What are the Medicare Savings Programs (MSPs)?
There are three different programs: QMB, SLMB and QI. They are called “buy-in programs” because they pay the Part B premium for people with limited incomes who otherwise might not be able to afford Medicare.
They are part of federal Medicaid, administered by the state Medi-Cal agency.
How does one apply?
- People with full Medi-Cal are usually automatically enrolled in QMB if eligible.
- Everyone else must complete a paper application and submit it to the County Medi-Cal processing office in Concord. HICAP has applications and envelopes.
What are the criteria for qualifying?
- Individuals must be eligible for, although not necessarily enrolled in, both Medicare A and B. It’s possible to apply for Medicare via the Social Security Administration while also applying for the MSP program at the County.
- Asset limits for the MSPs are higher than for Medi-Cal and are the same for all three MSPs ($9,360 single, $14,800 married). If monthly withdrawals of principal and interest are being taken, tax qualified accounts (IRAs, 401Ks, etc.) are not counted as assets although the withdrawals are counted as income.
- Income is gross income, before the Part B premium is deducted from their social security check.
- Unlike for Medi-Cal, people can’t “spend down” their countable income by buying other health insurance such as dental, etc.
Medicare Savings Programs income limits for 2020:
| Program | Income Limits |
|---|---|
| Qualified Medicare Beneficiary (QMB) | $1,083 single; $1,457 couple |
| Specified Low Income Beneficiary (SLMB) | $1,296 single; $1,744 couple |
| Qualified Individual (QI) | $1,456 single; $1,960 couple |
What are the other benefits?
- All programs automatically provide full Low Income Subsidy (LIS) for drug costs for the year.
- Recipients can change drug or Medicare Advantage plans quarterly.
QMB
- This is the only program that pays the Part A premium.
- It also pays the Part B premium and all Medicare Parts A and B deductibles and copays. Although it is against the law for providers to bill QMB recipients for Medicare deductibles and co-pays, it may be best to use providers who take both Medicare and Medi-Cal.
- Allows immigrants and others with very low incomes who don’t qualify for free Part A to get it at no cost.
- Someone can conditionally apply for Part A contingent upon being approved for QMB.
- Those with Medi-Cal should still apply for QMB if they don’t get free Part A because only QMB, not Medi-Cal, pays the Part A premium.
SLMB and QI
- Only pays Part B premium. Does not pay for any other Part B coinsurance or for Part A. QI program allows a slightly higher income.