Public Law 110-275, MIPPA amends the Social Security Act to require that applications for Extra Help (SSA-1020) effectively filed on or after January 1, 2010 will start the application process for Medicare Savings Programs (MSP) benefits unless the beneficiary objects. In addition, effective January 2010, MIPPA amended the Act to make the resource limits for the Qualified Medicare Beneficiary program, Specified Low-Income Medicare Beneficiary program, and Qualifying Individual program the same as the resource limits for individuals who qualify for the full low-income subsidy under the Medicare prescription drug coverage program. This MIPPA provision does not apply to the Qualified Disabled Working Individual program.

MSPs are administered by the States. Unless the beneficiary refuses on the Extra Help (also known as low income subsidy or LIS) application, data from the Extra Help determination will be sent daily (except Saturdays, Sundays, and holidays) to the appropriate state Medicaid agency to begin the MSP application process.

Regarding interviewing and filing procedures for Extra Help, see instructions

HI 03010.005 Interviewing for Medicare Part D Extra Help

HI 03010.010 Filing Applications

Social Security is also not sending data to the state Medicaid agency if the beneficiary is already deemed (see HI 03001.005A for definition of deemed) for LIS, or the application received is a duplicate, or the LIS application was denied because the beneficiary was not a US resident.

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.

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:

If a beneficiary requests an MSP application, check the Medicare Application Processing System (MAPS).

If listed in MAPS, check the effective filing date of the Extra Help application.

If the application was effectively filed on or after January 1, 2010, and the applicant did not refuse data referral to the state, explain that the Extra Help application was also an application for MSP and that the beneficiary should hear from the state soon.

If the beneficiary still requests current status, refer the beneficiary to the state medical assistance office (Medicaid).

If MAPS shows the beneficiary refused data referral to the state or the Extra Help application was effectively filed before January 1, 2010, explain the Medicare Savings Programs and refer the beneficiary to the State Health Insurance Counseling and Assistance Program (SHIP) for more information. You can use this language “Beneficiaries can obtain assistance through their State Health Insurance Counseling and Assistance Program. SHIP telephone contact information is on the back of the Medicare & You handbook or may be accessed by selecting the state at Medicare.gov/talk-to-someone or through SSA’s web site located at www.ssa.gov/benefits/medicare/prescriptionhelp/

If the beneficiary is on the phone and not listed in MAPS, ask if you can refer them for an Extra Help application (or mail an application).

If the beneficiary is in the field office offer to complete an application for Extra Help. Explain that unless they tell us otherwise, the Extra Help application will start the MSP process with their state. Also, explain the MSP benefits to the beneficiary. For more information about MSP, see HI 00815.025.

If a beneficiary calls and wants an MSP application (regardless of whether they want to file an Extra Help application), ask if they have computer access.

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  If yes, explain that an application is available in English and also available in 10 other languages at SSA.gov . They can scroll down on the right side, where the forms are located under “Additional Resources,” and click on “Medicare Savings Programs Model Application for Premium Assistance," or they can scroll down the middle and click on “The Official Government Site for People with Medicare.”

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  If no, or the individual wants the application from SSA, print the model application in the appropriate language from SSA.gov and mail it.

The available languages are English, Arabic, Chinese, French, Haitian-Creole, Farsi, Korean, Spanish, Tagalog, Russian, and Vietnamese.

Even if the state uses a different MSP application form from the model forms on SSA’s web pages, when the state receives this form from the beneficiary it will start the MSP application process.

Refer beneficiaries to their state Medicaid agency for any inquiries concerning the status of their MSP application.

HI 03001.001 Description of the Medicare Part D Prescription Drug Program

HI 03001.005 Medicare Part D Extra Help (Low Income Subsidy or LIS)

HI 00801.131 Eligibility for Premium-HI

HI 00801.139 QMB Provisions

TC 23001.050 Qualified Medicare Beneficiaries (QMB)

TC 23001.060 Specified Low-Income Medicare Beneficiaries (SLMB)

TC 23001.070 Qualifying Individual 1 (QI1)

MSOM INTRANETMEDQ 001.001 Medicare Query System (MEDQ)