Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs or Medicare Premium Payment Programs, help pay your Medicare costs if you have limited income and savings. There are four main programs, each with different benefits and eligibility requirements.
Qualified Medicare Beneficiary (QMB) Program
The Qualified Medicare Beneficiary (QMB) is a Medicare Savings Program that pays for the Medicare Part A premium and the Medicare Part B premium. The program also pays Medicare cost-sharing expenses, including deductibles, coinsurance, and copayments.
If you qualify for QMB, you automatically qualify for the Extra Help prescription drug program to save on out-of-pocket expenses for your medications.
You must be eligible for or currently enrolled in Medicare Part A to apply for the QMB Medicare Savings Program.
Specified Low-Income Medicare Beneficiary (SLMB) Program
Those who earn a little more than the maximum QMB income requirement may qualify for the Specified Low-Income Medicare Beneficiary (SLMB) Program, which helps pay for Medicare Part B premiums. This Medicare Savings Program does not pay other cost-sharing expenses or Medicare Part A premiums, but it does allow you to have a higher income. Like QMB, if you qualify for the SLMB Program, you automatically qualify for the Extra Help prescription drug program as well.
Qualifying Individual (QI) Program
The Qualifying Individual (QI) Program is another level of the Medicare Savings Program. If you don’t qualify for QMB or SLMB, you might try applying for the QI Medicare Savings Program instead. This program pays for Medicare Part B premiums and automatically qualifies you for the Extra Help prescription drug program. Be aware that you must reapply each year for these benefits. Also, program funding is limited, so benefits are available on a first-come, first-served basis, and priority is given to individuals who received QI benefits the previous year. If you qualify for Medicaid, you cannot receive QI benefits.
Qualified Disabled and Working Individuals (QDWI) Program
The Qualified Disabled and Working Individuals (QDWI) Program is different from the other three Medicare Savings Programs. Unlike the other programs, QDWI only pays for Medicare Part A premiums. You may qualify for this program if any of the following apply:
- You returned to work and, as a result, lost your premium-free Medicare Part A coverage.
- You’re disabled, under 65, and currently working.
- You aren’t currently getting state medical assistance.
- You meet the income and resource requirements for your state.
If you enroll in an MSP, you will automatically get Extra Help as well, the federal program that helps pay your Medicare prescription drug (Part D) plan costs.
To qualify for an MSP, you must have Medicare Part A and meet income and asset guidelines (note that these guidelines vary by state, and some states do not count assets when determining MSP eligibility). If you do not have Part A but meet QMB eligibility guidelines, your state may have a process to allow you to enroll in Part A and QMB. Many states allow this throughout the year, but others limit when you can enroll in Part A.
Remember, states use different rules to count your income and assets to determine if you are eligible for an MSP. Examples of income include wages and Social Security benefits you receive. Examples of assets include checking accounts and stocks. Certain income and assets may not count when determining your MSP eligibility. And some states do not have an asset limit.
If your income or assets seem to be above the MSP guidelines, you should still apply if you need the help.