Medicare Savings Programs

Medicare Savings Program

What are the Medicare Savings programs (MSPs)?

There are three different programs: QMB, SLMB and QI. They are programs that pay the Medicare premiums for people with limited incomes who otherwise might not be able to afford Medicare.

QMB pays for Part A and B premiums and the others pay for Part B premiums. They are part of federal Medicaid, administered by the state Medi-Cal agency.

How does one apply?

  • People with full Medi-Cal are usually automatically enrolled in QMB if eligible.
  • Everyone else must complete a paper application and submit it to the County Medi-Cal processing office in Concord. HICAP has applications and envelopes.

What are the criteria for qualifying?

  • Individuals must be eligible for, although not necessarily enrolled in, both Medicare A and B. It’s possible to apply for Medicare via SSA while also applying for the MSP program at the County.
  • Asset limits for the MSPs are higher than for Medi-Cal and are the same for all three MSPs ($7280 single, $10,930 married).  If monthly withdrawals of principal and interest are being taken, tax qualified accounts (IRAs, 401Ks, etc.) are not counted as assets although the withdrawals are counted as income.
  • Income criteria varies; see chart below.  Only half of earned income, less $65,  is included in countable income.
  • Income is gross income, before the Part B premium is deducted from their social security check.
  • Unlike for Medi-Cal, people can’t “spend down” their countable income by buying other health insurance such as dental, etc.

Medicare Savings Programs income limits for 2016:

 Program  Income Limits
 Qualified Medicare Beneficiary (QMB)  $1,010 single; $1356 couple
 Specified Low Income Beneficiary (SLMB)  $1,208 single; $1,622 couple
 Qualified Individual (QI)  $1,357 single; $1,823 couple

What are the other benefits?

  • All programs automatically provide full Extra Help for Part D, also known as the Low Income Subsidy (LIS), for drug costs for the year.
  • Recipients can change drug or Medicare Advantage plans monthly.

QMB

  • This is the only program that pays the Part A premium.
  • It also pays the Part B premium and all deductibles and copays, including Medicare Advanatage plan copays.  Although it is against the law for providers to bill QMB recipients for Medicare deductibles and co-pays, it may be best to use providers who take both Medicare and Medi-Cal.
  • Allows immigrants and others with very low incomes who don’t qualify for free Part A to get it.
  • Someone can conditionally apply for Part A contingent upon being approved for QMB.
  • Those with Medi-Cal should still get QMB if they don’t get free Part A because only QMB, not Medi-Cal, pays the Part A premium.
  • Automatically eligible for Extra Help for Part D.
  • Can change drug or Medicare Advantage Plans in any month.

SLMB and QI

  • Only pays Part B premium. Does not pay for any other Part B coinsurance or for Part A.  QI program allows a slightly higher income.
  • Can change drug and Medicare Advantage plans in any month.
  • Automatically eligible for Extra Help for Part D.

 

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