MSP
The Medicare Savings Programs (MSP) assist you with the cost of your Medicare “Part B” (medical insurance) premiums. Medicare “Part A” (hospital insurance) premiums may also be covered by the MSP for certain individuals.
States provide MSP to Medicare eligible individuals who are “unable to pay” associated expenses. Also, the MSP application process is handled by your state. Which program(s) you are “eligible for” depends on your state at the time of application. “Applying” is still recommended even if you think you don’t qualify.
For each state contacts, visit — “medicaid.gov/about-us/where-can-people-get-help-medicaid-chip/index.html”.
Public assistance offices are used by the majority of states to “manage” Medicaid and MSP locally. To apply for these programs, people need get in touch with local or state “social service, welfare, or public health” organizations.
In many circumstances, you have to have resources and income below a “specific level” in order to be eligible for an MSP. These caps change annually. In the event that your resources or income “exceed” the specified federal restrictions, you can still be eligible for these programs in your state. Certain categories or particular amounts of resources or income are not taken into account by “some states” for determining eligibility.
Money in a “checking/savings account, bonds, and stocks” are countable resources that are included in the MSP resource limits. Your house, one car, a burial site, furniture, personal belongings, and “up to $1,500 in burial expenditures per individual” are not countable resources.
Neither Puerto Rico nor “the U.S. Virgin Islands” offer MSP. Further, states may “differ” in what these programs are called and how they operate.
“Benefits.gov” wants you to know that if you are not eligible for Medicaid, you do have other options. To find out what additional benefits you might be qualified for, complete the questionnaire at “benefits.gov/benefit-finder”.
MSP Types -
Medicare Savings Programs come in four forms: Qualified Medicare Beneficiary (QMB), Qualifying Individual (QI), Specified Low-Income Medicare Beneficiary (SLMB) and “Qualified Disabled & Working Individual (QDWI).”
A recipient is immediately eligible for “Extra Help” if they meet the requirements for QMB, SLMB, or QI. Extra Help covers all expenses, with the exception of a small co-payment for Medicare “prescription drug” coverage. For more up-to-date information, visit — “secure.ssa.gov/poms.nsf/lnx/0600815024”.
Qualified Medicare Beneficiary (QMB) Program -
Part A and/or Part B premiums for qualified “low-income” Medicare beneficiaries are paid by states under the “QMB program” (a Medicaid program).
Stated differently, Part B premium and all Medicare cost-sharing (deductibles, co-insurance, and co-payments) are covered for Medicare beneficiaries “whose assets do not exceed the Part D low-income subsidy standard resource limit” and “whose income is at or below 100% of the Federal Poverty Level (FPL).” For more information, visit — “ssa.gov/legislation/Congressional%20Inquiries%20Guide.pdf”.
| For 2024 in QMB Program | ||
|---|---|---|
| Monthly income limit* | Resource limit** | |
| Individual | $1,275 | $9,430 |
| Married couple | $1,724 | $14,130 |
| *Alaska and Hawaii have marginally greater income restrictions. **your home, personal belongings, vehicle, and “up to $1,500 in burial costs for each individual” do not qualify as resources. | ||
Every time you receive care, make sure your provider/hospital is aware that you are a part of the QMB Program by presenting your both “QMB/Medicaid” and “Medicare” card. You may also present one of your claims statements, commonly known as a “Medicare Summary Notice” (MSN), if you are enrolled in “Original Medicare.”
In the event that you meet the “requirements” for the QMB program, Medicare providers are not permitted “to charge” you for any services or goods that Medicare covers, not even for copayments, deductibles, and coinsurance. If applicable, you can occasionally get a “small” Medicaid co-payment fee.
Qualifying Individual (QI) Program -
This program only assists with “Part B” premium payments, and one must have both Part A and Part B insurance to participate. To remain in the QI Program, you have to “reapply” each year. Applications are approved by the states according to a “first-come, first-served” policy, with preference going to those who received QI benefits the year before.
Stated differently, Part B premium (but not Medicare cost-sharing) are covered for Medicare beneficiaries “whose assets do not exceed the Part D low-income subsidy standard resource limit” and “whose income is ‘at least 120 and less than135’ percent of federal poverty guidelines.”
| For 2024 in QI Program | ||
|---|---|---|
| Monthly income limit* | Resource limit** | |
| Individual | $1,715 | $9,430 |
| Married couple | $2,320 | $14,130 |
| *Alaska and Hawaii have marginally greater income restrictions. **your home, personal belongings, vehicle, and “up to $1,500 in burial costs for each individual” do not qualify as resources. | ||
You cannot receive medical help from the “QI program” if you are eligible for Medicaid; however, you might be able to receive it through another Medicare Savings Program.
In contrast to the “cost-shared” QMB and SLMB programs between the Federal and State, the “QI program” is financed by discretionary Federal expenditures.
Specified Low-Income Medicare Beneficiary (SLMB) Program -
This program also only assists with “Part B” premium payments, and one must have both Part A and Part B insurance to participate.
Stated differently, Part B premium (but not Medicare cost-sharing) are covered for Medicare beneficiaries “whose assets do not exceed the Part D low-income subsidy standard resource limit” and “whose income is ‘greater than 100 and less than 120’ percent of Federal Poverty Level (FPL).”
| For 2024 in SLMB Program | ||
|---|---|---|
| Monthly income limit* | Resource limit** | |
| Individual | $1,526 | $9,430 |
| Married couple | $2,064 | $14,130 |
| *Alaska and Hawaii have marginally greater income restrictions. **your home, personal belongings, vehicle, and “up to $1,500 in burial costs for each individual” do not qualify as resources. | ||
Qualified Disabled & Working Individual (QDWI) Program -
This program only assists with “Part A” premium payments. If you have a disability, are employed, and “lost your premium-free Part A and Social Security disability benefits due to your return to work,” you might be eligible for this program. The “income threshold” is 200 percent of the federal poverty levels, or less.
| For 2024 in QDWI Program | ||
|---|---|---|
| Monthly income limit* | Resource limit** | |
| Individual | $5,105 | $4,000 |
| Married couple | $6,899 | $6,000 |
| *Alaska and Hawaii have marginally greater income restrictions. **your home, personal belongings, vehicle, and “up to $1,500 in burial costs for each individual” do not qualify as resources. | ||
*as was previously indicated, even if your resources or income exceed the specified federal limits, you might still be eligible for MSP in some states. To find out, contact your state. Visit — “medicaid.gov/about-us/where-can-people-get-help-medicaid-chip/index.html”.
Link to official MSP information page:
https://www.medicare.gov/basics/costs/helps/medicare-savings-programs/
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