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What is a Medicare Savings Program?

If you have limited resources or live on a fixed income, you might wonder whether you can afford an Original Medicare or Medicare Advantage plan. The good news is your state has resources for this, if you meet the income criteria. Medicare Savings Programs can cover items such as plan premiums, copays, deductibles and more.

There are four levels of savings programs, each with its own criteria for income and resources. The first program, QMB, has the lowest income limit and offers the greatest amount of coverage. The income limits increase, with the QDWI program at the highest threshold.

Qualified Medicare Beneficiary (QMB) Program

Specified Low-Income Medicare Beneficiary (SLMB) Program

Qualifying Individual (QI) Program

Qualified Disabled and Working Individuals (QDWI) Program

Am I eligible for a Medicare Savings Program?

Whether you are eligible depends on if your income and resources are at or below the threshold of at least one of the four Medicare Savings Programs. The limits are also higher for married couples.

Remember, even if your income is higher than what’s listed, you might still qualify for one of these programs. That’s because income from working doesn’t necessarily apply to these limits.

Your resources also help determine whether you’re eligible. These resources, considered separate of your income, include checking and savings accounts, stocks and bonds.

The limits change each year, and you can check the amounts on a site such as Medicare.gov to see if you’re eligible.

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What about Extra Help for prescription drugs?

If you're eligible for the QMB, SLMB or QI Medicare Savings Programs and you have a plan that includes prescription drug (Part D) coverage, you’re also eligible for Extra Help. This program helps cover prescription drug costs and waives late enrollment penalties for Part D. Further, if you’re eligible for Extra Help, the coverage gap stage will not apply to you.

While Medicare Savings Programs come from your state, Extra Help is a federal government resource. You can visit the Social Security website or local office to apply.

Many people are not aware they meet the requirements for these programs. Plus, it's possible to qualify for Extra Help even if you're not eligible for any of the Medicare Savings Programs. That’s why checking with Social Security to see if you qualify is worth your time.

How do I apply for Medicare Savings Programs?

Medicare.gov explains that if your answer is ‘yes’ to their three questions below, check with your state’s Medicaid program to see if you qualify. Medicaid programs vary from state to state, and whether or not you qualify for Medicaid depends on your income level. And remember, if you’re 65 or older, you qualify for Original Medicare.

  1. Do you have Original Medicare Part A (or are you eligible for it)?
  2. Is your yearly income at or below the program limits?
  3. Do you have limited resources at or below the program limits?

The limits for Medicare Savings Programs typically increase every year, so even if your income and resources are a bit higher, you should still fill out an application to see if you qualify.

Learn more about what Original Medicare is or see if an Amerigroup Medicare Special Needs Plan is right for you. Or, if you’re ready, find and compare plans now.

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Non-Discrimination Notice: The plan documents may be available in other languages. Or, if you have special needs, the documents may be available in other formats. Please review the Notice of Non-Discrimination in Health Programs and Activities and call Customer Service for details.

Amerigroup is an HMO plan with a Medicare contract and a contract with the State Medicaid Program. Enrollment in Amerigroup depends on contract renewal.

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Accepted 06/19/2020

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