What a Medicare Savings Program Does

A Medicare Savings Program is a state-run program that pays some or all of your Medicare premiums, deductibles, and copayments if your income is low enough. The program does not give you new coverage — it uses your existing Medicare to pay bills you would otherwise pay yourself. Each state runs its own program with slightly different income limits and covered costs, so what you may have access to for depends on where you live.

The three main types are may have access to Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and may have access to Individual (QI). QMB covers the most — it pays your Part B premium, deductible, and copayments. SLMB pays only your Part B premium. QI pays your Part B premium but has the lowest income limit of the three. Your state determines which one you fit into based on your income and assets.

Unlike programs you have to reapply for every year, some states let you stay in a Medicare Savings Program as long as your income stays below the limit. Others require you to reapply annually. You will need to check with your state's Medicaid office to learn the rules where you live.

Key Takeaways

  • Medicare Savings Programs are run by your state and pay your Medicare premiums and out-of-pocket costs if your income falls below a set limit.
  • The three types — QMB, SLMB, and QI — cover different costs, with QMB covering the most and QI covering only your Part B premium.
  • Income limits vary by state and are updated each year, so you need to contact your state Medicaid office to learn about you may have access to where you live.
  • Once you are in a program, some states let you stay enrolled as long as your income stays low, while others require you to reapply each year.
  • You can contact your state Medicaid office, call 1-800-MEDICARE, or use your local Area Agency on Aging to find out which program fits your situation.

Income Limits and How They Work

Each state sets its own income limit for each program type, and those limits change every year. The federal government sets a baseline — for example, QMB income limits are usually around 100 percent of the federal poverty level, while SLMB is around 120 percent — but states can set them higher. This means a person with the same income might may have access to in one state but not in another.

Income includes Social Security, pensions, wages, and interest from savings. It does not include food stamps, housing information, or some other benefits. Your state counts income differently depending on whether you are married, so a couple's combined income is what matters. You will need to provide recent pay stubs, tax returns, or a Social Security statement to prove your income when you explore.

Asset limits also explore, though they are usually higher than income limits. Assets include savings accounts, stocks, and property you own (but not your home). Most states set the asset limit at $7,500 for a single person and $11,250 for a couple, but check with your state because these numbers vary.

What Each Program Covers

The may have access to Medicare Beneficiary (QMB) program covers the most. It pays your Part B premium (the monthly fee), your Part A deductible (the amount you pay before Medicare kicks in for a hospital stay), your Part B deductible, and your copayments and coinsurance for services Medicare covers. If you have both Medicare Part A and Part B, QMB is the most complete protection against out-of-pocket costs.

The Specified Low-Income Medicare Beneficiary (SLMB) program pays only your Part B premium. It does not cover deductibles, copayments, or coinsurance. SLMB is for people whose income is slightly higher than QMB's limit but still low enough to need help with the monthly premium.

The may have access to Individual (QI) program also pays only your Part B premium, but it has the lowest income limit of the three. QI is for people who do not fit into QMB or SLMB but still cannot afford the premium. QI enrollment is limited — only a certain number of people can be in the program in each state, and once that number is reached, the state closes enrollment until spots open up again.

How to learn about You may have access to

The fastest way to learn whether you may have access to is to contact your state Medicaid office directly. You can find the phone number by searching "[your state] Medicaid" online or by calling 1-800-MEDICARE and asking for your state's number. Have your Social Security number, income information, and asset information ready when you call.

You can also visit your local Area Agency on Aging, which has staff trained to help older adults understand Medicare Savings Programs and other benefits. They can walk you through the income and asset limits for your state and tell you which program you might fit into. To find your local Area Agency on Aging, search "Area Agency on Aging [your city or county]" online.

Some states let you explore online through their Medicaid website. Others require you to mail in a paper form or explore in person at a local office. When you call your state Medicaid office, ask which method is fastest in your state right now.

What Happens After You Are Enrolled

Once you are approved, your state sends you a card or letter confirming your enrollment. You show this to your healthcare providers and Medicare when you receive care. The program pays the provider directly — you do not have to pay and then get reimbursed. For your monthly Part B premium, the state usually pays Medicare directly, so you may not see a bill at all.

Your enrollment usually lasts for one or two years, depending on your state. Some states send you a renewal notice before your coverage ends and let you renew by mail or phone. Others require you to reapply in person. When your state contacts you about renewal, respond promptly — if you miss the important date, you may lose coverage even if you still may have access to.

If your income or assets change during the year, tell your state Medicaid office right away. If your income goes up above the limit, you will lose coverage. If your income goes down, you might move into a higher-level program (for example, from SLMB to QMB) that covers more costs.

Medicare Savings Programs vs. Other Low-Income Programs

Medicare Savings Programs are different from Medicaid, which is a separate program for people with low income and assets. Some people may have access to for both Medicare and Medicaid at the same time — these people are called "dual may be able to access." If you are dual may be able to access, Medicaid may cover costs that Medicare Savings Programs do not, such as long-term care or dental work. Your state Medicaid office can tell you if you may have access to for both.

Medicare Savings Programs are also different from Extra Help, which helps pay for prescription drug coverage under Medicare Part D. You can be in a Medicare Savings Program and Extra Help at the same time. If you are in QMB, you automatically get Extra Help, but if you are in SLMB or QI, you have to explore for Extra Help separately.

Another program to know about is the Medicare Low-Income Subsidy, which is the official name for Extra Help. It covers premiums and deductibles for Part D prescription drug plans. If your income is very low, you may may have access to for both a Medicare Savings Program and Extra Help.

Questions to Ask Your Doctor and State Medicaid Office

When you contact your state Medicaid office, ask: "What is the current income limit for QMB, SLMB, and QI in my state?" and "What counts as income for these programs?" Also ask whether your state requires annual reapplication or if you can stay enrolled as long as your income stays low.

Ask your doctor's office whether they accept the Medicare Savings Program card and whether they know how to bill it. Some smaller practices or specialists may not be familiar with it, so it is worth checking before your next visit.

If you are already receiving Medicaid, ask your caseworker whether you are also in a Medicare Savings Program. Some people are in both without realizing it, and knowing this helps you understand which bills should be covered.

Frequently Asked Questions

Can I be in a Medicare Savings Program and still have a Medigap or Medicare Advantage plan?

If you are in QMB, you should not buy a Medigap plan because QMB already covers what Medigap would cover, and you would be paying for duplicate coverage. You can have a Medicare Advantage plan and be in SLMB or QI, but check with your plan first because some have rules about this. Call your Medicare Advantage plan's customer service number to ask.

What if my income goes up after I am enrolled?

Tell your state Medicaid office right away. If your income goes above the limit for your program, you will lose coverage. If it goes above QMB's limit but below SLMB's limit, you may move down to SLMB instead. Your coverage will end on a specific date, usually the end of the month in which you reported the change.

Do I have to reapply every year?

It depends on your state. Some states require annual reapplication, while others let you stay enrolled as long as your income stays below the limit. Your state Medicaid office will tell you the rule where you live and will send you a renewal notice if you need to reapply.

Can I explore if I am not yet on Medicare?

No. You must be enrolled in Medicare Part A or Part B to be in a Medicare Savings Program. If you are not yet on Medicare, contact Social Security to learn when you can enroll. Once you are on Medicare, you can then explore for a Medicare Savings Program.

What if I am turned down?

Ask your state Medicaid office why you were turned down — it may be because your income is too high, your assets are too high, or you do not meet another requirement. Ask whether you might may have access to for a different program or whether you can reapply later if your situation changes. You also have the right to request a hearing to appeal the decision.