The cost of Medicare benefits in the form of premiums, coinsurance, copayments and deductibles can raise concerns about affordability, especially when you are on a limited income. For Medicare recipients under a certain income and asset level, Medicare benefits can be cost prohibitive. A Medicare Savings Program (MSP) is designed to cover all or part of Medicare out-of-pocket expenses that encumber Medicare recipients who live within limited financial means.

Types of Medicare Savings Programs

There are currently four programs that fall under the MSP umbrella:

  • Qualified Medicare Beneficiary (QMB) Program for Part A and/or Part B premiums.
  • Specified Low-Income Medicare Beneficiary (SLMB) Program for Part B premiums.
  • Qualifying Individual (QI) Program for Part B premiums.
  • Qualified Disabled and Working Individuals (QDWI) Program for Part A premiums.

If your application for the QMB Program is accepted, you will receive a QMB card. Be sure to show this card along with your Medicare or Medicaid card every time you receive healthcare services. You will also receive a Medicare Summary Notice (MSN), which is proof of being in the program and shows the healthcare provider you should not be billed for services, deductibles, coinsurance or copayments. An exception is outpatient prescriptions. Sometimes, Medicare recipients are billed in error and mistakenly pay for covered Medicare benefits or services beyond their responsibility. In that case, Medicare can assist in securing a refund.

Qualifying for a Medicare Savings Program

The 2020 MSP Program income limits are approximately as follows:

  • QMB: Under $1,061 per individual or $1,430 per couple.
  • SLMB: Under $1,269 per individuals or $1,711 per couple
  • QI: Under $1,426 per individual or $1,923 per couple.
  • QDWI: Under $4,249 per individual or $5,722 per couple.

Program asset limits:

  • QMB, SLBM, QI: Up to $7,730 per individual or $11,600 per couple.
  • QDWI: Up to $4,000 per individual or $6,000 per couple.

The amounts above can be used as a ballpark, but keep in mind that Medicare Savings Programs are managed at the state level. Therefore, it is best to contact your State Medical Assistance Office to validate the criteria. States may establish their own threshold of income and resources, and may apply a different calculation to decide if someone is eligible. Additionally, the cutoff point may be higher for people who earn an income.

Reaching out for help
Other types of support for which you can apply include Medicaid, State Pharmacy Assistance Programs, Pharmaceutical Assistance Programs, Programs of All-Inclusive Care for the Elderly, and Supplemental Security Income. Check with the resources in your state for more detailed information.

Related articles:

How Do Medicare Benefits and Medicaid Work Together?(Opens in a new browser tab)

What Does Medicaid QMB Cover?(Opens in a new browser tab)