Medicare Savings Program

Medicare Savings Programs (MSPs) are Medicaid-administered programs for people on Medicare who have limited income and resources. These programs help those qualified to afford Medicare. If eligible, QMB will cover the Medicare premiums (Part A, if applicable, and Part B), deductibles, copayments and/or coinsurance.

Who qualifies for a Medicare Savings Program
  • Are age 65 or older 
  • Receive Social Security Disability benefits
  • People with certain disabilities or permanent kidney failure (even if under age 65)
  • Meet standard income and resource requirements.
Income Limits for Medicare Savings Programs

Effective March 2020

   Income  Resources
Program Individual  Couple Individual  Couple
Qualified Medicare Beneficiary - QMB
(Income between 0-100% FPL)
$1,083 $1,457 $7,860 $11,800
Specified Low-Income Medicare Beneficiary - SLMB I
(Income between 100-120% FPL)
$1,296 $1,744 $7,860 $11,800
Qualified Individual - QI
(Income between 120-135%
$1,456 $1,960 $7,860   $11,800

 

Medicare Savings Programs
Qualified Medicare Benefit (QMB)

The QMB program helps you pay for Medicare costs if you have lower income and resources. 

Specifically, the program pays for:

  • your Medicare Part A deductible
  • your Medicare Part B deductible and monthly premiums
  • other coinsurance and copay costs associated with Medicare Part A and Part B coverage

Extra Help: 

If you qualify for the QMB program, you’ll also qualify for extra help. This is a program that helps to pay for the costs associated with a Medicare prescription drug plan (Medicare Part D). Extra Help covers things like:

  • monthly premiums
  • deductibles
  • copays for prescriptions

Some pharmacies may still charge a small copay for prescriptions that are covered under Part D. For 2020, this copay is no more than $3.60 for a generic drug and $8.95 for each brand-name drug that is covered.

Extra Help only applies to Medicare Part D. It doesn’t cover premiums and costs associated with Medicare Part C (Medicare Advantage) or Medicare supplement insurance (Medigap) plans.

Specified Low-Income Medicare Beneficiary (SLMB)

Specified Low-Income Medicare Beneficiaries (SLMB) is a Medicaid program that will cover your Medicare Part B premiums if you have limited resources, an income below the poverty line, and are already receiving Medicare Part A.

People who qualify as an SLMB do not have to pay the Medicare Part B premium themselves, as Medicaid pays it instead. And these beneficiaries are also automatically eligible for Extra Help paying for Part D prescription coverage.

Extra Help: 

If you qualify for the SLMB program, you’ll also qualify for extra help. This is a program that helps to pay for the costs associated with a Medicare prescription drug plan (Medicare Part D). Extra Help covers things like:

  • monthly premiums
  • deductibles
  • copays for prescriptions

Some pharmacies may still charge a small copay for prescriptions that are covered under Part D. For 2020, this copay is no more than $3.60 for a generic drug and $8.95 for each brand-name drug that is covered.

Extra Help only applies to Medicare Part D. It doesn’t cover premiums and costs associated with Medicare Part C (Medicare Advantage) or Medicare supplement insurance (Medigap) plans.

Qualifying Individual (QI)

The Qualifying Individual (QI) Program is one of the four Medicare Savings Programs that allows you to
get help from your state to pay your Medicare premiums. This Program helps pay for Part B premiums
only.