The Medicare Savings Programs and Extra Help are available to people who qualify for Medicare but have limited income and resources. These programs help with paying the costs of Part A and Part B. When you enroll in an Medicare Savings Program, you will also automatically get Extra Help, the federal program that helps pay most of your Medicare prescription drug(Part D) plan costs.
These programs are offered through your State Medical Assistance (Medicaid) office but are not Medicaid.
Medicare Savings Programs Eligibility
The four Medicare Savings Programs are Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI), and Qualified Disabled and Working Individual (QDWI). Eligibility for these programs is based on the amount of income and resources held by the individual, and cover differing amounts of Medicare expenses.
- The Qualified Medicare Beneficiary (QMB) program is for the lowest monthly incomes, of less than $1,084 for an individual and $1,457 for couples. The QMB program covers these individuals’ Part A and Part B premiums, deductibles, copayments, and coinsurance.
- The Specified Low-Income Medicare Beneficiary (SLMB) program helps people with a monthly income of less than $1,296 for individuals and $1,744 for couples. The SLMB program covers the Part B premium.
- The Qualified Individual (QI) program is for individuals with monthly incomes less than $1,456 and couples with monthly incomes less than $1,960. The QI covers the Part B premium.
The first three programs have a resources requirement of less than $7,860 for individuals and $11,800 for couples.
The Qualified Disabled and Working Individual (QDWI) program covers individuals with a monthly income of less than $4,338 and less than $4,000 in resources, and covers couples with a monthly income of less than $5,832 and less than $6,000 in resources. The plan covers the Medicare Part A premiums for disabled individuals younger than age 65 who lost their premium-free Part A because they returned to work.
If you think you are eligible for one of these programs, you should apply!
Extra Help
Extra Help is a program to help pay prescription drug costs for people with low income and limited resources. This is also known as the Part D low-income subsidy.
There are three levels of Extra Help, based on monthly incomes and the worth of assets you own. The resources requirement for the first two levels is less than $9,360 for individuals and less than $14,800 for couples.
Level 1 of Extra Help covers the premium, deductible, and costs once drug totals exceed $9,038.7. For prescriptions at Level 1, you pay $1.30 for generic and $3.90 for name-brand. To qualify, your monthly income should be less than $1,083 for individuals and less than $1,457 for couples.
Level 2 also covers the premium, deductible, and costs once drug totals exceed $9,038.7. Generic prescriptions cost $3.60, and name-brand prescriptions cost $8.95. To qualify for Level 2, monthly income must be less than $1,457 for individuals and less than $1,960 for couples.
Level 3 of Extra Help is available to individuals with a monthly income of less than $1,615 and less than $14,800 in assets; couples need less than $2,175 in monthly income and $29,160 in resources. Level 3 covers the premium based on a sliding scale. The Part D deductible is $89. You pay 15% for prescriptions (versus 25%), and after prescriptions total $9,038.7, you pay $3.60 for generic and $8.95 for name-brand prescriptions.
The Extra Help program offers the following benefits:
– Pays for your Part D premium up to a state-specific benchmark amount
– Lowers the cost of your prescription drugs
– Gives you a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans (You cannot use the Extra Help SEP during the fourth calendar quarter of the year (October through December). You should use Fall Open Enrollment during this time to make prescription drug coverage changes.)
– Eliminates any Part D late enrollment penalty you may have incurred if you delayed Part D enrollment
Depending on your income and assets, you may qualify for either full or partial Extra Help. Both programs provide assistance with the cost of your drugs. To receive such assistance, your prescriptions should be on your plan’s formulary and you should use pharmacies in your plan’s network.
Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.
If you think you qualify for Extra Help, apply!
For all of your Medicare questions, speak with Turning 65 Solutions.