Medicare can be a significant financial burden for many Americans, especially those who are retired or living on a fixed income. Fortunately, the Medicare Savings Program (MSP) can help eligible individuals with their Medicare expenses. In this comprehensive guide, we will discuss everything you need to know about the Medicare Savings Program Eligibility and Coverage.
What is the Medicare Savings Program (MSP)?
The Medicare Savings Program (MSP) is a federally funded program that provides financial assistance to eligible individuals to help pay for their Medicare expenses. The MSP has four different levels, each with its own eligibility criteria and benefits. The four levels of MSP are:
- Qualified Medicare Beneficiary (QMB), which covers the costs of Medicare Parts A and B premiums. When you have QMB, typically you should not receive bills for Medicare-covered services when visiting Medicare providers or providers in your Medicare Advantage Plan’s network.
- T Specified Low-Income Medicare Beneficiary (SLMB), which covers the Medicare Part B premium.
- Qualifying Individual (QI) Program covers the Medicare Part B premium.
In addition, if you enroll in any of these Medicare Savings Programs (MSP), you will also automatically receive Extra Help, a federal program that assists with your Medicare prescription drug (Part D) plan expenses.
- The fourth Medicare Savings Program (MSP) is the Qualified Disabled Working Individual (QDWI) program, which covers the cost of the Medicare Part A premium.
Benefits and Eligibility of the Medicare Savings Program Eligibility
QMB-BASIC PROGRAM (QMB-BAS)
Who is eligible and what are the benefits?
To be eligible for the QMB-Basic program, you must:
- Be qualified for Medicare Hospital Insurance (Part A); and
- Have an annual income that does not exceed 100 percent of the Federal Poverty Level
For those who qualify for the QMB-Basic program, the state will cover:
- The monthly premium for Part B ($99.90 per month in 2012); and
- The monthly premium for Part A ($451 per month in 2012 for applicants with 0-29 quarters of coverage; $248 per month for certain applicants with 30-39 quarters) for those who do not qualify for free Part A; and
- All deductibles and coinsurance amounts for Medicare.
QUALIFIED MEDICARE BENEFICIARY-DISABLED WORKER PROGRAM (QMB-DW)
Who is eligible and what are the benefits?
To be eligible for QMB-DW, an individual must meet the following requirements:
- Be eligible for Medicare Hospital Insurance (Part A) as a qualified disabled worker, which includes individuals under 65 who are no longer receiving Social Security disability benefits due to substantial gainful employment but can still receive Part A by paying a premium.
- Have an annual income that does not exceed 200 percent of the Federal Poverty Level (FPL).
The benefit of QMB-DW is payment of Part A Medicare premiums.
QUALIFIED MEDICARE BENEFICIARY-SPECIAL MEDICARE BENEFICIARY PROGRAM (QMB-SMB)
Who is eligible and what are the benefits?
In order to be eligible for QMB-SMB, an individual must fulfill the following requirements:
- Currently enrolled in Medicare Hospital Insurance (Part A).
- Have an annual income that is greater than 100% but less than 120% of the Federal Poverty Level (FPL).
- Note: If you are eligible for any other Medicaid benefit offered by the state, you are not eligible for the SMF program.
The state will only cover the Part B monthly premium ($99.90 per month in 2012) for those who meet the QMB-SMB eligibility criteria.
QUALIFIED MEDICARE BENEFICIARY-SUPPLEMENTAL MEDICARE FULL (QMB-SMF)
Who is eligible and what are the benefits?
An individual can qualify as a QMB-SMF by meeting the following criteria:
- They must be entitled to Medicare Hospital Insurance (Part A).
- Their annual income should be more than 120 percent but less than or equal to 134 percent of the FPL.
- Individuals who live in a nursing facility, an intermediate care facility for the mentally retarded (ICF/MR), or a hospital are not eligible for QMB-SMB if their income is equal to or greater than 120% of the Federal Poverty Level.
For those who qualify as a QMB-SMF, the State only pays for the Part B monthly premium ($99.90 per month in 2012.) However, there is a limit on the total number of eligible individuals for this benefit.
How to Apply for the Medicare Savings Program
To apply for the Medicare Savings Program Eligibility and Coverage, you will need to contact your state’s Medicaid office. You can find your state’s Medicaid office contact information by visiting Medicaid.gov.
Once you contact your state’s Medicaid office, they will provide you with the necessary application forms and instructions. You will need to provide information about your income, resources, and Medicare enrollment.
FAQS
What is the Medicare Savings Program?
The Medicare Savings Program (MSP) is a program that provides financial assistance to people who are enrolled in Medicare and have limited income and resources.
When should I apply for the MSP?
You should apply for the MSP as soon as possible if you think you may be eligible. There is no enrollment period for the program, so you can apply at any time.
How often do I need to renew my MSP eligibility?
You need to renew your MSP eligibility every year or as required by your state. Your state Medicaid program will notify you when it’s time to renew.
The Bottom Line
Medicare Savings Program (MSP) provides financial assistance to Medicare beneficiaries with limited income and resources. Eligibility for the MSP is based on monthly income limits, which vary by state. The program covers Medicare Part B premiums, deductibles, and coinsurance, and may also cover other costs depending on the state. To apply for the MSP, individuals should contact their state’s Medicaid program, and they should renew their eligibility annually or as required by their state. Overall, the MSP can provide valuable support for individuals struggling to afford healthcare costs under Medicare.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
