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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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Last Update: December 21, 2009

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 co-pays. 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 private health 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.
  4. To find out what costs are under Medicare Parts A and B, click on the link in the GO TO box.

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.

    For more information about Extra Help, click on the links in the GO TO box.

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.

    For more information about enrolling in Part A and QMB, contact your local State Health Insurance Assistance Program (SHIP). For your SHIP’s contact information, click on the link in the LINKS box.

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.

    To find out more about applying if you are over the income guidelines, click on the link in the GO TO box.

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.
For more information about the MSPs, contact your local Medicaid office or your state’s SHIP. For Medicaid and SHIP contact information, click on the links in the LINKS box.

For more information about government programs that can help you pay for your health care, click on the link in the GO TO box.

For more information about hospitals and health care facilities that offer care at a reduced cost, click on the link in the GO TO box.

For more information on programs that can help pay for your prescriptions, click on the GO TO box.


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

Mr. and Mrs. O’s Medicare Savings Program application was denied.

Related Questions
Can I avoid the Part B premium penalty if I did not enroll in Medicare when I was first eligible and do not have health coverage?

Can my state give me more rights and protections than federal Medicare law?

I have a disability and am going back to work. What happens to my Medicare and Social Security benefits?

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GO TO
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?

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

I have Medicare. Are there government programs that can help me pay for my health care and prescription costs?

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

Will I get help paying for the Medicare drug benefit if my income is low (Extra Help)?

 
LINKS
Medicaid-covered Benefits By State

State Health Insurance Assistance Program (SHIP) Directory

State Medicaid Programs

 
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