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Summary

The following programs are available for people who are eligible for Medicare who have low income. 

  • Qualified Medicare Beneficiary Program ("QMB")
  • Specified Low-Income Medicare Beneficiary Program ("SLIMB")
  • Qualified Working Disabled Individual Program ("QWDI")

For each of the programs, "net countable income" and assets (resources) cannot exceed a defined level which is different for individuals, married people, and people with children. The way these programs define countable income, you can actually earn slightly more than twice the limit and still be eligible. 

Some programs assist with Medicare premiums. Other programs assist with premiums and portions of medical bills that Medicare does not pay, such as deductibles and coinsurance. Together these programs are known as Medicare Savings Programs (or Medicare Buy-In Programs).

These programs are administered by your state Medicaid agency.

For information about each of these programs, see:

NOTE: Everyone enrolled in a Medicare Savings Program is automatically eligible for full, no-deductible, premium-free, very low co-pay "Extra Help" coverage in a Medicare Part D prescription drug plan with no doughnut hole.

If your income is too high for one of these programs:

  • You may qualify for Medicaid.  If you have HIV, you may qualify for your state's AIDS Drug Assistance Program.
  • You may also be able to obtain care at a Federally-funded health center (also known as HRSA Health Centers). In these centers the Medicare deductible and/or co-insurance may be reduced or waived entirely.

NOTE:  

  • For information about financial assistance in general, click here.
  • For information about assistance with paying premiums, copays, deductibles and co-insurance, click here.

The Benefits Under Each Of The Assistance Programs

QMB: Qualified Medicare Beneficiary Program

QMB pays for a beneficiary's Medicare premiums, deductibles and coinsurance.

To be eligible, Medicare beneficiaries must have net countable income at or below the federal poverty level and with limited resources (see below.)

Eligible individuals receive full coverage for just about all medical care except prescriptions, dental and nursing home case. These excepted items are covered by state Medicaid.

Most states do not cover adult dental care in their Medicaid programs. Some states such as New York do cover adult dental care.

If you don't qualify for state Medicaid, see Drugs 101 to find out how to qualify for free medications.

SLMB: Specified Low Income Medicare Beneficiary Program

Under SLIMB, Medicare premiums are paid for the recipient (deductibles and co-payments are the recipient's responsibility). As a bonus, the monthly deduction for Medicare Part B is restored to the recipient's check for Social Security Disability Insurance (SSDI).

To be eligible, Medicare beneficiaries can have a net countable income between 100 and 120% of the federal poverty level and have limited resources. (See below.)

Q1-1 (or QQDI): Qualified Individual Program

Q1-1pays for Medicare Part B premium.

Eligibility is Medicare beneficiaries with net countable income between 120 and 135% of the federal poverty level and limited resource. (See below.)

Income And Resource Limits For Financial Assistance

The various programs are shown below with their income limits and the benefits they provide.  If you meet the requirements listed above, look at the following chart to determine the plans for which your income qualifies you.

You can enroll in the programs at your state Medicaid office. 

If you do not qualify for one of these limits, check the limits for Medicaid in your state. The income limits may be higher. You can find contact information for your local Medicaid office at:  www.colorado2.com/medicaid/states.html   offsite link

If you have HIV, and do not qualify for Medicaid, you may still be eligible for your state's AIDS Drug Assistance Program (ADAP) which has higher income limits. To learn more, see ADAP 101.

2016 Monthly Income Limit (limits vary each year starting January 1]

Program

Program Pays Medicare's:

Individual

Couple

48 States

(Alaska & Hawaii see below)

 Resources
 

48 States

(Alaska & Hawaii see below)

Resources
 

$1,010

$7,280

 

$1,355

$10,930

 

Qualified Medicare Beneficiary (QMB) -pronounced "Quimby"

Premiums, deductibles, and coinsurance

$1,208

$7,280

 

$1,622

$10,930

 

Specified Low Income Beneficiary (SLMB) - pronounced "Slimby"

Monthly Part B Premium

$1,357

$7,280

 

$1,823

$10,930

 

Qualified Individual 1 (QI1)

Monthly Part B Premium

 

 

 

 

 

 

Qualified Individual 2 (QI2)

A "small" part of Part B premium, about $7.00/month

$4,045

$4,000

 

$5,425

$6,000

 

Qualified Disabled Working Individual (QDWI) Not pronounced

Only pays Part A premiums of people who have exhausted their Trial Work Period and Extended Period of Eligibility

* Incomes for Alaska and Hawaii are slightly higher. If your income is close to these amount, it is worth exploring whether you qualify for this program. To find out if you qualify, call your state Medicaid office. You can find the contact information for your local office at www.colorado2.com/medicaid/states.html offsite link or you can find the telephone number online at www.medicare.gov offsite link, Under "Search Tools" select "Helpful Phone Numbers and Websites" or call Medicare at 800.633.4227.

Eligibility For Medicare Financial Assistance

To qualify for financial assistance, you must:

  • Be eligible for Part A Medicare (Hospital Insurance).
  • Have a limited income that varies by program (See below).
  • Have assets or resources such as bank accounts, stocks, and bonds of less than $4,000 for a single person or $6,000 for a couple.
    • Your lived-in home of any value, one vehicle, and burial plots do not count.
    • An additional $1,500 in savings is permitted if it's kept separate from other money and is earmarked for your burial.
  • Not already be receiving Supplemental Security Income (SSI) or Medicaid.

Definition of Net Countable Income

"Net countable income" for purposes of these programs is determined in the same manner as it is for eligibility for Supplemental Security Income (SSI). This means you can earn (from a job) slightly more than twice the limit and still be eligible.

In calculating income for eligibility purposes, total Social Security Disability Insurance (SSDI) payments are included before deduction for the Medicare Part B premium.

To determine whether income is sufficiently limited ("net countable income"), Social Security "disregards" (deducts):

  • $20 of any income per month; then
  • If you are working, $65 and one half of the remainder of any earned monthly income.
  • If you work, medical expenses paid from your own money to directly support your work attempt are also deducted. For example, if your condition requires that you take a taxi to work instead of public transport, the cost is deducted before determining net countable income.
  • If you are a student and under age 22, another $400 a month is disregarded.
  • If you are blind, work related expenses of any kind not already disregarded are disregarded.

The net effect of the disregards is that a working person can earn a bit more than twice the required level and still qualify.

When a husband and wife share a common household, a spouse's income and assets are deemed to belong to the applicant spouse. This is the case as long as a husband and wife live together in a common household, even if they prove they are not sharing income and assets. If a household is not shared, only actually proven transferred income or assets are counted.

In determining eligibility, so-called "exempt" assets are disregarded, (i.e., they are not counted in determining eligibility). Exempt assets include an automobile to go to and from the doctor, business equity and equipment worth under $6,000 and your lived-in home no matter how valuable. The only residences that qualify are those occupied by applicants, their spouses or their minor or disabled children. Second houses are not included as exempt assets. Also exempted are a separate bank account of up to $1,500 for "burial" and $2,000 cash or cash equivalent.

Generally, the program does not care if an applicant sells assets for less than fair market value or even gives them away in order to qualify for Supplemental Security Income.

How Do I Enroll In One Of The Medicare Buy-In Plans?

The Medicare Buy-In Programs (QMB, SLMB, QI1, QI2, QDWI) are all administered by the state or county agency that administers Medicaid in your state, usually the Department of Public Social Services or the Department of Health Services.

If you are already receiving Supplemental Security Income (SSI), apply at your Social Security office. Otherwise apply through your local welfare office.

Generally you will have to go to one of those offices and apply in person for the program.

NOTE: The workers you will be dealing with are primarily Medicaid eligibility workers so all may not be familiar with the Medicare Buy-In programs. If your worker does not seem clear on the Programs or their eligibility requirements, ask to speak to a supervisor -- politely, of course. (See Make a Friend).

When you apply, take with you:

  • Birth, death, marriage, divorce, separation and child support/custody papers
  • Citizenship or immigration forms
  • Documentation to confirm your income and resource levels. Each office may have different requirements. If your assets and income are low enough to qualify for one of the programs, you will probably need only proof of your Social Security benefit, if that's your only income, and six months of bank statements if they are your primary assets in addition to one car and a residence.
  • Auto registration
  • Driver's license or other proof of identity and residence
  • Your Medicare card. If you are receiving a Social Security benefit such as Social Security Disability Insurance (SSDI), also take the latest letter from Social Security stating what your benefit total is. If you've lost this letter, call 800.772.1213 for a new one.

Medicaid eligibility offices can be crowded so go as early as possible, wear comfortable clothes and shoes, and take plenty of reading material.

Federally-funded Health Centers (also known as HRSA Health Centers)

There are hundreds of Federally-funded health centers around the country that provide medical care regardless of your ability to pay. They are often run by the government's Human Resources and Services Administration (HRSA). Such centers are often referred to as HRSA Health Centers.

If you have Medicare, these centers generally waive the Medicare Part B deductible and may waive or reduce the 20% coinsurance for Medicare-covered benefits for people with an annual income at or below the federal poverty level ($10,386 for an individual, $14,580 for a couple in 2009). They may also provide services not generally covered by Medicare.

To locate a Federally-Funded Health Center, go to: http://findahealthcenter.hrsa.gov offsite link

For Additional Information

If you have questions about Medicare, call the Medicare Rights Center Hotline at 800.333.4114 or 212.869.3850 or the Medicare hotline 800.863.6833.

For information about Medicaid in your state, contact your state Medicaid office. You can find the contact information at: http://www.colorado2.com/medicaid/states.html offsite link