Medicare savings programs

and Part D Extra Help

Original Medicare does not cover all healthcare costs, but there are four Medicare Savings Programs that can help offset expenses and are designed to pay for additional costs like deductibles, co-insurance and premiums.

Medicare Part D Extra Help pays for prescription drug costs and qualification for Savings Programs and Part D Extra Help is based on a combination of income and countable resources. Let us walk you through each.

What Do Medicare Savings Programs Cover?

Medicare Savings programs help pay Medicare Part A, or hospice insurance and Medicare Part B, or medical insurance.

To qualify for the following programs, you must meet certain income requirements as well as adhere to other criteria. However, even if you earn more than the income limits, you may still be eligible to enroll. If you believe you may qualify for something detailed below, be sure to contact the number provided to you at Medicare.gov.

Types of Savings Programs

Qualified Medicare Beneficiary Program (QMBP)

msp-pd-01

The Qualified Medicare Beneficiary Program provides payment for the following: Medicare Part A monthly premiums if they are applicable, Medicare Part B monthly premiums and the annual deductible, co-insurance and deductibles for services Medicare Parts A and B covers. In order to qualify for QMB, the applicant must:

  • Be eligible for Medicare Part A (doesn’t have to be enrolled)
  • Have a monthly income at or below 100% of the federal poverty level
  • Use the Low-Income Subsidy asset test, which is indexed each year, of $6,000 per individual and $9,000 per couple
  • Comply with individual states, which may change these amounts

Specified Low-Income Medicare Program (SLMB)

msp-pd-02

The Specified Low-Income Medicare Program provides payment for the following: Medicare Part B monthly premium only. In order to qualify for SLMB, the applicant must:

  • Be eligible for Medicare Part A (doesn’t have to be currently enrolled)
  • Have a monthly income between 100% through 120% of the annual federal poverty level. This level is changed in the beginning of each year.
  • Use the Low-Income Subsidy asset test, which is indexed each year, of $6,000 per individual and $9,000 per couple
  • Comply with individual states, which may change these amounts

Qualifying Individual Program (QI)

msp-pd-03

The Qualifying Individual Program provides payment for the following: Part B monthly premium only. In order to qualify for SLMB, the applicant must:

  • Have incomes between 120% through 135% of the annual federal poverty level. This level is changed in the beginning of each year.
  • Use the Low-Income Subsidy asset test, which is indexed each year, of $6,000 per individual and $9,000 per couple
  • Apply for these benefits on an annual basis
  • Comply with individual states, which may change these amounts
  • Apply early to ensure obtainment, as eligible applicants are served on a first come, first served basis

This program gives priority to those who have been enrolled in the program the previous year.  It began as an expansion of the SLMB, but with a limited number of funds per state. QI is not available to applicants who qualify for any other Medicaid.

Qualified Disabled and Working Individuals Program (QWDI)

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The Qualified Disabled and Working Individuals Program provides payment for the following: Medicare Part A premiums. It pays for hospital insurance premiums for disabled individuals who have returned to the work force. In order to qualify for QWDI, the applicant must:

  • Be ineligible for free Medicare Part A, as they had a cease for disability benefits due to working above the SGA limit.
  • Be ineligible for Medicaid
  • Be under age 65
  • Comply with individual states, which may change these amounts
  • Have incomes of 200% or more than the annual federal poverty level. This level is changed in the beginning of each year.

This program is for people in the higher income bracket as opposed to the other 3. Although the QWDI program pays for Medicare Part A premiums, it does not cover deductibles and co-payments in Part A. It also does not pay anything towards Part B.

2016 Medicare Savings Programs Income & Resource Limits

saving-programSavings Program qmbpQMBP slmbSLMB qi
QI
qwdiQWDI
Monthly Income Limit $1,010 $1, 208 $1,357 $4,045
Couple Monthly Income Limit $1,355 $1, 622 $1,622 $5,425
Individual Resource Limit $7,280 $ 7,280 $7,280 $4,000
Married Resource Limit $10,930 $10,930 $10,930 $6,000

 

Countable Resource Limits

Resources are checked when applying for any of the four Medicare savings programs. The ones counted towards eligibility include:

  • Money in the bank (checking or savings account)
  • Bonds
  • Stocks

Resources that aren’t included in your resource assessment:

  • Your place of residence
  • One vehicle
  • Your burial value
  • Money saved for burial expenses
  • Furniture
  • Household items: clothes, jewelry, appliances

Medicare Part D Extra Help

What is Part D Extra Help?

With rising costs of prescription drugs, many Medicare beneficiaries are finding it difficult to pay for these medically necessary supplies.

“In 2015, drug costs for qualified people were approximately $2.65 for generics and $6.60 per brand-name covered drug. In 2016 those costs are about $2.95 and $7.40, respectively.”

When faced with such a circumstance, you can apply for the Medicare Part D Extra Help program, a low-income subsidy. This program is intended for low-income Medicare members who need assistance paying for Medicare Part D prescription drug expenses.

What Does It Cover?

The beneficiaries of Extra Help do not have to pay for any gaps in prescription drug coverage, which is also known as the Medicare Donut Hole. Instead, they get coverage in paying their Part D monthly premium, which includes the annual deductible, co-payments, and co-insurance. The amount of subsidy the beneficiary receives depends on income in relation to the Federal Poverty Level, as well as their resource limitations.

Eligibility

To be eligible for Medicare Part D Extra Help, you must:

  • Have an income and assets below the eligibility thresholds, which change yearly
  • Have an income higher than the eligibility limit and you support family members in your household, or
  • Live in Alaska or Hawaii

https://www.ehealthmedicare.com/about-medicare/savings-programs/?redirectFromHTTP
https://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html


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