Medicare Savings Programs

Medicare Savings Programs allow a person to get assistance from their state to help pay for monthly Medicare premiums. In some cases, MSP will also pay for Part A (hospital) and Part B (medical) deductibles, coinsurance, and copayments.

MSP does have income and asset requirements that must be met to qualify for help. MSP counts your gross income (before any deductions and withholdings) and includes, but is not limited to, Social Security, pensions, job earnings, alimony, unemployment, and workman’s compensation.

Assets include, but are not limited to, savings, stocks, bonds, IRAs, and 401k. Assets do not include your home, your vehicle, or your possessions. There is one application for MSP but two different programs for which you will be considered

MSP called Qualified Medicare Beneficiary Program (QMB): For 2019 if you are single and your gross income is below $1,061/month (below $1,429/month for a married couple) and your assets are below $9,230 for a single person (below $14,600 for a married couple), you may be approved for QMB program. QMB will pay the monthly premiums for Medicare Part B (and, if you do not have enough work quarters for premium-free Part A, QMB will also pay Part A monthly premiums).

If approved for QMB, you will be issued a gray and white Medical Assistance card that will pay for your copays/coinsurances for Medicare-approved inpatient and outpatient services. Your Medicare will be your primary insurance and your QMB will be your secondary insurance. You will want to check with your providers to see if they accept both Medicare and QMB.

MSP called Specified Low-Income Beneficiary Program: If your gross income is above the QMB level mentioned above but below $1,425/month as a single person (below $1,922 for a married couple) and your assets are below $9,230 for a single person (below 14,600 for a married couple), you may qualify for the SLMB program. This program will pay your monthly Part B premiums. You will not be issued a gray and white Medical Assistance card so you may be billed for copays/coinsurances for Medicare-approved services.

If approved by either QMB or SLMB, you will be granted “Extra Help” with the cost of a Part D drug plan. Extra Help is a federal program that will help pay the monthly premiums for a Part D drug plan. The Extra Help program also helps to reduce your out-of-pocket costs for your Part D medicines.

Medicare’s Extra Help Program

Also referred to as Low-Income Subsidy (LIS), the Medicare Part D Extra Help program, administered by the Social Security Administration, was created to help people with limited incomes pay for prescription drugs. If you qualify for Medicare Part D Extra Help, you will pay less in drug premiums and copayments or coinsurance. You also will be covered during the Coverage Gap and will not have to pay a Part D late enrollment penalty.

Medicare Part D Extra Help Contact Information

You may be able to get Medicare Part D Extra Help to lower your prescription drug premiums and costs. To find out if you qualify for Medicare’s Extra Help program, call:

1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week. Visit Medicare’s website.
The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778. Visit Social Security Administration’s website.
Your state Medicaid office.

Note: If you qualify for Medicare’s Extra Help program, your copayments or coinsurance for prescription drug costs, as well as your monthly plan premium, will be lower. Once you are enrolled in a Medicare Prescription Drug Plan (PDP) or a Medicare Advantage Prescription Drug Plan (MA-PD), this subsidy will be applied to your coverage. We will send you information on the lower amount for your monthly premium. Cost-sharing for your prescription drugs will be lower. Note that Medicare Part D Extra Help will not pay for your monthly Medicare Part B premium.

There are four different levels of the Medicare Part D Extra Help program. Depending on which level you are eligible for, your monthly plan premium will vary. The four levels of Extra Help cover 100%, 75%, 50%, or 25% of your monthly Medicare Part D plan premium. Extra Help does not always apply to the full amount of your Medicare Part D plan premium. Note that if you have a Medicare Advantage Prescription Drug Plan, your Medicare Part C Premium will not be lowered.

You must be enrolled in a Prescription Drug Plan (PDP) or a Medicare Advantage Plan that includes a prescription drug benefit (MA-PD) to qualify for Medicare Part D Extra Help.

Helpful Links on Medicare’s Extra Help Program

Are you eligible for Extra Help? Read about Medicare’s Extra Help program, and who may qualify for Medicare Part D Extra Help assistance.
To find out if you are eligible for Medicare Part D Extra Help, call your Social Security office, or go to the Social Security Administration’s website.