Medicare Savings Programs

Medicare Savings Program

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 ($7730 single, $11,600 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 2018:

Program Income Limits
Qualified Medicare Beneficiary (QMB) $1,061 single; $1,430 couple
Specified Low Income Beneficiary (SLMB) $1,269 single; $1,711 couple
Qualified Individual (QI) $1,426 single; $1,923 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.

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