Medicare Savings Program 101: Eligibility and Coverage

Medicare Savings Program

Medicare costs increase each year. Unfortunately, it will continue on this upward trend. Because Medicare recognizes these increasing costs, Medicare provides a state-by-state Medicare Savings Program. This program aids lower-income Medicare beneficiaries by helping pay parts of their out-of-pocket Medicare costs. Original Medicare premiums, deductibles, coinsurance, and copayments might be among some of the covered costs.

Medicare Savings Program

With the rising costs in Medicare, some might not be able to pay the full amount of their Medicare costs. The Medicare Savings Program helps cover the cost of Original Medicare for these individuals.  There are multiple types of Medicare Savings Programs; each program has specific individual monthly income limits. It is possible to qualify for one of the programs even if your income exceeds the program’s income limit.

The four different types of Medicare Savings Programs are outlined below:

Qualified Medicare Beneficiary (QMB) Medicare Savings Program

To qualify for this savings program, you must meet the following criteria:

  • Individual monthly income limit of $1,032*
  • Individual resource limit of $7,560
  • Married monthly income limit of $1,392*
  • Married resource limit of $11,340

The QMB program typically helps pay for Part A and Part B premiums, coinsurance, copayments, and deductibles.

*These limits may be higher in Alaska or Hawaii

Specified Low-Income Medicare Beneficiary (SLMB) Medicare Savings Program

To qualify for the SLMB program, you must meet the following criteria:

  • Individual monthly income limit of $1,234*
  • Individual resource limit of $7,560
  • Married monthly income limit of $1,666*
  • Married resource limit of $11,340

Unlike the QMB program, the SLMP program typically helps pay for Medicare Part B premiums only.

*These limits may be higher in Alaska or Hawaii

Qualifying Individual (QI) Medicare Savings Program

The QI Program relies on yearly applications to qualify for benefits. Applications for this program are processed on a first-come, first served basis. Priority is typically given to those who received QI benefits in previous years. To qualify for the QI program, you must meet the following criteria:

  • Individual monthly income limit of $1,386*
  • Individual resource limit of $7,560
  • Married monthly income limit of $1,872*
  • Married resource limit of $11,340

This program typically only helps pay for Part B premiums.

*These limits may be higher in Alaska or Hawaii

Qualified Disabled and Working Individuals (QDWI) Medicare Savings Program

To qualify for the QDWI program, you must meet the following criteria:

  • Individual monthly income limit of $4,312*
  • Individual resource limit of $4,000
  • Married monthly income limit of $5,572*
  • Married resource limit of $6,000
  • You are a working disabled person under 65
  • You meet your state’s income and resource limits
  • Your state does not help you with medical assistance
  • Your premium-free Part A was lost when you returned to work

The QDWI program typically only helps pay for Part A premiums.

*These limits may be higher in Alaska or Hawaii

How the Medicare Savings Program Works

The listed programs help pay some of the costs associated with any out-of-pocket costs from Original Medicare. Depending on the program you qualify for, you may also qualify for the Medicare Extra Help program. This program helps cover costs associated with prescription drug coverage through Medicare Part D. With these two assistance programs, you may have as much coverage as possible to help with Medicare-related costs.

Each Medicare Savings Program may vary from state to state. To better understand this, Medicare created a page that links to each state’s individual program website. Use this page to find the program in your state.

Apply for a Medicare Savings Program

To see if you qualify for your state’s Medicare Savings Program, you can call your state Medicaid program. You must first be eligible for, or have Medicare Part A. In addition, your income limits must meet the required limits (in most situations), and your resources must be below the required limits.

Save on Medicare Costs

There are other ways you can save on Medicare costs. For example, you can get a Medicare supplement plan to help pay for some fees associated with Medicare. Some plans may completely cover the 20% that Medicare does not cover.  These plans could cover some deductibles, copayments, and out-of-pocket fees. You can get a free Medicare supplement quote online, or call one of our licensed Medicare supplement agents at (800) 310-2550.

Compare Your Medicare Supplement Rates Immediately!

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