Life After 50 Expo

Dear Marci,

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Dear Marci,

I was at a health fair recently where someone told me that I might qualify for a Medicare Savings Program to help me save on Medicare costs. What is the Medicare Savings Program?

-Vernon (Bend, OR)

Dear Vernon,

Medicare Savings Programs (MSPs) are state programs that assist you with paying your Medicare costs. These costs include premiums, deductibles, coinsurance charges, and copayments for Part A and Part B. there are three main programs, each with different benefits and eligibility requirements*:Qualified Medicare Beneficiary (QMB): Pays for Medicare Parts A and B premiums. If you have QMB, typically you should not be billed for Medicare-covered services when seeing Medicare providers or providers in your Medicare Advantage Plan’s network.Specified Low-income Medicare Beneficiary (SLMB): Pays for Medicare Part B premium.Qualifying Individual (QI) Program: Pays for Medicare Part B premium.If you enroll in an MSP, you will automatically get Extra Help, 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.

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 you MSP eligibility. And some states do not have an asset limit.
If your income and assets seem to be above the MSP guidelines, you should still apply if you need the help.

*Qualified Disabled Working Individual (QDWI) is the fourth MSP and pays for the Medicare Part A premium. To be eligible for QDWI, you must:Be under age 65Be working but continue to have a disabling impairmentHave limited income and assetsAnd, not already by eligible for Medicaid.To learn if you qualify for an MSP, contact your State Health Insurance Assistance Program (SHIP). A SHIP counselor can help you find out if your income and assets are under your state’s limits for an MSP. The names of these programs may vary by state, and MSPs are not available in Puerto Rico and the U.S. Virgin Islands. To contact your SHIP, call 877-839-2675 or visit www.shiptacenter.org.

-Marci

Dear Marci,

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Dear Marci,

My Part B premium is difficult for me to afford each month. I called Medicare to ask about help paying for this, and they told me to apply for a Medicare Savings Program. What is a Medicare Savings Program?

– Emma (Jackson, MS)

Dear Emma,

A Medicare Savings Program (MSP) is an assistance program that can help pay for your Medicare costs if you have limited finances. MSPs may also be called Medicare premium assistance programs or Medicare buy-in programs.

There are three main types of MSPs. Each program has certain income and asset limits in order to qualify for them.

  1. Qualified Medicare Beneficiary (QMB) pays yourMedicare Part B premium, as well as your Medicaredeductibles, coinsurances, and copayments. Although most people get Part A for free, some individuals must pay a Part A premium. QMB also helps pay the Part A premium. You can qualify for QMB even if you qualify for Medicaid.
  2. Specified Low Income Medicare Beneficiary (SLMB)pays your Medicare Part B premium. You can qualify for SLMB even if you qualify for Medicaid.
  3. Qualifying Individual (QI) pays your Medicare Part B premium. You cannot have both QI and Medicaid.

In addition, all three MSPs allow you to enroll in Medicare outside of the formal Medicare enrollment periods. They also waive any late enrollment Part B premium penalties that you may have. When you have an MSP, you also automatically qualify for Extra Help, the federal assistance program that helps to pay Medicare prescription drug costs.

To qualify for an MSP, you must have Medicare Part A and meet certain income and assets guidelines. If you do not have Part A but meet QMB eligibility guidelines, your state should 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.

Keep in mind that you should still apply for an MSP if you need the help even if your income seems slightly above your state’s income and asset guidelines. This is because states use different rules to count your income and assets to determine your eligibility for an MSP. Certain income or assets may not count, and some states do not have an asset limit. Know that you cannot choose which MSP you receive, but are assigned to one of the three MSPs based on your income and assets. To learn about MSPs in your state and to find out where to apply, contact your State Health Insurance Assistance Program (SHIP) or your local Medicaid office. You can find the contact information for your SHIP by going towww.shiptacenter.org or by calling 877-839-2675.

-Marci