With millions of people out of work due to the COVID-19 pandemic, many of the older adults who lost or quit their jobs are now enrolling into Medicare. Yet with little income coming in, many people may unknowingly qualify for programs that can help cover some of Medicare’s costs. One of these programs is the Medicare Savings Programs (MSPs) that helps with Medicare Part A and/or Part B costs. The MSPs discussed below include: the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Beneficiary (SLMB) program and the Qualified Individual (QI) program.
Medicare Savings Programs: what they are and the costs they cover
The Qualified Medicare Beneficiary (QMB) program is the most comprehensive of the MSPs, in that those who qualify and don’t already receive free Medicare Part A, will have all their Medicare Part A and Part B costs covered. This includes:
- Medicare Part A monthly premium. Again, most people don’t pay a premium, but for those who don’t have enough Social Security credits to get Part A for free, they can receive “free” Part A with QMB. (The full Part A premium is $458 in 2020.)
- Medicare Part B monthly premium ($144.60 per month in 2020)
- Deductibles for both Part A ($1,408 per benefit period in 2020) and Part B ($198 annually in 2020)
- Coinsurance under both Part A and Part B. For example, under Part A, QMB pays the $352 per day for hospital days 61-90, and the $704 per day for the 60 hospital lifetime reserve days in 2020. Under Part B, QMB pays the remaining 20% coinsurance after Medicare pays 80% of the covered outpatient medical services such as physician visits, as long as you see doctors and other providers who accept Medi-Cal. Note: This is because Medi-Cal administers the MSPs and will only pay providers who accept Medi-Cal.
To qualify for QMB, your monthly income cannot exceed $1,063 if you are single ($12,760/year) or $1,437 ($17,240/year) if you are part of a couple. And your personal assests (cash, money in the bank, stocks, bonds, etc.) cannot exceed $7,860 for an individual or $11,800 for a married couple. Certain items are not calculated in your personal asset limit; see our website for more details.
To qualify for SLMB, your monthly income cannot exceed $1,276 if you are single ($15,312/yr.) or $1,724 ($20,688/yr.) if you part of are a couple. For QI, your monthly income cannot exceed $1,436 if you are single ($17,226/yr.) or $1,940 ($23,274/yr.) if you are part of a couple. As is the same for QMB, for both SLMB and QI, your personal assests (cash, money in the bank, stocks, bonds, etc.) cannot exceed $7,860 for an individual or $11,800 for a married couple. The same exemptions reference above with QMB apply to all MSPs.
To read about additional MSP programs, see our Medicare Savings Program section on our website.
How to apply for an MSP
To apply for QMB, SLMB, or QI, you must also be eligible to receive Medicare Part A and Part B. If you are already enrolled in both Medicare parts, contact your California Department of Health Care Services (DHCS) county office to apply for these programs.
If you are eligible for Medicare but not enrolled in Part A and/or Part B, you can enroll in Part B anytime through your local Social Security Administration (SSA) office (1-800-772-1213). However, you can only enroll in Part A during a specific enrollment period. This is important if you are applying for the QMB program. For instance:
- If you just became eligible for Medicare and are in your Initial Enrollment Period (IEP) or an 8-month Special Enrollment Period after losing your job, you may apply for QMB (through your DHCS county office), and Parts A and B (through the SSA).
- If you are already enrolled in Part B, and eligible but not enrolled in Part A, you may apply for QMB (through your DHCS county office) and Part A (through the SSA) during the Medicare General Enrollment Period (GEP), which is January 1 to March 31 each year.
Additional Help through “Extra Help” with Part D Costs
If you are eligible for an MSP, you are also eligible to receive “Extra Help,” also known as the Low-Income Subsidy (LIS) program, for your Part D Medicare prescription-drug costs. This program helps pay for a portion of Part D prescription drug plan costs, including Part D premiums, deductibles and copayments. Depending on your income and assets, you may qualify for the full subsidy or a partial subsidy. All beneficiaries who qualify for the LIS program are permitted to change Part D plans once a quarter for the first 3 quarters with an effective date of change being the first of the following month. In addition, one change can be made in the last quarter of the year, with the effective date being January 1. See our section on Part D Extra Help for more information on how to qualify and apply.
Need help? Call HICAP
If you require some assistance with your Medicare coverage, application of MSPs or Extra Help, or any other Medicare related question, contact your local Health Insurance Counseling and Advocacy Program (HICAP). They provide free, individual and unbiased information and assistance on Medicare and other health insurance related issues.