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What Is a Medicare Savings Program?

The Medicare Savings Program (MSP) is a federal program that provides financial relief to Medicare beneficiaries with limited incomes. It can help pay for premiums and many out-of-pocket medical expenses. Not everyone will qualify for the MSP as it is based on income and resources or assets. In addition, there are three different MSP classes that pertain to retired Medicare beneficiaries.

Today, we’ll discuss what it takes to qualify for each MSP and what each one covers. Plus, we’ll briefly introduce Medicare Advantage DSNP plans, which are specifically designed for people who are enrolled in a Medicare Savings Program.

Qualified Medicare Beneficiary (QMB)

QMB is the highest level of financial assistance within the MSP program. If you qualify for QMB, it will pay your Part B premium (and your Part A premium if it applies to you). It will also cover all medical deductibles, coinsurance, and copayments. In addition, anyone who qualifies for QMB automatically qualifies for the Extra Help program, which reduces prescription drug costs.

Medicare providers are not allowed to bill QMB enrollees for any covered cost-sharing amounts under Original Medicare (Parts A and B). To prevent billing errors, it’s best to present your QMB card at each doctor’s visit. If errors continue, enrollees can contact the Medicare program directly, who will then reach out to the provider’s office to resolve the situation.

Eligibility Requirements

Requirements to qualify for the QMB program often change every year. As of 2022, the requirements are as follows:

  • Individual monthly income no more than $1153
  • Married couple’s monthly income no more than $1546
  • Individual resources no more than $8400
  • Married couple’s resources no more than $12,600

Specified Low-Income Medicare Beneficiary (SLMB)

The next level within the MSP is the SLMB. This program does not offer as much financial assistance as the QMB level does. The only thing it pays for is the Part B premium. Those who qualify for SLMB also receive Extra Help.

Eligibility Requirements

As of 2022, the eligibility for SLMB is as follows:

  • Individual monthly income no more than $1379
  • Married couple’s monthly income no more than $1851
  • Individual resources no more than $8400
  • Married couple’s resources no more than $12,600

Qualified Individual (QI)

QI and SLMB are similar in the fact that they both pay the Part B premium. They are different in their eligibility requirements and one other important aspect. QI members must reapply every year. Plus, applications are considered on a first-come, first-served basis. Individuals who were enrolled in QI the previous year are given priority.

People who are also enrolled in their state’s Medicaid program are not eligible for the QI program. Lastly, these individuals are also eligible for Extra Help.

Eligibility Requirements

As of 2022, the eligibility for QI is as follows:

  • Individual monthly income no more than $1549
  • Married couple’s monthly income no more than $2080
  • Individual resources no more than $8400
  • Married couple’s resources no more than $12,600

Medicare Savings Programs and Medicare Advantage

Some Medicare Advantage (Part C) plans are designed specifically for people who are eligible for Medicare and Medicaid. These plans are called D-SNPs, which stands for Dual-Eligible Special Needs Plans.

Every insurance company has its own requirements when it comes to DSNP enrollment. Some only take one type of MSP, while others offer their plans to several levels. If you qualify for a D-SNP in your area, they can be another great way to reduce your out-of-pocket costs and offer extra benefits not found in either Medicare or Medicaid.

How to Apply for the Medicare Savings Program

Before applying, try to determine if you think you’d qualify. Income limits are based on all income sources, including Social Security benefits. Resources can be a bit more tricky to determine. They include any money you have in your checking accounts, savings accounts, and retirement accounts like a 401k, annuity, CDs, stocks, bonds, etc. States do not include your home, one car, burial plots, furniture, and other household items, and up to $1500 for burial expenses.If you think you may qualify for one of these programs, you can apply online through your state’s Medicaid website or contact them by phone. You can also chat with a Local Medicare Specialist to determine if you might be eligible for one of these programs.

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