Medicare Savings Program: How You Can Apply For It

Medicare Savings Program is a savings program launched by Medicare to facilitate its members with financial assistance

Medical insurance is an important facility that every individual or family needs to buy to live a healthy life. Medical insurance offers all the luxuries that one needs for medical treatment. It not only covers the medical bills for you but also gives you the benefit of saving up money for other things.

Progressive people always buy medical insurance because they are well aware of the advantages. It saves them the cost of affording expensive prescription drugs and lab tests for diagnosis.

Once you buy medical insurance, you just have to pay a premium cost from your salary. The cost of the premium depends on the type of insurance you buy. Sometimes a person’s salary is less than the premium they have to pay for, this is why the Medicare Savings Program exists.

The Medicare Savings Program helps an individual in paying the premium for the insurance plan from the savings account. You do not have to worry about buying the best plan for yourself because of this program.

If you earn minimum wage and are unable to pay the premium, you can apply for the Medicare Savings Program. Here is everything you need to know about Medicare Savings Program:

What is medical insurance?

Medical insurance is a type of insurance that provides medical benefits to people once they sign a contract with an insurance company. This contract contains some policies that you need to follow in order to enjoy the medical benefits based on the plan you sign.

Medical insurance fulfills all the needs of a layman by giving them maximum benefits. There are many plans and coverage offered by insurance companies that differ from one another in terms of medical benefits depending on the premium you pay on a monthly basis until the contract ends.

Medical insurance is provided to people of all ages and medical conditions.

Why is medical insurance important?

You might wonder why medical insurance is so important? Medical insurance was initially introduced to the public in the 1920s to cover the hospital and other medical expenses for people. Since then many people buy medical insurance because it gives so many benefits that a person without insurance cannot enjoy.

Medical insurance is important because not everyone has the financial funds to pay for hospital bills all the time. Insurance enables a person to keep their finances organized while maintaining their health.

What does medical insurance cover?

Medical insurance consists of medical services that a person can benefit from. When an insured person buys medical insurance, they are given all the medical benefits written in the plan.

Medical insurance policies are made by experts and medical professionals who are aware of patients’ and any layman’s medical needs in daily life. Some medical insurance plans are focused on long-term illness coverage, while some only cover accidents.

The medical insurance plans also depend on the type of plan you subscribe to and how much you pay for it. The higher premium you pay, the more benefits you will get in terms of coverage.

Medical insurance covers the cost of:

– Medical checkups

– Accident or sudden injury bills

– Laboratory and other diagnostic tests

– Surgeries, minor or major

– Dental checkups

– Vision test

– Rehabilitation facilities

– Mental health checkup

– Preventive and wellness services

– Pediatric services

– Prescription drugs

There are other medical services that can be covered as well based on the program you apply to.

What is Medicare?

Medicare is a health insurance program launched by the federal government of the United States to facilitate its citizens in medical benefits. This health insurance program is specifically designed for people older than 65 and young people with disabilities.

Medicare gives old people the opportunity to live a healthy life without worrying about finances. The program does not discriminate against any high-income or low-income earners; it provides assistance to every person who is eligible for the program.

How does Medicare work?

The Medicare program was created under the Social Security Act 1965 to benefit old people and physically disabled people. The government was motivated to provide the best medical services to progress as a medically fit country. Medicare has continued with many modifications in policies based on the demands of people.

Now, the program is managed by the Centers for Medicare and Medicaid Services. They have also included patients who suffer from end-stage renal disease and amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease. The program aims to provide maximum benefits to people who are unable to afford medical expenses.

If you have a Medicare Savings Program, you will be able to afford Medicare. As the government’s aim is to provide advantages to old and disabled people. They lessen the burden of expenses for insurance buyers on Medicare.

What are the parts of Medicare?

Medicare consists of parts that are divided because every person might need different services. These parts are made by medical professionals and experts to provide maximum benefits. The  Medicare Savings Program provides assistance to these parts as well.

There are three parts in Medicare that you should know:

Medicare Part A

Medicare Part A is also known as hospital insurance that covers all the expenses related to the hospital bills. This part also includes people who live in a nursing facility. People buy this insurance to get coverage in hospice care and home health care expenses.

The monthly payment of premium for Part A has an exception for those who paid Medicare taxes while they were working. Otherwise, everyone has to pay the premium on a monthly basis.

Medicare Part B

Medicare Part B is different from the other part because of its services. Medicare Part B is more focused on covering the doctor’s bills and other preventive care. They also help cover expenses of medical supplies like wheelchairs, hospital beds, crutches, etc.

You have to pay a certain amount of premium without any exceptions.

Medicare Part D

Medicare Part D is focused on providing coverage for prescription drugs. There are many people who need to afford prescription drugs on a regular basis. This part specifically provides the services to those people.

Medicare Part D covers the cost of a certain brand or generic drugs, however, there are different plans within the part that vary in terms of specific drugs and policy set by Medicare. The type of drugs they cover is called a formulary, in which the prescription drug list is arranged to fit the criteria for the patient.

Every part has a specific service so that people can only buy the part they want.

Medicare coverage

Medicare coverage comes under the parts. When you decide to buy Medicare insurance, you have two options to choose from in terms of coverage.

Original Medicare

Original Medicare is the coverage for Part A and Part B insurance. You have to choose between these services to pay for your coverage. Once you have subscribed to any of these two coverages, you will have to pay a certain amount of deductible at the initial time of every year.

The original Medicare requires you to pay 20% of the amount until the medicare insurance covers the cost, which is also known as coinsurance. This insurance covers a lot in the medical expenses, but not all of it.

There are some policies in insurance in which Medicare does not pay at all. For the Medicare Savings Program, there is a different policy.

Medicare Advantage

Medicare advantage varies from the original Medicare. It covers the cost of drugs when you buy Part D. This coverage plan is approved by Medicare but offered by a private company that covers the cost of your health and drug expenses.

Medicare advantage offers coverage in all parts–Part A, Part B, and Part D– with even more benefits compared to original Medicare. Just like original Medicare, you have to pay a certain amount at the start of the year.

There are different types of Medicare Advantage plans HMO, PPO, PPFS, SNPs, that you can choose from based on your medical needs.

Medicare Savings Program

Medicare Savings Program is financial assistance provided by the state to those who cannot afford to buy or pay monthly premiums for a Medicare insurance plan. If you have limited income, Medicare helps you in covering the deductibles, out-of-pocket, and coinsurance costs through this program. This program is also known as the Medicare Buy-In program or Medicare Premium Payment Program.

You can buy a Medicare Savings Program and benefit from the insurance plan without worrying about the finances.

Types of Medicare Savings Program

The Medicare Savings Program has four types out of which you can choose which one is best for you based on the policies. Each type is closely planned by the experts of Medicare to ensure that they bring you an advantage even if you have a low income and need financial assistance.

Before you know about the types of Medicare Savings Program, you should be aware of the resource limits that every type has set for individuals and a married couple. This program’s resource limits include money in a savings account, stocks, and bonds. It does not include your house, car, furniture, burial plot, and other personal items. So, when you apply to one of the programs, your resource limit will be reviewed.

Medicare Savings Program types are determined by the income of the person who is buying the insurance plan as well. Here are four types of Medicare Savings Program:

Qualified Medicare Beneficiary (QMB) Program

Qualified Medicare Beneficiary (QMB) Program is a type of Medicare Savings Program that covers the cost of an insured person who buys Plan A or Plan B. They cover the cost of the premium for both plans.

Furthermore, the program also covers the deductibles and copayments for the individual. They do not cover the cost of prescription drugs, so you will have to buy drugs on your own. So, if you fall under the category of this program, you will not have to pay much when you see the Medicare physicians.

The Medicare health providers will not charge you any fee or copayment if you have the QMB plan. You will be covered from expenses that fall under Part A and Part B, and some of Part D. The drug prescription policy is set on a certain limit that the insured has to pay for or the pharmacist under Medicare can charge.

In short, if you have a QMB program you will not be charged for deductibles out of pocket and copayments by Medicare health providers.

Specified Low-Income Medicare Beneficiary (SLMB) Program

The second type of Medicare Savings Program is the Specified Low-Income Medicare Beneficiary (SLMB) program. This Medicare Savings Program is introduced by the state that covers the cost of Part B premium if a person has only bought Part A. It also covers those who have limited income and resources.

The SLMB program is only made for people who need financial assistance in paying for Part B premium. Your income should fall under 120% of FPL to benefit from this program.

Qualifying Individual (QI) Program

The Qualifying Individual Program is a type of program that offers coverage for Part B premium only. This Medicare Savings Program is a first come first serve basis for every individual or couple. To benefit from this program, you have to apply every year, unlike the SLMB Program that does not require it.

The preference is given to those people who were previously part of the QI Program. You cannot benefit from this program if you have Medicaid insurance. Furthermore, if your income is not more than 135% FPL, you are eligible for this program.

Qualified Disabled Working Individual (QDWI) Program

Qualified Disabled Working Individual (QDWI) Program is for those who need financial assistance to pay a premium for Part A.

You are only qualified for this program if you are a disabled person or if you have an income-based job. This Medicare Savings Program is also eligible for those who lost disability benefits in Social Security or have no one covering the cost of the premium for Part A when returned to work.

Extra Help

Extra Help is a state program in Medicare that covers the cost of Part D. If you meet the income limit and resource limit then you are eligible to apply for this with your Medicare Savings Program. Extra Help facilitates paying the premium for Part D up to a certain limit set by each state. This enables a person to afford their prescription drugs at a lower cost.

Extra Help is only for those who have Medicare as their insurance plan and need financial assistance with prescription drugs. Many people do not realize the benefit of this program as a part of a savings program. Extra Help is worth $5,000 on a yearly basis for prescription drugs.

If you are enrolled in a Medicare Savings Program, then you are automatically eligible for Extra Help.

What is the income limit for Medicare Savings Program?

Now that you know the four types of Medicare Savings Program, you should know the income limit of each program set by the state and Medicare. These income limits help you determine whether you are eligible for a certain program or not.

Your income and resource must fall under this limit so that you can apply for Medicare Savings Program:

Income limit for QMB program

The criteria for the QMB program are the income and resource limit of the insured person. As of 2021, the income limit set by Medicare is $1,094 for individual monthly income and $1,472 is for a married couple.

The resource limit for an individual person is $7,970 and for a married couple, it is $11,960. You can apply for Part B premium to be covered by the state if you have an income limit.

Income limit for SLMB program

The government wants to benefit its disabled and old citizens to live healthy and happy lives through its savings program. The criteria for the SLMB program are based on the income and resource limit set by the state.

If your individual monthly income is around $1,308 and married couple income is around $1,762, then you can benefit from this program. The individual resource limit is set at $7,970 and for a married couple, it is $11,960.

Income limit for QI program

The income and resource limit of the QI Program is different from other programs. The individual monthly income limit should be $1,469 and $1,980 for a married couple.

The resource limit for an individual is $7,970 and for a married couple, it is $11,960. This income limit is for those who do not fall in other types.

Income limit for QDWI program

There is also an income and resource limit set by Medicare for this program. You can apply for the QDWI program if you have an individual monthly income limit of $4,379 and $5,892 for a married couple.

You can be qualified for this program if your resource limit is $4,000 as an individual and $6,000 for a married couple.

Income limit for Extra Help

Extra Help also meets certain criteria and limits for the individuals who need the Medicare Savings Program. If your monthly income as an individual is $1,630, then you can qualify for the Extra Help.

Based on your income, you can either be compensated fully or partially by Medicare for prescription drugs coverage.

All the Medicare Savings Program limits and resources vary from state to state. The limits that are mentioned above are a rough estimate of the income and resource limit. Every state has its own income data that varies, which is why the limits are also different. You can visit the official website of Medicare associated with your state to know the exact figures.

Does Social Security count as income for Medicare Savings Program?

Social Security is offered by the federal government to disabled and old people. Your government pays some of the expenses of daily life for well-being if you qualify for their Social Security program.

Medicare is offered to people who are disabled because it focuses on certain medical services that can be beneficial for them by dividing them into parts. The Medicare Savings Program is made for those disabled and old people who cannot afford the financials of the insurance plan. They give financial assistance to people based on the income and asset limit.

The Social Security as income depends on the type of Medicare Savings Program you buy for yourself. In QDWI, the program covers the cost if you lost your benefits in Social Security. Therefore, you need to check up with the state Medicare website and ask their agents directly as to whether Social Security counts as income for the Medicare Savings Program or not.

What is the difference between Medicare Savings Program and Medicaid?

Health insurance is an important facility that every person needs to have in life. The government provides many health insurance benefits through its organization to every kind of person.

Medicaid is a health insurance program run by the state government to benefit people with limited income. They provide maximum medical services to their citizens as long as they fall under certain criteria of income and resource limits set by the state.

People who have Medicare can be eligible for Medicaid because it is part of the organization’s program. People who need insurance in vision, dental, and other specific medical treatment can apply for Medicaid anytime.

The Medicare Savings Program is part of Medicaid. It is the sub-set of the Medicaid program that is made to benefit disabled people with low income in covering the cost of Medicare.

So, the difference between the Medicare Savings Program and Medicaid is that the savings program falls under the broader state program called Medicaid.

How to apply for Medicare Savings Program

Since you have read all the details about the Medicare Savings Program, you can apply for it. Based on the income and resource limit, you are eligible to apply and benefit from all the medical services without having any financial burdens.

Before applying you need to make sure you have eligibility to apply for Part A, your income in the current resources that are included in the program as limits to benefit from the program.

You can apply for the Medicare Savings Program in two ways:

Apply online

In the digital world, everything works online. Every organization has a website where you can apply for a subscription. Insurance companies also offer this facility to people. You can apply for the Medicare Savings Program through the website.

You can visit the Medicare page to know everything about the Medicare Savings Program. It includes all the details that you might have questions about before you apply.

To apply online, you need soft copies of your official documents that you can upload if needed. Just make an account on the website, and fill out the form details on your own then submit it to get a response on whether you are eligible to apply or not.

Call Medicare

You can apply for the Medicare Savings Program through a phone call as well. Every state has different phone numbers for Medicaid where you can call to apply for health insurance.

You can also apply by phoning directly on Medicare’s number 1-877-486-2048 as well. They have 247 services with call operators always ready to help you with any queries or application process.

Conclusion

The Medicare Savings Program is a smart way of affording health insurance if you are disabled and over the age of 65 in the United States. Medicare offers you all the medical facilities that are focused on services you need to maintain health.

Some believe that having medical insurance is a waste of money, which is wrong. The state government works hard to provide facilities to its old citizens and medical insurance is one of them. The Medicare Savings Program is solely made for the benefit of the health of the disabled without worrying about financial burdens.

So, by reading the above article if you think you are eligible for the Medicare Savings Program, then apply and benefit from it today!

Tony Bennett

Tony Bennett

Tony Benett makes his living in the insurance industry by teaching and consulting. He is also recognized by the legal profession as an expert on insurance coverages. His insurance experience includes having worked at the company level, owned an independent general agency and having worked for an insurance association. He has received various certificates over the past few years and helps his clients and readers by giving them a realistic outlook on what they can expect to achieve within their set targets. At Insurance Noon, he is known for his in-depth analysis and attention to details with accuracy. He has been published as one of the most referred agents by his peers in the insurance community. Tony loves the outdoors and most sport events. His passion other than providing excellent advice is playing golf.