Need help paying for Medicare-related costs? You may qualify for a Medicare Savings Program.


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Understanding "Extra Help" and Medicare Savings Programs



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About Medicare Savings Programs

If you need help paying for Medicare-related costs, you may be eligible for a Medicare Savings Program (MSP). There are four main kinds of MSPs. All four provide different levels of coverage, and all four have different eligibility requirements. Eligibility is mostly based on your income and your Medicare coverage. Read on to learn more about MSPs, then reach out to Medicare Plan Finder if you need help with your application.

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Click the links below to learn more about MSPs:

Qualifying for Medicare Savings Programs (MSPs)

To qualify for a MSP, you have to be enrolled in Original Medicare (or at least Medicare Part A) first. Then, whether or not you qualify is based on your income and resources*, otherwise known as “assets.”

Even if you think you do not qualify, it is worth applying. Food stamps (SNAP) do not count towards your monthly income, so you can deduct that when looking at your eligibility. Additionally, to find what is actually counted for your monthly wages, subtract $65 and then divide that number in half. That number is what your state will consider your “monthly wage.” You can also subtract $20 from your overall monthly income (including wages and all other sources of income). View the sections below to discover whether or not you qualify.**

*Hawaii and Alaska residents may be able to qualify with slightly higher income and reosurce limits than the continental United States based on employment.

**Alabama, Arizona, Connecticut, Delaware, Mississippi, New York, Oregon, Vermont, and Washington D.C. do not have asset limits in 2019.

What Counts as a Resource or Asset?

The term “resources” can be misleading. In the case of MSPs, resources, or assets, refer to stocks, bonds, and money that you have stowed away in the bank (both checkings and savings accounts). Assets do NOT include physical property such as cars, houses, and other property.

QMB Program (Qualified Medicare Beneficiary Program)

The QMB program covers Medicare Part A and Part B premiums, deductibles, coinsurance, and co-payments. You will not recieve reimbursement for any payments you made before your QMB effective date. You will not recieve a bill from Medicare after your QMB effective date. If you recieve Social Security benefits, your Part B premium will be covered by QMB and will no longer be deducted from your Social Security check. Requirements in 2019 are:

  • Single monthly income of $1,061 or less
  • Married monthly income of $1,430 or less
  • Single resources of $7,730 or less
  • Married resources of $11,600 or less
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QI Program (Qualifying Individual Program)

The QI program covers the Medicare Part B premium. If you recieve Social Security benefits, your Part B premium will be covered by QI and will no longer be deducted from your Social Security check. When you start recieving QI, you may reimbursed for your Part B premiums from up to three months before your QI effective date. Uniquely, QI is awarded on a first-come, first-serve basis and is not awarded to anyone who has Medicaid. You must reapply every year. Requirements in 2019 are:

  • Single income of  $1,426 or less
  • Married income of $1,923 or less
  • Single resources of $7,730 or less
  • Married resources of $11,600 or less

SLMB Program (Specified Low-Income Medicare Beneficiary Program)

The SLMB program covers the Medicare Part B premium only. You may recieve reimbursement for up to three months of Part B premium payments from before your SLMB effective date. If you recieve Social Security benefits, your Part B premium will be covered by SLMB and will no longer be deducted from your Social Security check. Requirements in 2019 are:

  • Single income of $1,269 or less
  • Married income of $1,711 or less
  • Single resources of $7,730 or less
  • Married resources of $11,600 or less

QDWI Program (Qualified Disabled and Working Individuals Program)

The QDWI program covers the Medicare Part A premium only. It is only available to those who are working and disabled (under 65), or those who returned to work and therefore lost their premium-free Part A eligibility. Additionally, QDWI is not available to anyone with state medical assistance (mainly Medicaid). Requirements in 2019 are:

  • Single income of $4,249 or less
  • Married income of $5,722 or less
  • Single resources of $4,000 or less
  • Married resources of $6,000 or less
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Qualifying for Extra Help

If you qualify for QMB, SLMB, or QI, you will also automatically qualify for LIS, or Low-Income Subisides. The LIS program is commonly referred to as “Extra Help.” It provides additional assistance for prescription drug plan costs like Part D premiums, deductibles, coinsurance, and co-payments.

Medicare Savings Programs Application Process

When you apply for MSPs, you will apply for all of the MSP programs listed above at the same time. If your application is approved, you will be automatically enrolled in the program that most aligns with your qualifications.

When you apply, you may need legal documentation such as your Social Security card, your Medicare card, your birth certificate (or passport/green card), and proof of your address and income. If you have qualifying assests and resouces, you may need proof for those as well (bank statements, life insurance policies, stocks, etc.). The Medicare Savings Program Application is actually different in every state, because the programs are tied directly to Medicaid, which is state-funded. Most states will actually allow you to apply for Medicaid, MSPs, and other health care and financial programs all at the same time.

After you file a Medicare Savings Program application, you should recieve a “Notice of Action” within 45 days. This notice will tell you whether or not you have been approved. If you are denied, you can request a hearing. If you are approved, your benefits will begin on the month indicated on your Notice of Action (usually the following month). However, if you do not hear within 45 days, contact your state Medicaid office to be sure that your application was not lost.

To apply, click here. Then, click on your state. When you've reached your state's Medicaid page, search for "Medicare Savings Program."

Have Questions? Request Information On Local Options

Need Help?

Our licensed agents can help you apply for savings programs that you may be eligible for. Then, they can help you enroll in Medicare Advantage, Medicare Supplements, Prescription Drug Plans, and even Medicare Special Needs Plans for those eligible. To get started, complete the form above or give us a call at 833-438-3676.

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