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Medicare Extra Help or the Medicare Savings Program, as it’s sometimes called, is a great program for seniors on Medicare with very limited incomes and assets. Many seniors qualify, but don’t know they qualify because they’ve never asked for help and didn’t know they had to apply to get Extra Help with their premiums, medical costs, and prescription costs. In the next few paragraphs, I will highlight why this is so important. So, let’s get down to the nuts and bolts of this program.

The Medicare Savings Program is for seniors on Medicare with very low incomes and resources. How low of an income do you need to qualify? Below I have listed the four kinds of Medicare Savings Programs and each program’s qualifications.

Qualified Medicare Beneficiary (QMB) Program: As of 2024, your monthly income cannot be more than $1,275 for an individual or $1,724 for a married couple to qualify. An individual’s resource limit cannot be more than $9,430 or $14,130 for a married couple. If you qualify for this program, this program helps pay for Part A and Part B premiums and deductibles, coinsurance, and copayments.

Specified Low-Income Medicare Beneficiary (SLMB) Program: In 2024, you qualify for this program if you have a monthly income of not more than $1,526 for an individual or $2,064 for a married couple. An individual’s resource limit cannot be more than $9,430 or $14,130 for a married couple. If you qualify for this program, the program helps pay for your Part B premiums, which are currently $174.70 monthly.

Qualifying Individual (QI) Program: To qualify for this program in 2024, your monthly income cannot be more than $1,715 for an individual or $2,320 for a married couple. An individual’s resource limit cannot be more than $9,430 or $14,130 for a married couple. If based from your income and resources you qualify at this level, you get help paying your Part B premiums. However, the Qualifying Individual program is a state program, and you must reapply every year for these benefits that are on a first-come, first-served basis with priority given to those who had Qualifying Individual benefits the previous year.

Qualified Disabled and Working Individuals (QDWI) Program: To qualify for this program in 2024, which pays for your Part A premiums, you are either a working disabled person under 65, you lost your premium free Part A when you went back to work, you aren’t getting medical assistance from your state, or you meet the income limit for your state, which is $5,105 monthly for an individual or $6,899 for a married couple.  The resource limit for the QDWI program is $4,000 for individual and $6,000 for married couples.

If you qualify for either of the Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary or Qualifying Individual Programs, you automatically get Extra Help paying for prescription coverage or what is referred to as a Low-Income Subsidy (LIS).

Applying for Extra Help through the Medicare Savings Program: There a few ways to apply. You can either call your state’s Medicaid office and apply that way or you can do a simple search for your state’s Medicare Savings Program application online, print out a paper application, fill out the application and mail it in. The paper application for Kentucky is here.  If you think you may qualify for the Medicare Savings Program, please apply! It can make a big difference in your quality of life. I see seniors often who qualify and didn’t know they qualified and have been through more stress than is necessary.

Medicare Savings Program Change in Status: So, what if you are already receiving benefits from the Medicare Savings Program and have a change in your Extra Help status due to an increase in income? If this happens and you are currently on a specific Medicare Advantage plan called a Dual-Eligible Special Needs plan or DSNP, don’t fret if the company you have your plan with sends you a letter that states you must leave your plan. You have two months to change to a plan that will still work fantastic for you, and you may possibly still be able to keep the Low-Income Subsidy for your prescriptions. If you are in this situation, reach out to us here and we’ll help you navigate this issue stress free.