Medicare premiums and out-of-pocket costs can take a big bite out of a fixed income. Medicare Savings Programs are designed to help. They are run by each state's Medicaid program. Even the most basic help, paying your Part B premium, is worth about $200 a month. Many people who would qualify never apply, often because they assume their income is too high or that they own too much.
The four programs
Qualified Medicare Beneficiary (QMB). The most generous program. It pays:
- Your Part A premium, if you have one.
- Your Part B premium.
- Medicare deductibles, coinsurance and copays for covered services.
Providers who accept Medicare are not allowed to bill people in the QMB program for Medicare-covered services.
Specified Low-Income Medicare Beneficiary (SLMB). Pays your Part B premium.
Qualifying Individual (QI). Pays your Part B premium. Funding is limited, so applications are approved on a first-come, first-served basis, and you must reapply each year.
Qualified Disabled and Working Individuals (QDWI). Pays the Part A premium for certain people under 65 with disabilities who returned to work.
Who qualifies
Each program has income and resource limits based on the federal poverty level, and many states set more generous limits than the federal minimum. Some states, including New York, Arizona and Connecticut, have no resource limit for some or all programs.
Things to know about the limits:
- Income limits for the Part B premium programs range up to about 135% of the federal poverty level, and higher in some states.
- Some income does not count, and the first $20 a month of most income is usually ignored.
- Your home, one car, household belongings and burial funds generally do not count as resources.
Because of these rules, people with incomes somewhat above the published limits may still qualify. If you are close, apply.
How to apply
- Contact your state Medicaid office. You can apply online, by mail, by phone or in person in most states.
- Gather documents: your Medicare card, proof of income such as your Social Security benefit letter, bank statements and proof of address.
- Ask for help if you need it. Your State Health Insurance Assistance Program, or SHIP, can help with the application for free. See how SHIP counseling works.
When you apply through Social Security for Extra Help, Social Security also sends your information to your state to start a Medicare Savings Program application, unless you ask it not to.
What happens after approval
- Your Part B premium will stop being deducted from your Social Security payment, usually within a few months, and you may receive a refund for months already paid.
- If you are in QMB, show your Medicare and Medicaid or QMB cards to providers so they know not to bill you.
- Report changes in income or resources, and renew when your state asks.
Not sure where to start?
The National Council on Aging's free BenefitsCheckUp tool can screen you for Medicare Savings Programs and dozens of other programs in a few minutes. Our guide to finding benefits you may qualify for explains how to use it.
