(HealthyExaminer.com) – Medicare insurance typically includes coverage for medical care, special procedures, hospitalizations, and prescription drugs for qualifying members. Individual premiums and coverage vary based on Medicare insurance contributions throughout the working years. Even though Medicare coverage is often more affordable than private health plans, deductibles, copays, and medical premiums can put a financial strain on elderly individuals with fixed incomes.
There are four Medicare Savings Programs provided by the federal government to help pay or reduce Medicare insurance costs for those in need. The following is a broad overview of each of the four programs and the qualifications for assistance.
Qualified Medicare Beneficiary Program
The Qualified Medicare Beneficiary (QMB) Program assists individuals in paying for Part A and B insurance premiums, deductibles, copays, coinsurance, and copayments for qualifying items and services. The QMB program sets strict income and resource limitations for individuals and married couples, which change annually. At present, they are as follows:
- $1,153 individual monthly income and $1,546 married couple monthly income
- $8,400 individual resource limit and $12,600 married couple resource limit
These limits are typically higher in Alaska and Hawaii. Applicants in these states with income or resources slightly over the aforementioned limits may still qualify for the QMB program.
Individuals and couples who qualify for the QMB program cannot be billed for services or healthcare items other than outpatient prescription drugs. As of 2022, pharmacists could not charge more than $4.00 for any drug covered under Medicare Part D.
Specified Low-Income Medicare Beneficiary Program
The Specified Low-Income Medicare Beneficiary (SLMB) program helps eligible individuals pay for Medicare Part B premiums. These premiums often cover various doctors’ services, outpatient care, preventative services, and medical supplies. The SLMB program has its own income and resource limitations. As of 2022, the limits are as follows:
- $1,379 individual monthly income and $1,851 married couple monthly income
- $8,400 individual resource limit and $12,600 married couple resource limit
Income and resource limitations in both Alaska and Hawaii are slightly higher for the SLMB program.
Qualifying Individual Program
The Qualifying Individual (QI) program helps qualifying individuals pay for Part B premiums if they also have Medicare Part A. QI benefits must be applied for annually, and you must be able to prove that you have limited income and resources. These benefits are offered on a first-come, first-served basis with a priority for individuals who have received QI benefits during previous years. As of 2022, the income and resource limitations for this program are as follows:
- $1,549 individual monthly income and $2,080 married couple monthly income
- $8,400 individual resource limit and $12,600 married couple resource limit
The QI program limitations are higher than the SLMB program limitations. Medicaid recipients do not qualify for QI program benefits.
Qualified Disabled and Working Individuals Program
The Qualified Disabled and Working Individuals (QDWI) program provides help for individuals over the age of 65 with a disability who are working and lost their Social Security Disability (SSD) benefits and free Part A premiums after returning to work. The program helps cover the Part A premiums. The income and resource limitations as of 2022 for the QDWI program are as follows:
- $4,615 individual monthly income and $6,189 married couple monthly income
- $4,000 individual resource limit and $6,000 married couple resource limit
Individuals cannot qualify for the QDWI program while receiving state medical benefits.
Qualified Medicare recipients with limited income and resources to pay premiums may find relief through one of these four government assistance programs. Go to the Medicare website and select your state to begin the application process.
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