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Medicare Savings Programs


By: CalMedicare.org

Overview

There are several Medicare Savings Programs that help people with low income and asset levels pay for health care coverage.

You must meet certain income and asset limits to qualify for these programs. Note that the income limits listed are for people with unearned incomes (people who are no longer working). People with earned incomes (who are working) are allowed higher income limits when qualifying for Medi-Cal or Medicare Savings Programs. Contact your county Department of Social Services for more information.

The asset limits are the same for all programs. Your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $4,000 for an individual or $6,000 for married couples. Exclusions include a home, household goods and personal belongings, one car, a life insurance policy up to a cash value of $1,500 per person, a prepaid burial plan (unlimited if irrevocable; up to $1,500 if revocable), and a burial plot. For six months after receipt, retroactive Social Security or SSI benefits are also excluded. The value of these items is not calculated into your personal asset limit.

Qualified Medicare Beneficiary (QMB)

The Qualified Medicare Beneficiary (QMB) program helps people whose assets are not low enough to qualify them for Medi-Cal.

For QMB, your monthly income cannot exceed $798 if you are single. If married, a couple's monthly income cannot exceed $1,070. (April 1, 2005 - March 31, 2006)

QMB pays for the following:

  • Medicare Part A premium for those who do not receive it automatically because they are not eligible for Social Security. (The premium is $206 or $375 per month in 2005, depending on the number on Social Security quarters earned).*
  • Medicare Part B premium ($78.20 per month in 2005)
  • Deductibles for both Part A and Part B. The Part A (hospital inpatient) deductible is $912 per benefit period (2005). The Part B annual deductible is $110 in 2005.
  • Co-insurance under both Parts A and B.

For example, under Part A, QMB would pay the $912 first-day hospital deductible, the $228 per day for hospital days 61-90, and the $456 per day (in 2005) for the 60 hospital reserve days. Part B Medicare coverage pays 80% of physician and outpatient expenses, and QMB would pay the remaining 20% co-insurance, as long as the person sees doctors and other providers that accept Medi-Cal.

* Note: Most people do not have to pay a Medicare Part A premium. But if you are not entitled to receive Medicare Part A for free, you may benefit the most from the QMB program because QMB pays this premium, which is $375 per month in 2005. (Medi-Cal does not pay the Part A premium.)

Specified Low-income Medicare Beneficiary (SLMB)

The Specified Low-income Medicare Beneficiary (SLMB) program helps low-income persons by paying their Medicare Part B premiums ($78.20 per month in 2005). These premiums would otherwise be deducted from their Social Security checks.

For SLMB, your monthly income cannot exceed $957 if you are single. If married, a couple's monthly income cannot exceed $1,283. (April 1, 2005 - March 31, 2006)

Qualified Individual 1 (QI-1)

The Qualified Individual 1 (QI-1) program helps low-income people by paying their Part B premiums ($78.20 per month in 2005).

For QI-1, your monthly income cannot exceed $1,077 if you are single. If married, a couple's monthly income cannot exceed $1,444. (April 1, 2005 - March 31, 2006)

Qualified Disabled Working Individual (QDWI)

The Qualified Disabled Working Individual (QDWI) program is available to people who had Social Security and Medicare because of disability, but who have lost their Social Security benefits and free Medicare Part A because they returned to work and their earnings exceed the limit allowed.

QDWI pays the Part A premium ($375 per month in 2005); it does not pay the Part B premium.

For QDWI, your monthly income cannot exceed $1,595 if you are single. If married, a couple's monthly income cannot exceed $2,139. (April 1, 2005 - March 31, 2006)

Note: Add $20 to each of the monthly amounts listed above to determine the actual income limit. Since applicants are allowed a $20 disregard from any income before their income is measured against the federal poverty levels. Couples only get one $20 disregard.

How to apply for Medicare Savings Programs

If you think you qualify under any of the Medicare Savings Program categories, you can apply for help with your Medicare costs.

To enroll in QMB, SLMB, QI-1, or QDWI, you must also be eligible to receive Medicare Parts A and B.

If you are already on Medicare, contact your county Department of Social Services to apply for QMB, SLMB, QI-1, or QDWI benefits. Applications for the Medicare Savings Programs are processed through the county offices.

If you are not on Medicare, apply at any Social Security office and state in writing that you are applying for conditional Medicare under one of the Medicare Savings Programs. Once you become eligible for Medicare, you should follow up with your county's Department of Social Services to apply for QMB, SLMB, QI-1, or QDWI benefits or to verify your application status. (Medi-Cal recipients do not need to complete a new application.)

The rules for these programs can be complicated. If you need help, contact your local Health Insurance Counseling and Advocacy Program (HICAP) at (800) 434-0222.