If you are on a fixed income, you may be able to get Extra Help with the high cost of health care. A Medicare Savings Program can pay deductibles, coinsurance, and other expenses that aren’t ordinarily covered by Medicare.
A related program called Extra Help offsets the cost of prescriptions.
In the context below, we’ll discuss everything you need to know about the Medicare Savings Program and Extra Help.
Understanding the Medicare Savings Programs
There are four kinds of savings programs, or MSPs, each tailored to a different set of circumstances:
- Qualified Medicare Beneficiary, or QMB, pays most of your out of pocket costs, including deductibles, copays, and premiums for Part B, and the premium for Part A, if you have one. If you qualify for the QMB Medicare program, you are also automatically eligible for the Extra Help program for prescriptions.
- Specified Low-Income Medicare Beneficiary, or SLMB, pays your Part B premium. It also automatically qualifies you for Extra Help.
- Qualified Individual, also known as QI or ALMB, offers the same benefits as the SLMB Medicare program, but you can qualify for benefits with a higher income.
- Qualified Disabled and Working Individual, or QDWI, pays the monthly Part A premium for a qualified individual with a disability or another individual who is working and ineligible for free Part A coverage.
What are the Income Limits for Extra Help in 2020
The Medicare Savings Program is for people with a limited income and few resources. Monthly income and assets determine eligibility.
The income limits to qualify for MSP benefits in 2020 are:
- QMB — less than $1,061 in monthly income, or $1,430 for a couple.
- SLMB — less than $1,269, or $1,711 for a couple
- QI — less than $1,426 for an individual or $1,923 for a couple
- QDWI — less than $4,249 for an individual or $5,722 for a couple.
Even if your income is low enough, you cannot qualify if you have too many assets, such as bank accounts, investments, and retirement accounts. Some assets aren’t considered when calculating eligibility, including your house, car, furniture, personal possessions, and burial plot.
- To qualify for QMB, SLMB, and QI, you cannot have more than $7,730 in assets ($11,600 for a couple).
- To qualify for QDWI, your assets must be less than $4,000 for an individual ($6,000 for a couple).
Because these programs are administered at the state level, different states may calculate income, assets, and eligibility somewhat differently.
To be eligible for Extra Help with Medicare Part D in 2020, an individual must have an income of less than $19,140, or a married couple would have an income of $25,860 for the year. If you qualify for Medicaid or the Medicare Savings Program, you automatically qualify for Extra Help.
Extra Help With Your Medicare Prescription Drug Plan Costs
You may also qualify for Extra Help with Medicare if your income is less than $18,735 for an individual or $25,365 for a couple.
Getting Extra Help with your Part D plan can:
- Reduce your out of pocket costs for prescription drugs
- Eliminate your monthly Part D premiums
- Reduce or eliminate your annual Part D deductibles
- Eliminate the coverage gap, also known as the “donut hole.” This means your prescriptions won’t cost more just because you went over a spending limit in a particular year
How to Save Even More with a Medicare Supplement
If you qualify for a Medicare Savings Program or Extra Help, you’ll save money on your out-of-pocket Medicare costs. To save even more, you can add supplemental coverage to your Medicare Parts A and B coverage.
For example, if you qualify for the SLMB or QI program, the program will pick up the cost of your monthly premium for Part B.
Pairing a Medicare Supplement plan with your Medicare Savings program is an excellent way to protect yourself from high medical bills because of a chronic condition or unexpected illness or accident.
State-Specific Name Conventions for their MSPs
- Alaska: QI is called SLMB Plus
- Connecticut: QI is called ALMB
- Maryland: QI is called SLMB II
- North Carolina: QMB, SLMB, and QI are called MQB, MQB-B, and MBQ-E respectively
- Nebraska: Federal QMB is replaced with full Medicaid. SLMB and QI are referred to as QMB
- New Hampshire: QI is called SLMB-135
- Oregon: SLMB and QI are called SMB and SMF respectively
- Wisconsin: QI is called SLMB Plus
How to Apply for Medicare Savings Programs
You need to ask yourself three questions:
- Do you have limited resources below the above-listed income limits?
- Are you eligible for Part A?
- Is your income at or below the above-listed income limits?
If you answered yes to all three questions, you could call your state Medicaid program to see if you qualify for a Medicare Savings Program.
Medicare Extra Help Application
At MedicareFAQ, we can help you find the best Medicare Supplement policy for your situation and your budget. Compare rates online now, or call the number above to speak to a Medicare agent.