Eligible individuals for Medicare savings programs.
The Medicare Savings Programs (MSPs) are state-administered initiatives designed to support low-income Medicare beneficiaries with out-of-pocket healthcare costs, such as premiums, coinsurance, copays, and deductibles. These programs are crucial for individuals who struggle to meet the financial burden of Medicare expenses.
There are four main types of MSPs, each with distinct benefits and eligibility criteria:
1. **Qualified Medicare Beneficiary (QMB)**: This program covers the cost of Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments for those with an income up to about 138% of the Federal Poverty Level (FPL). The resource limit for an individual is $9,660, and for a married couple, it is $14,470 in 2025.
2. **Specified Low-Income Medicare Beneficiary (SLMB)**: SLMB helps pay for Medicare Part B premiums only. Eligibility requirements include an income between 138% and 150% FPL, and the resource limit for an individual is $9,660 in 2025.
3. **Qualified Individual (QI)**: QI also covers Medicare Part B premiums only. Eligibility requirements include an income between 150% and 175% of the FPL, and the resource limit for an individual is $9,660 in 2025.
4. **Qualified Disabled and Working Individuals (QDWI)**: This program helps a person pay Medicare Part A premiums for certain disabled working individuals under age 65. Eligibility requirements include being disabled, currently working, and having income and assets below specified limits.
In addition to these programs, it's essential to note that resources such as a primary home, vehicle, furniture, personal and household items, a pre-paid burial plot, and a burial plan allowance of $1,500 do not count towards the limit. Resources counting towards the resource limit include money in bank accounts, stocks, and bonds.
It is also important to note that if someone qualifies for Medicaid, they cannot get assistance from the QI program. People with a Medicare Advantage plan, in the QDWI program, or in a Medigap plan cannot also get Extra Help benefits.
MSPs typically require the beneficiary to be enrolled in Medicare Part A or Part B to qualify (except the QDWI program, which targets specific disabled workers). Most MSP enrollees automatically qualify for *Extra Help* with Medicare Part D prescription drug costs.
Eligibility income and asset limits vary by state, and some states do not count assets at all in eligibility determinations. The QMB program can be combined with full Medicaid or with Medicaid that has spenddown requirements depending on income and assets.
To apply for these programs, individuals typically contact their state Medicaid agency, and application processing can take 45 to 90 days. People must reapply annually for MSP benefits, and people who were in a program the previous year are given priority. Medicare Savings Program benefits are allocated on a first-come-first-served basis.
In 2025, the maximum copays for prescription drugs under the Extra Help program are $4.90 for generic drugs and $12.15 for brand-name drugs.
In summary, these programs offer crucial financial assistance to Medicare beneficiaries with limited income and resources, helping reduce the cost burden of Medicare premiums and other related expenses according to the program type and eligibility.
- Individuals who qualify for the QMB program may find themselves eligible for assistance with Medicare Part D prescription drug costs known as Extra Help.
- For eligible individuals residing in states that do not count assets in eligibility determinations, the QMB program can be combined with full Medicaid or Medicaid that has expenditure requirements.
- Applicants for these programs typically contact their state Medicaid agency, and it may take 45 to 90 days for the application processing.
- In contrast to the other MSPs, the QDWI program targets specific disabled workers and assists them with Medicare Part A premiums, regardless of whether they are enrolled in Medicare Part A or Part B.
