How A Medicare Savings Program Can Help Lower Your Costs

Some people are hesitant to sign up for Medicare because they don’t think they can afford the monthly premiums. Or they qualify for premium-free Medicare Part A at 65, but don’t enroll in Part B or any Medigap plans. If you’re low-income and either disabled or approaching retirement age, there are four Medicare savings programs you should know about. Learn the income and asset limits for each and how to apply for financial assistance in your state below.

How Medicare Savings Programs Decide Who Qualifies for Financial Assistance

If you’re low-income enough and have few countable resources, then you may qualify for one or more Medicare savings programs. In addition, those approved for the first three Medicare savings programs automatically qualify for “Extra Help” paying prescription drug costs. In 2021, Extra Help beneficiaries pay no more than $3.70/generic and $9.20/brand-name prescriptions covered under Medicare Part D.

Financial holdings that each program will review and count towards your total asset limit when you apply include:    

• How much money you have in your bank accounts (i.e., checking, savings)
• Stocks
• Bonds

Things you own that will not count towards your total asset limit for Medicare savings programs include:

• Your home (if you own it)
• One vehicle used for your primary household transportation needs
• Your furniture and other household or personal items (i.e., appliances, bedding, clothes, dishes, wedding rings)
• A burial plot as well as up to $1,500 put aside specifically to cover your burial expenses

Every Medicare savings program has a different income and asset limit you must fall under to qualify. That said, all four programs use the same list of assets when estimating the value of each applicant’s countable resources.

1. Qualified Medicare Beneficiary (QMB) Program Eligibility Guidelines

Once your state’s QMB program approves your application, no Medicare provider should bill you for any medical services or items. You must still pay for prescription medications covered under Medicare Part D, but at a reduced cost. In 2021, pharmacies cannot charge QMB Program beneficiaries more than $4 for any prescription drug covered under Medicare Part D.

What It Helps Pay For:

• Part A monthly premiums
• Part B monthly premiums
• Annual deductibles for Original Medicare
• Coinsurance and copayments, when applicable

2021 Income & Resource Limits:

• $1,094 in monthly income for individuals (applicants in Alaska or Hawaii may earn slightly more and still qualify)
• $7,970 or less in total countable resources for individual applicants
• $1,472 in monthly income per married couple (couples in Alaska or Hawaii may earn slightly more and still qualify)
• $11,960 or less in combined countable resources for married couples who apply

2. Specified Low-Income Medicare Beneficiary (SLMB) Program Eligibility Guidelines

This state-run program covers Medicare Part B premiums for people with limited income and resources who already have Part A.

What It Helps Pay For:

• Part B monthly premiums only

2021 Income & Resource Limits:

• $1,308 in monthly income for individuals (applicants in Alaska or Hawaii may earn slightly more and still qualify)
• $7,970 or less in total countable resources for individual applicants
• $1,762 in monthly income per married couple (couples in Alaska or Hawaii may earn slightly more and still qualify)
• $11,960 or less in combined countable resources for married couples who apply

3. Qualifying Individual (QI) Program Eligibility Guidelines

Much like the SLMB Program, the QI Program only helps pay Part B premiums for low-income people with Part A. However, the QI Program operates more like a grant since it only provides financial assistance for one year. As a result, you must re-apply for QI Program benefits annually, and states prioritize applications from the previous year’s beneficiaries. In addition, people who currently qualify for Medicaid coverage cannot get QI benefits in any U.S. state.

What It Helps Pay For:

• Part B monthly premiums only

2021 Income & Resource Limits:

• $1,469 in monthly income for individuals (applicants in Alaska or Hawaii may earn slightly more and still qualify)
• $7,970 or less in total countable resources for individual applicants
• $1,980 in monthly income per married couple (couples in Alaska or Hawaii may earn slightly more and still qualify)
• $11,960 or less in combined countable resources for married couples who apply

4. Qualified Disabled and Working Individuals (QDWI) Program Eligibility Guidelines

The QDWI Program is the only Medicare savings program that specifically helps working disabled applicants younger than 65. To qualify for your state’s QDWI Program benefits, all the following must be true before you apply:

• You previously received Social Security disability benefits and premium-free Medicare Part A, but lost both when you started working again
• You’re younger than 65 and earn a working wage
• Your state doesn’t currently provide you with any medical assistance
• You can meet your state’s asset and income limits for this year (see amounts listed below)

What It Helps Pay For:

• Part A monthly premiums only

2021 Income & Resource Limits:

• $4,379 in monthly income for individuals (applicants in Alaska or Hawaii may earn slightly more and still qualify)
• $4,000 or less in total countable resources for individual applicants
• $5,892 in monthly income per married couple (couples in Alaska or Hawaii may earn slightly more and still qualify)
• $6,000 or less in combined countable resources for married couples who apply

To start your application for a Medicare savings program in your state, call 1-800-MEDICARE today.