Updated: May 28
Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs, are state-run programs that assist lower-income individuals or couples with some of their Medicare costs.
These costs include premiums, deductibles, coinsurance charges, and co-payments for Part A and B. There are certain eligibility requirements, and different benefits, depending on your individual situation.
There are three main MSPs:
1. Qualified Medicare Beneficiary (QMB)
2. Specified Low-income Medicare Beneficiary (SLMB)
3. Qualifying Individual (QI). Listed below are each program’s coverage, monthly income limits, and asset limits as of July 2019. These are used to determine your eligibility under each program.
MSP WHAT IS COVERED INCOME LIMIT ASSET LIMIT
QMB Parts A and B premiums Individual: $1,061 Individual: $7,730 Parts A and B cost-sharing Couple: $1,430 Couple: $11,600 (deductibles, co-payments, co-insurances)
SLMB Part B premium Individual: $1,269 Individual: $7,730 Couple: $1,923 Couple: $11,600
QI Part B premium Individual: $1,426 Individual: $7,730 Couple: $1,923 Couple: $11,600
The income and asset limits listed above are the baseline federal income and asset limits for each MSP. You should consider applying for the MSP even if you are over the limits, because certain income types and assets are not counted toward the limits.
A fourth MSP is known as Qualified Disabled Working Individual (QDWI). It is available to some individuals under the age of 65 who currently work and have a disabling impairment. Contact your State Health Insurance Assistance Program (SHIP) by calling 877-839-2675 or visiting www.shiptacenter.org to learn more details about this MSP.
If you are eligible to enroll in an MSP, you will automatically receive Extra Help, the federal program that helps pay your Medicare prescription drug (Part D) plan costs. The MSP allows you to enroll in Part B outside of the regular enrollment periods. If you missed your Initial Enrollment Period to enroll in Part B, the MSP will allow you to enroll in Part B during any time of the year. If you have a Part B late enrollment penalty (LEP), the MSP will eliminate it.
Additionally, if you have a Part A late enrollment penalty (LEP) and qualify for QMB, that MSP will eliminate your Part A LEP. Once enrolled in QMB, providers who accept Original Medicare or who are in network for your Medicare Advantage Plan cannot bill you for any Medicare cost-sharing. This includes deductibles, co-payments, and coinsurances for all Medicare covered services. If you have QMB and your provider bills you for services, let them know that you have QMB and should not be billed. If you continue to have problems, call 1-800-MEDICARE.
Remember that the MSP is available to all people with Medicare who qualify, not just those who are enrolled in certain private plans.
HOW DO I APPLY FOR AN MSP?
You will need to apply to your local Medicaid office or other state agency that receives MSP applications. You or a State Health Insurance Assistance Program (SHIP) counselor can contact the local Medicaid office to learn how to apply. You will usually need to send in documentation with the application, such as copies of your Social Security card, Medicare card, birth certificate, and/or proof of income and assets.
Once you apply for an MSP, you should hear back from your Medicaid office within about 45 days. If you do not receive a notice, follow up with the office where you applied. If you are approved for the MSP, it can take up to three months for your benefits to start. However, you will be reimbursed for any premiums you paid during those months.
To enroll in the MSP, contact the State Health Insurance Assistance Program (SHIP) by calling 877-839-2675 or visiting www.shiptacenter.org.
Gary Floring, WeSpeak Medicare
Serving Clallam & Jefferson Counties