Not all clients have the income and resources available to afford the entirety of their Medicare plan. That’s where Medicare Savings Programs (MSPs) can step in to help out.
MSPs — federally funded and administered by state Medicaid agencies — can assist in paying Medicare premiums, deductibles, coinsurance and copayments.
Your clients may qualify for financial assistance through one of these programs, and they might not even know it. General requirements include:
- Age 65+
- Live in any of the 50 states or Washington, D.C.
- Meet income and resource requirements (varies by program and state, see below)
- Receive Social Security disability benefits
- Have certain disabilities or permanent kidney failure
The 4 Medicare Savings Programs
There are four types of MSPs, and income and resource requirements vary for each of them.
When it comes to income limits, if your clients live in Alaska or Hawaii, their limits will be a bit higher than what’s listed below. It’s also important to note that someone can still qualify for these programs if they’re currently working and their income is higher than what’s listed.
As for resource limits, these only include money in a checking or savings account, as well as any stocks and bonds a person may hold. Other resources like houses, cars, furniture or other common assets won’t be considered.
For full details on requirements and coverage, click here — but here’s a quick breakdown of each of the four MSPs:
Qualified Medicare Beneficiary (QMB) Program
The QMB program can help pay for premiums for Medicare parts A and B, as well as deductible, coinsurance and copayments for things covered by Medicare.
- Individual monthly income limit: $1,094
- Married couple monthly income limit: $1,472
- Individual resource limit: $7,970
- Married couple resource limit: $11,960
Specified Low-Income Medicare Beneficiary (SLMB) Program
The SLMB program is meant to help with Medicare Part B premiums only.
- Individual monthly income limit: $1,308
- Married couple monthly income limit: $1,308
- Individual resource limit: $7,970
- Married couple resource limit: $11,960
Qualifying Individual (QI) Program
The QI program covers only Part B premiums, as well, with some additional caveats. Clients will need to apply each year for the program, and they won’t receive QI benefits if they also qualify for Medicaid. Benefits for the QI program are granted on a first-come, first-served basis — and repeat recipients are given priority.
- Individual monthly income limit: $1,469
- Married couple monthly income limit: $1,980
- Individual resource limit: $7,970
- Married couple resource limit: $11,960
Qualified Disabled and Working Individuals (QDWI) Program
The QDWI only covers Medicare Part A premiums for those who are working with a disability and have lost prior benefits because of returning to work.
- Individual monthly income limit: $4,379
- Married couple monthly income limit: $5,892
- Individual resource limit: $4,000
- Married couple resource limit: $6,000
How To Apply for Medicare Savings Programs
If your client has Medicare Part A or they’re eligible for it, they could already qualify for an MSP. Check out the income and resource limits listed above to determine whether your client’s are at or below the given amounts.
If they think they could qualify for Medicare savings with an MSP, they can contact their state’s Medicaid program to begin the application process. As a bonus: Once they’re enrolled in an MSP, they’ll automatically get Part D Extra Help, which can help pay prescription drug plan costs.
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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.
