The terms Medicare and Medicaid are similar sounding names; however, these programs serve very different needs. Medicare is a health insurance benefit program for those aged 65 and older and others with certain disabilities. Medicare has no income or asset limit. Medicaid is a health insurance benefit for anyone who is low-income. The program has a countable resource limit. Medicaid has no age limits and provides benefits for qualified persons, from children to the elderly.
Sometimes, people who have Medicare may also be eligible for Medicaid. Medicare Savings Programs help qualified Medicaid beneficiaries pay Medicare-related costs. Learn more about Medicare Savings Programs and how they may help save money on health care costs if you are eligible.
What are Medicare Savings Programs?
Those who have Medicare and also receive Medicaid are called "dual-eligibles." Medicare Savings Programs help dual-eligibles cover Medicare copayments, deductibles, and services, including prescription drug costs.
There are four types of Medicare Savings Programs: 1) Qualified Medicare Beneficiary; 2) Specified Low-Income Beneficiary; 3) Qualified Individual, and 4) Qualifying Disabled Working Individual.
Qualified Medicare Beneficiary
Dual-eligibles may receive benefits as a Qualified Medicare Beneficiary (QMB) if their 2022 monthly income is less than $1,153 (individual) or $1,546 (married couple) and their countable resources are under $8,400 (individuals) or $12,600 (married couples). Limits are higher in Alaska and Hawaii. You may still qualify if you have income from work that exceeds these limits.1
Countable resources include cash in a bank, stocks, bonds, and other assets not included on the exception list. Here is the list of exceptions that are not countable for the limit: a home, furniture, one car, household and personal items, one burial plot, and up to $1,500 saved for burial expenses.1
QMB benefits cover Medicare Part A premiums, Part B premiums, deductibles, copayments, and coinsurance for things covered by Medicare.
Specified Low-Income Beneficiary
Those with disabilities may qualify for Specified Low-Income Beneficiary (SLMB) benefits if their 2022 monthly income is no more than $1,379 (individual) or $1,851 (married couple) and their countable resources are under $8,400 (for singles) or $12,600 (for married couples).1
SLMB benefits cover Medicare Part B premiums.
Qualifying Individual
The Qualifying Individual (QI) program is limited to states that received block grants. Once this grant funding runs out, the benefits stop. Medicare beneficiaries may qualify for QI if your income is no more than $1,549 (individual) or $2,080 (married couple) and your countable resources are under $8,400 (for singles) or $12,600 (for married couples).1
Those who qualify for Medicaid do not qualify for QI. You must reapply for QI annually. Priority is given to those who qualified from the previous year. QI, like SLMB, also covers Medicare Part B.
Qualified Disabled Working Individual
Those less than age 65, disabled, and who returned to work may receive Qualifying Disabled Working Individual (QDWI) benefits. To qualify for QDWI, your 2022 monthly income must be no more than $4,615 (individual) or $6,189 (married couple) and countable resources are limited to $4,000 (singles) and $6,000 (married couples).1
QDWI benefits cover the Medicare Part A premium.
Advantages of Medicare Savings Programs
The advantages of these programs are twofold:
- Reducing medical costs
- Qualifying for additional help
Enrolling in a Medicare Savings Program may help a dual-eligible person to receive a low-income subsidy from the Extra Help program for Medicare Part D and prescription drug coverage.2
Important Disclosures
Content in this material is for educational and general information only and not intended to provide specific advice or recommendations for any individual.
All information is believed to be from reliable sources; however LPL Financial makes no representation as to its completeness or accuracy.
This article was prepared by WriterAccess.
LPL Tracking #1-05313105.
Footnotes
1 Medicare Savings Programs, Medicare,
https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs
2 Find your level of Extra Help (Part D), Medicare,
https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d