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Low-Income Subsidies and Medicare


Those on Medicare with a low income may qualify for a subsidy to help cover the costs of medical care and medications. Even if you don’t qualify for Medicaid, you may be eligible for one of these programs. Although, if you do qualify for Medicaid, you’re automatically eligible for Extra Help. Below, we answer the most frequently asked questions about low-income subsidy benefits and Medicare.

Medicare and Low-Income Subsidy Eligibility

It’s possible to be eligible for both Medicare and Medicaid. Additionally, financial help is offered is through the Medicare Low-Income Subsidy (LIS). This program is known as Extra Help and assists with Part D prescription drug plan costs. Also, LIS enrollees are exempt from the prescription drug coverage donut hole.

How Do I Qualify for Medicare Low-Income Subsidy?

To be eligible you must have Medicare and a lower income. Assets must be below a certain amount as well. Some people may find they’re ineligible for Medicaid, yet still eligible for Low-Income Subsidy.

Low-Income Subsidy (LIS / Extra Help)

If eligible for any of the below programs, you qualify for a Low-Income Subsidy:

  • Qualified Medicare Beneficiary (QMB)
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Qualifying Individual (QI)

Otherwise, income and resource limits apply. If your income and resources are above the limits, but you think you may still qualify for a LIS, you should still apply.

Income limits are $19,140 for an individual and $25,860 for a married couple. There are levels of assistance you can receive from a LIS, depending on your need. You could qualify for partial assistance based on your assets. See the chart below for limits.

2022 LIS Resource Limits
Applicant(s) Resource Limit Resource Limit
with Burial Expenses
Individual (Full) $8,400 $9,900
Married Couple (Full) $12,600 $15,600
Individual (Partial) $14,010 $15,510
Married Couple (Partial) $27,950 $30,950

Applying for Medicare Low-Income Subsidy

Social Security or your State Medicaid office will determine your eligibility for a Low-Income Subsidy. Yet, if you’re denied, you’ll receive a Pre-Decisional Notice, explaining why you aren’t eligible.

Then, you have ten days to correct the information. Social Security will send you a Notice of Award, explaining your level of coverage. If you don’t meet the qualifications, you’ll get a Notice of Denial.

If you disagree with the denial, you have 60 days from the time of rejection to request an appeal hearing. You can ask for a case review, and you may send in any other information you feel is pertinent.

Depending on how your hearing goes, you’ll get a notice for approval or denial. If you still disagree, you can appeal to the Federal District Court.

Help with Medicare Premiums – QMB Program

If you’re struggling to pay your premiums, you should apply for a QMB program. Keep in mind that this program is called MQB in North Carolina and replaced with Medicaid in Nebraska.

A QMB program pays your premiums for Part A and Part B, your annual deductible for Part B, and coinsurance and deductibles for Part A services. It’s the most comprehensive MSP available, so its income and resource limits are the lowest. Please note that 2021 limits are not yet available and this content will but updated when they are.

2021 QMB Resource and Monthly Income Limits
Applicant(s) Resource Limit Monthly Income Limit
Individual $7,970 $1,094
Married Couple $11,960 $1,472

Help with Part B Premium – SLMB Program

An SLMB pays your Part B premium. It’s called an MQB-B in North Carolina, QMB in Nebraska, and SMB in Oregon. This program covers less than a QMB, and the income limits are higher. Please note that 2022 limits are not yet available and this content will but updated when they are.

2021 SLMB Resource and Monthly Income Limits
Applicant(s) Resource Limit Monthly Income Limit
Individual $7,970 $1,308
Married Couple $11,960 $1,762

Annual Help with Part B Premium – QI Program

Like the SLMB program, a QI program pays your Part B premium. However, the difference is that you can qualify for a QI program with a higher income, but you need to apply each year. You would have priority for these benefits if you received them the previous year.

Please note that there are differences in this program name in several states and 2021 limits are not yet available and this content will but updated when they are.

2021 QI Resource and Monthly Income Limits
Applicant(s) Resource Limit Monthly Income Limit
Individual $7,970 $1,469
Married Couple $11,960 $1,980

Help with Part A Premium for Working Beneficiaries Under 65 – QDWI Program

A QDWI program is available for disabled individuals under age 65 who are working. This program pays for monthly Part A premiums. The monthly income limits are higher for this type of program than the others, and resource limits are the lowest. Unlike the above three MSPs, you don’t automatically qualify for a LIS with a QDWI. Additionally, please note that 2021 limits are not yet available and this content will but updated when they are.

2021 QDWI Resource and Monthly Income Limits
Applicant(s) Resource Limit Monthly Income Limit
Individual $4,379 $4,379
Married Couple $5,892 $5,892

Part D Premium Benchmark Amounts and Low-Income Subsidies

Those who qualify for a LIS should note the premium benchmark for Part D prescription drug plans in their state. These dollar amounts change each year.

If you select a plan that charges a premium less than the benchmark amount for your state and you’re eligible for a LIS, you should be able to enroll in the plan without paying a monthly premium. Should the monthly premium for the plan you select exceed the benchmark premium amount, your LIS will have you pay the difference between your (larger) premium and the benchmark amount.

Supplemental Security Income (SSI)

In contrast to Social Security retirement benefits, SSI benefits are available to those with limited income and resources who are over 65, blind, or disabled. Social Security taxes do not fund SSI. Instead, its funding comes from U.S. Treasury general funds. In essence, SSI intends to help people pay for their basic needs.

To determine whether you’re eligible, use the Benefit Eligibility Screening Tool. Individuals who are disabled or blind can complete an online application. If you’re over 65, you cannot apply online. Instead, call the toll-free number for Social Security or visit your local Social Security office.

If you’re eligible for SSI, you will likely be eligible for Medicaid in your state. Being Medicaid-eligible will qualify you to have your state pay your Medicare premiums. Additionally, you will be entitled to Extra Help.

How to Get Help with Medicare Low-Income Subsidies

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

12 thoughts on “Low-Income Subsidies and Medicare

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