Medicare Savings Program basics

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 income and savings. There are three main programs, each with different benefits and eligibility requirements.*

1. Qualified Medicare Beneficiary (QMB): Pays for Medicare Parts A and B premiums. If you have QMB, typically you should not be billed for Medicare-covered services when seeing Medicare providers or providers in your Medicare Advantage Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan’s network network A network is a group of doctors, hospitals, and pharmacies that contract with a Medicare Advantage Plan to provide health care services. Generally, plan members will have the lowest costs when using providers and facilities in the plan’s network. Networks may be made up of both preferred and non-preferred providers. .
2. Specified Low-Income Medicare Beneficiary (SLMB): Pays for Medicare Part B premium.
3. Qualifying Individual (QI) Program: Pays for Medicare Part B premium.

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

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Get Help Applying for Medicare Cost-Savings Programs

If you live in New York, the Medicare Rights Center can help you enroll in various Medicare cost-savings programs. Please answer a few questions to see if we can connect you with a trained benefits enrollment counselor.

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If your monthly income is below $2446 (or below $3299 if married) you may qualify for several Medicare cost-savings benefit programs. The following information will help us determine which programs you might be eligible for.

What is your marital status? * Please select your marital status Married Single Married and living separately Divorced Widowed

What is your average monthly income? * Please include the combined monthly household income of you and your spouse Income examples Common sources of countable income include; gross Social Security benefits, pension, VA benefits, employment income, IRA distributions, etc.

In addition to Medicare, do you have Medicaid? (Optional) Please select your Medicaid status Yes No

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Contact your local State Health Insurance Assistance Program

Each state offers a SHIP, partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.

Visit www.shiptacenter.org to find your local SHIP office.

Find Your Local SHIP

Contact your local State Health Insurance Assistance Program

Based on the information you provided, you do not appear to be eligible for Medicare cost-saving programs.

[glossary_exclude]Each state offers a State Health Insurance Assistance Program (SHIP), partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.[/glossary_exclude]

Visit www.shiptacenter.org to find your local SHIP office.

Find Your Local SHIP

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A trained counselor from the Medicare Rights Center will be in touch soon to discuss your options.

Click here to learn more about the various Medicare cost-savings programs.

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To qualify for an MSP, you must have Medicare Part A and meet income and asset guidelines (note that these guidelines vary by state, and some states do not count assets assets Assets are resources such as savings and checking accounts, stocks, bonds, mutual funds, retirement accounts, and real estate. when determining MSP eligibility). If you do not have Part A but meet QMB eligibility guidelines, your state may 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.

Remember, states use different rules to count your income and assets to determine if you are eligible for an MSP. Examples of income include wages and Social Security benefits you receive. Examples of assets include checking accounts and stocks. Certain income and assets may not count when determining your MSP eligibility. And some states do not have an asset limit.

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 the fourth MSP and pays for the Medicare Part A premium. To be eligible for QDWI, you must:

• Be under age 65
• Be working but continue to have a disabling impairment
• Have limited income and assets
• And, not already be eligible for Medicaid