Could I be eligible for a government program other than Medicaid to help with my health care costs (Medicare Savings Programs)?

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Yes. Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs or Medicare Premium Payment Programs, help pay your Medicare costs if you have limited finances. There are three main programs, and each has different income eligibility limits.

  1. Qualified Medicare Beneficiary (QMB): Pays for Medicare Part A and B premiums, deductibles and coinsurances or copays. If you have QMB, you will have no coinsurance or copayment for Medicare-covered services you get from doctors who participate in Medicare or Medicaid or are in your Medicare Advantage plan’s network.
  2. Specified Low-income Medicare Beneficiary (SLMB): Pays for Medicare's Part B premium.
  3. Qualifying Individual (QI) Program: Pays for Medicare's Part B premium.

Medicare Savings Program Financial Eligibility Guidelines by State

If you enroll in an MSP, you will also automatically get Extra Help, the federal program that helps pay most of your Medicare prescription drug (Part D) plan costs.

To qualify for an MSP, you must have Medicare Part A and meet income and assets guidelines. If you do not have Part A but meet QMB eligibility guidelines, your state will have a process to allow you to enroll in Part A and QMB. Many states allow this throughout the year, but others limit when you can enroll in Part A.

States use different rules to count your income (money you take in, for example, Social Security payments that you get or wages that your earn) and assets (resources such as checking accounts, stocks and some property) to determine if you are eligible for an MSP. Certain income or assets may not count. Some states do not have an asset limit.

For this reason, if your income or assets seem to be above the MSP guidelines, you should still apply if you need the help.

Qualified Disabled Working Individual (QDWI) is a less common MSP that pays for the Medicare Part A premium. To be eligible for QDWI, you must:

  • be under the age of 65;
  • be working but continue to have a disabling impairment;
  • have limited income and resources; and
  • not already be eligible for Medicaid.

 

 

 

 

 

 


Case Examples
Ms. L qualified for a Medicare Savings Program but never received the benefit.

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Are there any hospitals or health facilities that offer care at a reduced cost?

Should I apply for a Medicare Savings Program if I am over the income limit?

What do I have to pay for services covered under Medicare Part A?

Medicare Part B costs

Government programs that can help pay for health care and prescription costs

My income is low. Are there programs that can help pay for my prescriptions?

Extra Help: Assistance paying for the Medicare drug benefit

 
LINKS
Medicaid-covered Benefits By State

State Health Insurance Assistance Program (SHIP) Directory

State Medicaid Programs

 
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