Have You Have Been Enrolled Into A Medicare Savings Program (QMB)?

You may have received a letter saying that you have been enrolled into a Medicare Savings Program. These are low-income support programs administered through your state Medicaid program. Here in California it is administered through Medi-Cal. To be clear, these programs are separate from your Medicare and are strictly income-based.


What Are The Differences Between Medicare and MediCal?


The 4 Medicare Saving Programs


What items are included in the Medicare Savings Program resource limits?

Countable resources include:

  1. Money in a checking or savings account

  2. Stocks

  3. Bonds

Countable resources don’t include:

  1. Your home

  2. One car

  3. Burial plot

  4. Up to $1,500 for burial expenses if you have put that money aside

  5. Furniture

  6. Other household and personal items


How do I apply for Medicare Savings Programs?

If you answer yes to these 3 questions, call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state:

  1. Do you have, or are you eligible for, Part A?

  2. Is your income for 2019 at, or below, the income limits above?

  3. Do you have limited resources, below the limits above?

It’s important to call or fill out an application if you think you could qualify for savings—even if your income or resources are higher than the amounts listed here.


Qualified Medicare Beneficiary (QMB) Program Requirements

If you meet the income and resource requirements above, you will be entitled to the highest level of support from Medicaid. Individuals who qualify for the QMB program will receive the following:

  1. Full support in paying for their Part A premiums (if applicable). Those who havn’t payed into Medicare taxes for at least 10 years will generally have to pay for their Medicare Part A. Those in the QMB program will have these premiums payed for by the state.

  2. Full support in paying for their Part B premiums. Medicare Part B has a monthly premium of $135.50 (2019 amounts) for all of those who choose to enroll. Those enrolled into the QMB program will have these premiums payed for by the state.

  3. Full support in paying all Medicare deductible, coinsurances, and copayments. Normally Medicare Part A has a 2019 deductible of $1364 when hospitalized and Part B has a coinsurance of 20% for all Medicare covered medical services (doctors, labs, surgeries, ect.). Those in the QMB program will not have to pay for any service that is covered by Medicare.

  4. Automatic enrollment into the Social Security Extra Help Program that lowers your copays for covered medications, eliminates the “Donut Hole” for you, and prevents you from paying any applicable Part D penalties you may incur.

For those in the QMB program, Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments, except outpatient prescription drugs. Pharmacies can only charge you up to a limited amount (no more than $3.80 in 2019) for prescription drugs covered by your Medicare Part D drug plan.


To make sure your provider knows you’re in the QMB program, show both your Medicare and Medicaid or QMB card each time you get care. If you get a bill for medical care Medicare covers, call your provider or Medicare Health Plan about the charges. Tell them that you’re in the QMB program and can’t be charged for Medicare deductibles, coinsurance and copayments. If this doesn’t resolve the billing problem, call Medicare at 1-800-MEDICARE (1-800-633-4227) or your health plan and file a grievance. If you have experienced issues being billed while enrolled into the QMB program check out our other article that details your rights.


Specified Low-Income Medicare Beneficiary (SLMB) Program

Those enrolled in the SLMB program will get their Medicare Part B premiums payed for by the state. You will also be automatically enrolled into the Social Security Extra Help Program that lowers your copays for covered medications, eliminates the “Donut Hole” for you, and prevents you from paying any applicable Part D penalties you may incur.


Qualifying Individual (QI) Program

You must apply every year for the QI benefits program. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. You can’t get QI benefits if you qualify for Medicaid (aka Medi-Cal). This program is for those who are at the cusp of qualifying for Medi-Cal but don’t make it.


Those enrolled in the QI program will get their Medicare Part B premiums payed for by the state. You will also be automatically enrolled into the Social Security Extra Help Program that lowers your copays for covered medications, eliminates the “Donut Hole” for you, and prevents you from paying any applicable Part D penalties you may incur.


Qualified Disabled and Working Individuals (QDWI)

Those enrolled into the QDWI program will get help paying their Part A premium. You may qualify if any of these apply to you:

  1. You’re a working disabled person under 65

  2. You lost your premium-free Part A when you went back to work

  3. You aren’t getting medical assistance from your state

  4. You meet the income and resource limits required by your state

For more information on these programs and other options available to you, please contact us to meet with a licensed professional that is eager to support you.

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