Healthcare costs can be a super significant burden for many, especially those on a fixed income, such as retirees. Medicare provides essential health coverage, but it doesn’t cover everything, and out-of-pocket expenses can add up quickly. Fortunately, there are Medicare Savings Programs (MSPs) designed to help low-income individuals reduce their healthcare costs. These programs can provide significant savings by assisting with Medicare premiums, deductibles, copayments, and coinsurance.
In this blog, we’ll explore what Medicare Savings Programs are, who qualifies, and how they can help you save money on your healthcare expenses.
What Are Medicare Savings Programs (MSPs)?
Medicare Savings Programs are state-run programs that assist eligible individuals with paying for various Medicare costs. These programs are designed for people who have limited income and resources, making it easier for them to afford Medicare’s Part A (hospital insurance) and Part B (medical insurance) expenses.
There are 4 types of Medicare Savings Programs, each tailored to help people with different levels of income. These programs are:
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individuals (QDWI) Program
Each program has specific eligibility requirements and offers varying levels of financial assistance. Contact Weller Insurance Services for a detailed consultation.
Qualified Medicare Beneficiary (QMB) Program
The QMB program offers the most comprehensive financial assistance. It helps pay for Medicare Part A and Part B premiums, as well as deductibles, copayments, and coinsurance. Essentially, if you qualify for this program, you can avoid almost all out-of-pocket costs related to Medicare services.
Eligibility:
- You must have limited income and resources. As of 2024, the income limit for an individual is around $1,153 per month, and for couples, it’s $1,546 per month.
- The resource limit is $9,090 for an individual and $13,630 for a couple. Resources include things like savings, stocks, and bonds but do not include your home, car, or personal belongings.
How it helps: The QMB program ensures that you don’t have to pay Medicare Part A and B premiums or any out-of-pocket costs like deductibles or coinsurance, making healthcare almost free for those who qualify.
Specified Low-Income Medicare Beneficiary (SLMB) Program
The SLMB program is designed for individuals with slightly higher income than those eligible for the QMB program. It provides help with paying the Medicare Part B premium, which covers outpatient care, doctors’ services, and other medical services.
Eligibility:
- The income limit is slightly higher than the QMB program. As of 2024, an individual must have an income of less than $1,379 per month, while a couple’s income limit is $1,851 per month.
- The resource limit is the same as the QMB program, $9,090 for individuals and $13,630 for couples.
How it helps: The SLMB program will pay your Part B premium, helping you save on monthly costs related to medical services.
Qualifying Individual (QI) Program
The QI program also helps pay for Medicare Part B premiums, but unlike the QMB and SLMB programs, funding for QI is limited and applications are approved on a first-come, first-served basis. Those with higher incomes than the QMB and SLMB thresholds but who still struggle with healthcare costs may qualify.
Eligibility:
- The income limit for individuals is $1,549 per month, and for couples, it’s $2,080 per month in 2024.
- The same resource limits apply: $9,090 for individuals and $13,630 for couples.
How it helps: Similar to the SLMB program, the QI program covers your Medicare Part B premium, but it’s important to apply early since funds are limited.
Qualified Disabled and Working Individuals (QDWI) Program
The QDWI program is specifically designed to help disabled individuals who are under 65 and lost their Medicare Part A coverage due to returning to work. It helps by paying for Medicare Part A premiums.
Eligibility:
- To qualify, your monthly income must be no more than $4,615 for an individual or $6,189 for a couple in 2024.
- Resource limits are $4,000 for individuals and $6,000 for couples.
How it helps: The QDWI program assists in covering the Part A premium, which can be especially beneficial for those who need to continue working but have lost Medicare Part A benefits due to employment.
How to Apply for Medicare Savings Programs?
Applying for Medicare Savings Programs is relatively straightforward. Since these programs are administered by each state’s Medicaid office, you’ll need to apply through your state’s specific program. You can do this by contacting your state Medicaid office directly or by visiting their website.
Here are the steps to apply:
- Check your eligibility: Review the income and resource limits for the Medicare Savings Program that you might qualify for.
- Gather necessary documents: You’ll likely need to provide proof of income, resources, and Medicare enrollment when you apply.
- Submit your application: Apply through your state Medicaid office, either online, by mail, or in person.
- Await approval: Once your application is submitted, your state Medicaid office will determine your eligibility and notify you of approval.
How Medicare Savings Programs Can Help You Save?
For those who qualify, Medicare Savings Programs can provide substantial financial relief by:
- Covering the cost of Medicare Part A and Part B premiums
- Reducing or eliminating out-of-pocket expenses for deductibles, copayments, and coinsurance
- Freeing up funds for other necessary living expenses, such as housing, groceries, or prescriptions
- Providing a safety net to ensure access to essential healthcare services without the stress of overwhelming medical bills
Additionally, we suggest reading out “AEP vs. OEP Medicare: Understanding the Key Differences and Making the Right Choice.”
Additional Savings Through Extra Help
Many people who qualify for Medicare Savings Programs also qualify for the Extra Help program, which assists with Medicare Part D (prescription drug) costs. Extra Help can reduce your monthly premiums, deductibles, and copayments for medications, providing even more savings.
Final Thoughts
Medicare Savings Programs (MSPs) are a lifeline for individuals who may struggle to afford healthcare costs. If you meet the income and resource requirements, these programs can help cover premiums, deductibles, and other out-of-pocket expenses, ensuring you get the healthcare you need without the financial strain.
If you think you may qualify, don’t hesitate to contact your state’s Medicaid office to apply. With the right program, you could save hundreds, if not thousands, of dollars each year on healthcare costs.
By taking advantage of Medicare Savings Programs, you can reduce your financial burden, improve your access to healthcare, and focus on living a healthier life.
