A Medicare beneficiary may qualify to get help paying for their Medicare Part A or
Part B premiums. States have programs that can help pay their Medicare expenses like
premiums, deductibles, and coinsurance.
There are four Medicare Savings Programs:
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•
Qualified Medicare Beneficiary (QMB)
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•
Specified Low-Income Medicare Beneficiary (SLMB)
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•
Qualifying Individual (QI or QI-1)
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•
Qualified Disabled & Working Individuals (QDWI)
If a beneficiary qualifies for QMB, SLMB, or QI, the beneficiary automatically qualifies
for Extra Help, which pays for all costs, except for a minimal co-payment of Medicare
prescription drug coverage (see the chart in HI 03001.005G.1).
To qualify for the QMB, SLMB, or QI programs a beneficiary must meet all of these
conditions:
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•
Have Medicare Part A (hospital insurance) including Premium-free HI or Premium HI
for the Aged, but excluding Premium HI for the Working Disabled;
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Reside in a state or the District of Columbia; and
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Meet the following standard income and resource limits:
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–
2024
limits – Single person – monthly income of $1,715 or less (higher in Alaska and Hawaii)
and resources not more than $9,430.
Married and living together – monthly income of $2,320 or less (higher in Alaska and
Hawaii) and resources not more than $14,130.
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–
2023
limits – Single person – monthly income of $1,660 or less (higher in Alaska and Hawaii)
and resources not more than $9,090.
Married and living together – monthly income of $2,239 or less (higher in Alaska and
Hawaii) and resources not more than $13,630.
The resource limits do not include the $1500 per individual ($3,000 for a married
couple) burial exclusion.
To qualify for the QDWI program, a beneficiary must:
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Have lost entitlement to free Part A solely because of substantial gainful activity
(SGA);
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Continue to be disabled and under age 65;
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Reside in a state or the District of Columbia;
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Not be otherwise eligible for Medicaid;
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Be eligible to enroll in Medicare Part A; and
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Meet the following income and resources limits:
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–
2024
limits – Single person – monthly income of $5,105 or less (higher in Alaska and Hawaii)
with resources not more than $4,000.
Married and living together – monthly income of $6,899 or less (higher in Alaska and
Hawaii) with resources not more than $6,000.
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–
2023
limits – Single person – monthly income of $4,945 or less (higher in Alaska and Hawaii)
with resources not more than $4,000.
Married and living together – monthly income of $6,659 or less (higher in Alaska and
Hawaii) with resources not more than $6,000.
Only the state can determine if an individual qualifies for coverage under one of
these programs. Many states apply different standards and methods to determine MSP
eligibility. Some states, for example, have no resources for these programs or figure
the income and resources differently.
For more information regarding MSP, see
HI 00815.023 Medicare Savings Programs Income Limits
HI 00815.025 SSA Outreach to Low-Income Medicare Beneficiaries – Extra Help and Medicare Savings
Programs
HI 00801.170 Premium-HI for the Working Disabled
The chart explains how MSP can help with Medicare expenses:
Medicare Savings Programs
|
Helps Pay For
|
QMB
|
Part A and Part B premiums and other covered cost-sharing expenses like deductibles
and coinsurance.
|
SLMB
|
Part B premiums only
|
QI
|
Part B premiums only
|
QDWI
|
Part A premiums only
|