria, but there are general guidelines that apply across the country. To qualify for the MSP, you generally need to meet the following requirements:
- Medicare Part A and/or Part B Enrollment: You must be enrolled in Medicare Part A (hospital insurance) and/or Part B (medical insurance) to be considered for the MSP.
- Income Limits: The MSP considers your income to determine eligibility. The income limits vary by state, and some states may have higher limits than others. In general, the program is designed to assist individuals with limited financial resources.
- Asset Limits: In addition to income, the MSP also considers your assets, such as savings accounts and investments. Like income limits, asset limits vary by state. However, some assets, like your primary residence and personal belongings, are not counted when determining eligibility.
What Counts Toward the Medicare Savings Programs Resource and Income Limits?
Countable resources (also known as assets) include:
- Money in a checking or savings account
- Money market accounts
- Mutual funds
- Certificates of deposit (CDs)
- Individual retirement accounts (IRAs)
Countable resources don’t include:
- Your home
- One car
- Other household and personal items
- A burial plot
- Up to $1,500 for burial expenses if you have put that money aside
Calculated income includes:
- Social Security benefits
- Supplemental Security Income (SSI)
- Railroad benefits
- Veterans benefits
- Public assistance
- Unemployment insurance
- Workers’ compensation
- Alimony payment
- Dividends and interest
- Rental income
|Medicare Savings Program||Individual monthly income limit*||Married couple monthly income limit*||Individual resource limit||Married couple resource limit|
|Qualified Medicare Beneficiary (QMB)||$1,235||$1,663||$9,090||$13,630|
|Specified Low-Income Medicare Beneficiary (SLMB)||$1,379||$1,851||$9,090||$13,630|
|Qualifying Individual (QI)||$1,549||$2,080||$9,090||$13,630|
|Qualified Disabled and Working Individuals (QDWI)||$4,945||$6,659||$4,000||$6,000|
How does the Medicare Savings Program help?
Once you are determined eligible for the Medicare Savings Program, it can provide different levels of assistance, depending on your income and assets. Here are some common ways in which the MSP can help:
- Paying Medicare Premiums: The MSP may cover some or all your Medicare Part B premium, which is the monthly amount you pay for medical insurance. In turn, this helps reduce your healthcare expenses and frees up funds for other needs.
- Covering Deductibles and Coinsurance: Medicare involves deductibles and coinsurance, which are out-of-pocket costs you must pay when receiving healthcare services. As a result, the MSP can assist in covering these expenses, making it more affordable for you to access necessary medical care.
- Providing Extra Help: In some cases, individuals eligible for the MSP may also qualify for Extra Help, a separate program that assists with prescription drug costs under Medicare Part D. This additional support further reduces the financial burden of healthcare.
What are the levels of help offered?
Within the Medicare Savings Program (MSP), there are different levels of assistance available to eligible individuals. These levels are known as Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI), and Qualified Working Disabled Individual (QWDI). Each level provides varying degrees of financial support to help individuals manage their Medicare-related costs. Let’s explore each level in more detail:
Qualified Medicare Beneficiary (QMB):
The QMB program offers comprehensive assistance to eligible individuals. It covers Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments. Essentially, if you qualify for QMB, the program will help pay for most of your Medicare costs, including premiums and out-of-pocket expenses. The QMB level of the MSP is not limited by funding and is available year-round.
Specified Low-Income Medicare Beneficiary (SLMB):
The SLMB program provides assistance with Medicare Part B premiums. If you qualify for SLMB, the program will help pay your Part B premiums, which are the monthly payments you make for medical insurance coverage. It may also cover Part A premiums in certain cases. Like QMB, SLMB is not limited by funding and is available throughout the year.
Qualified Individual (QI):
The QI program assists with Medicare Part B premiums. If you qualify for QI, the program will pay your Part B premiums on your behalf. However, it’s important to note that QI has limited funding available and operates on a first-come, first-served basis. Therefore, it’s crucial to apply as soon as possible if you meet the eligibility criteria.
Qualified Working Disabled Individual (QWDI):
The QWDI program provides assistance to individuals with disabilities who are working and have limited income and resources. It helps cover Medicare Part A premiums, which are typically associated with hospital insurance. Like QI and SLMB, QWDI is not limited by funding and is available year-round.
It’s worth mentioning that the eligibility criteria for these Medicare Savings Programs can vary slightly from state to state. Therefore each state sets its own income and asset limits for these programs. To determine your eligibility and apply for QMB, SLMB, QI, or QWDI, it is recommended to contact LMS Insurance group and a licensed broker can see to it you receive every benefit you are entitled to. You can also contact your state’s Medicaid office or your local Social Security Administration office. They will guide you through the application process and provide you with the necessary information.
By participating in any of these MSP levels, you can significantly reduce the financial burden associated with Medicare premiums, deductibles, and other costs. Furthermore, if you meet the eligibility criteria, exploring these programs can provide valuable assistance in managing your healthcare expenses.