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Medicare Savings Programs

 

Source for below, and for more information: 2023 QMB, SLMB, and QI Programs

The federal Medicare Savings Programs (MSPs) help low income elders and younger Medicare beneficiaries access Medicare benefits. These programs pay Medicare premiums and, in some cases, may also pay Part A and Part B deductibles and coinsurance for certain people with low income.

In Massachusetts the MSP consists of the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programs.

To qualify for a Medicare Savings Program, you must meet all of these conditions:

  • Have Part A
  • Meet Income and Asset limits

    Note: income limits change each year.

Patient financial counselors at Partners hospitals and health centers can assist Medicare patients who may be eligible to apply for this assistance through the MassHealth application process.

What are these Programs?
For most younger Medicare beneficiaries, MassHealth Standard encompasses these programs.

If you are eligible for any of these programs, you are entitled to have your Part B premium paid through the state MassHealth program, rather than paying it directly or having it deducted from your monthly benefit check, and are eligible for premium-free Medicare prescription drug coverage (Medicare D). If you are eligible for QMB, you are also entitled to get assistance paying out-of-pocket co-payments to doctors and hospitals and your Part A premium (if you have to pay one).

See the Justice in Aging Fact Sheet (rev 1/23).

Who is Eligible?
All persons age 65 or older who have been legal U.S. residents for at least five consecutive years and all younger Medicare beneficiaries who meet the income and asset limits.

What are the Current Program Income Limits?

  • QMB - Countable income at or below 190% of the federal poverty level
  • SLMB - Countable income greater than 190% and less than or equal to 210% of the FPL
  • QI - Countable income up to 225% FPL
  • See 2023 guidelines

What is Countable Income?
Countable income is $20 less than gross income, if your only income is unearned income. Greater deductions are allowed if you have earned income.

What are the 2023 Program Resource (Assets) Limits?

  • Individual: $18,180
  • Married Couple living together: $27,260
Up to $1,500/person in a burial account is not counted.

What are the Program Benefits?

Each of the QMB, SLMB and QI Programs cover:
  • Medicare Part B standard monthly premium.
  • Medicare Part D prescription drug premium up to a certain limit.

QMB Program Only

  • Medicare Part A monthly premium for persons not eligible for premium-free Part A.
  • Medicare Part A and Part B co-payments, including co-payments for Medicare services not covered by MassHealth if received from a MassHealth provider.
  • Medicare Part A and Part B deductibles.

SLMB and QI Programs
Three months retroactive benefits, in most cases.

Who pays Medicare A premiums?
There are many individuals age 65 or older who are not eligible for premium-free Medicare Part A because they never performed Medicare-covered work or did not work long enough to be eligible for retirement benefits. Examples include domestic workers, seasonal workers, and migrant workers (many of whom are immigrants) as well as some federal, state, and local government employees. These people may purchase Part A by paying a monthly premium. The only requirements are that the person be at least age 65 and a legal U.S. resident for at least five consecutive years. Once eligible for the QMB program, the state will pay both the Part A and Part B premiums. If eligible for the SLMB or QI program, the state will pay only the Part B premium.

To Apply
As of October 2024, most individuals enrolled in Supplemental Security Income (SSI), Medicaid, and eligible for Medicare, will be automatically enrolled in the Qualified Medicare Beneficiary (QMB) program. Automatic enrollment rules vary based on individual circumstances. Effective October 1, 2024:  Free Part A: All states will be required to automatically enroll SSI recipients in QMB when: (1) they are enrolled in SSI-based Medicaid and (2) they are eligible for premium-free Medicare Part A. Part A with a Premium: Some individuals have to pay a premium in order to enroll in Medicare Part A. For those individuals, thirty-six states and DC will be required to automatically enroll individuals in QMB when (1) they are enrolled in SSI-based Medicaid and (2) they are enrolled in Medicare Part B. More Information.

If not auto-enrolled, you must apply through a MassHealth Enrollment Center (or via Patient Financial Services). You can obtain an application by calling 1-800-408-1253. You can apply at any time, with benefits beginning the month after you are determined to be eligible for QMB, and three months retroactively for SLMB and QI benefits in most cases.

If you are not currently enrolled in Part A, once you are determined to be eligible for all QMB requirements except enrollment in Part A, Massachusetts should enter your name in a computer system used by the federal government to bill the state for Part A premiums.

The QMB application is the same as the MassHealth application, with the same information required. The SLMB and QI applications are shorter “MassHealth Buy-In” applications. If you apply for MassHealth, and do not already have QMB, SLMB or QI benefits, you should apply for the QMB, SLMB or QI program at the same time. MassHealth has 45 days to process the application. Assistance completing the application is available from SHINE, 1-800-243-4636.

For more information, see Enrolling in Qualified Medicare Beneficiary (QMB) Program...- MGH Community News, August 2018.

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