Unlocking the Secrets of Medicare Savings Programs for Those 65+

Turning 65 is a milestone for starting Medicare health coverage. But Medicare costs like premiums, deductibles, and coinsurance can strain your budget. Fortunately, the Medicare Savings Programs exist to help qualifying seniors 65+ reduce these expenses. This guide will unlock these little-known but secret Medicare programs.

What Are Medicare Savings Programs?

Medicare Savings Programs help pay Medicare premiums, deductibles and copayments for beneficiaries with limited income and resources. They include:

  • Qualified Medicare Beneficiary (QMB): Helps pay Original Medicare Part A and Part B premiums, deductibles and coinsurance.
  • Specified Low-Income Medicare Beneficiary (SLMB): Helps pay Part B premiums.
  • Qualifying Individual (QI): Helps pay Part B premiums for those who qualify.
  • Qualified Disabled and Working Individual (QDWI): Pays Part A premiums for qualifying disabled individuals under age 65.

When you enroll in Medicare, these programs are administered by states following federal rules and adhering to the enrollment period. To qualify when you sign up for Medicare, you must meet certain income and asset limits that vary by state. Your state health insurance assistance program can detail eligibility guidelines for your area.

Savings from joining these Medicare Savings Programs can be significant. For 2022, the Part B standard premium is $170.10 but QMB recipients have this fully covered. This results in over $2,000 in annual savings from reduced Medicare expenses for just Medicare enrollment.

Eligibility for Medicare Health Savings Programs?

Eligibility and benefits available depend on your income, resources (savings, stocks, etc.), and household size for the state you live in. Here are the federal monthly income limits as of 2023 to qualify for each program:

  • QMB: Individuals $1,153 or less. Couples $1,546 or less.
  • SLMB: Individuals $1,379 or less. Couples $1,851 or less.
  • QI: Individuals $1,549 or less. Couples $2,080 or less.
  • QDWI: Individuals $4,615 or less.

Your countable resources must be below $8,400 for QI or $7,970 for other programs. Not all resources are counted so check specific guidelines.

If your income hovers near these ranges, you may still qualify by deducting medical expenses when applying. States can set higher limits too. Use the programs’ resource tests and your state’s income limits to see if you’re eligible.

How to Enroll in Medicare Savings Programs

Applying for a Medicare Savings Program involves submitting an application to your state Medicaid office. Here are some tips to streamline the process:

  • Contact your State Health Insurance Assistance Program (SHIP) to verify you meet eligibility and get help applying.
  • Collect financial statements like bank accounts and IRS tax returns to document income and resources.
  • Be ready to provide household size, Social Security numbers for those on your tax return and proof of legal U.S. residency.
  • Apply online through your state Medicaid portal if available or submit paper applications.
  • Make sure to apply within 3 months of becoming eligible for Medicare to get the most savings.
  • If approved, re-verify your Medicaid eligibility each year as required to stay enrolled. Report any changes that may affect eligibility like increased income.

Assistance programs can guide you through gathering records, filling out applications correctly and determining the right Medicare Savings Program for your situation.

4 Key Medicare Savings Programs

Here is an overview of the four main Medicare Savings Programs and how they work:

QMB – Pays Medicare Premiums, Deductibles & Coinsurance

The Qualified Medicare Beneficiary program provides the most savings. QMB helps pay:

  • Medicare monthly premiums for Part A and/or Part B based on eligibility
  • Yearly Medicare Part A and Part B deductibles
  • Medicare Advantage Plan part c has limit on out-of-pocket costs
  • All Medicare coinsurance and copays after meeting deductibles

With QMB, there is no cost to you for Medicare-covered services. You also get automatic enrollment into Extra Help for Part D prescription drug coverage with reduced costs.

SLMB – Covers Part B Premiums

The Specified Low-Income Medicare Beneficiary program helps pay for one major expense:

  • Your standard monthly Part B premium ($170.10 in 2022)

While not as comprehensive as QMB, the Part B premium is one of the larger Medicare expenses, so SLMB can still save you a meaningful amount each year.

QI – Pays Part B Premiums for Those Near Limits

The Qualifying Individual program also pays for Part B premiums like SLMB. But it has higher income limits ($1,549 monthly for individuals) so you can earn more and still qualify.

Because QI has limited funding, states pay premiums on first come, first served basis. Apply quickly once the program year starts to secure savings.

QDWI – Covers Part A for Disabled Individuals

Lastly, Qualified Disabled and Working Individuals helps pay Medicare Part A premiums for certain disabled adults under 65. You must meet work requirements to qualify.

While not for seniors, QDWI helps younger disabled Medicare recipients keep Part A premiums affordable as they work.

Partner Programs for Extra Savings

Those eligible for Medicare Savings Programs also qualify for Extra Help from Social Security to pay for prescription drugs.

Extra Help can save over $5,000 annually on costs like premiums and copays. Plus there is no “donut hole” coverage gap while enrolled.

You also automatically qualify for subsidies under Part D Low-Income Subsidy Benchmark Premium plans with premiums covered up to the benchmark amount.

Pairing Medicare Savings Programs with Extra Help and Benchmark plans provides multiple layers of savings on top of Medicare coverage.

Unlocking the Secrets for Medicare Health care Costs Savings

Now you can unlock the secrets of Medicare Savings Programs! Here’s a quick recap:

  • Four programs help pay premiums, deductibles and coinsurance if income and resources are below set limits
  • Household size and your state determine eligibility requirements
  • Apply through your State Medicaid Office or State Health Insurance Assistance Program
  • Partner with Extra Help and Benchmark plans for added prescription drug savings

Don’t leave money on table by missing out on Medicare Savings Programs. See if you qualify and apply for these “secrets” to save on costs.

FAQS

What is the enrollment period for Medicare?

Most people can enroll in Medicare during the 7-month open enrollment period that begins 3 months before their 65th birthday, includes their birthday month, and ends 3 months after their 65th birthday. There are also special enrollment periods for people with certain circumstances.

How do I apply for a Medicare savings program?

If you have limited income and resources, you may qualify for a Medicare savings program to help pay for Medicare costs. To apply, contact your State Health Insurance Assistance Program. These savings programs can help pay for Medicare Part A and Medicare Part B premiums, deductibles, and copays. If you’re one of the people with limited income it’s advisable o get a medicare saving program.

When does Medicare coverage begin?

If you enroll during your initial enrollment period, your Medicare coverage will begin on the first day of the month you turn 65. If you enroll during a special enrollment period, your coverage start date varies.

What are the costs for Medicare Part A?

For 2023, the traditional Medicare Part A deductible is $1,600 per benefit period. Most people don’t pay a Part A premium because they paid Medicare taxes while working. If you don’t qualify for premium-free Part A, the monthly premium is $506 in 2023.

What are the costs for Medicare Part B?

The standard Part B premium is $164.90 per month in 2023. The annual Part B deductible is $226 in 2023. Higher-income beneficiaries pay higher premiums.

How can I get help paying for Medicare if I have limited income?

If you have limited income and resources, you may qualify for help through one of the Medicare Savings Programs. Depending on your income and assets, these programs can help pay for Medicare premiums, deductibles, and copays.

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