Medicare Savings Programs are discussed here not because they offer any significant long term care resources, but instead to help clear up the misperception that they cover long term care.
Definition
Medicare Savings Programs (MSPs) are designed to help low-income Medicare beneficiaries who have financial resources that exceed the maximum allowed by Medicaid, but still cannot afford to pay their Medicare premiums, deductibles, and co-payments. There are four types of Medicare Saving Programs. Eligibility for each is primarily based on a senior’s financial resources and income.
1) Qualified Medicare Beneficiary (QMB) – helps pay for Medicare Part A & Part B, as well as deductibles, copayments, and coinsurance
2) Specified Low-Income Medicare Beneficiary (SLMB) – helps pay for Medicare Part B only
3) Qualifying Individual (QI) – helps pay for Medicare Part B only
4) Qualified Disabled & Working Individuals (QDWI) – helps pay for Medicare Part A only
While MSPs help elderly individuals with their Medicare premiums, deductibles, and co-payments, Medicare itself offers very few long-term care benefits. Medicare is not a long-term care solution, and therefore, neither are MSPs. Having said that, there are some benefits for seniors with recoverable conditions on a short-term basis.
Long Term Care Benefit Summary
Skilled Nursing Facilities
Medicare will pay for 100% of the cost of care for 20 days at a skilled nursing facility and 80% of the cost for 80 more days. The care must be for short term recovery following a hospital stay.
Assisted Living Communities
Medicare does not cover any cost of assisted living. It will pay for some medical costs incurred while the senior is in assisted living, but will pay nothing toward custodial care or room and board.
In Home Care
Medicare will cover skilled nursing care given in the home for a limited time period, but not non-medical care. Care must be prescribed by a doctor and needed part-time only. The senior must be “confined,” meaning they are unable to leave the home without the assistance of another person. Medicare hospice care is the one notable exception to this rule.
Adult Day Care
Medicare does not pay for adult day care services
Qualifying / Eligibility Requirements
Age
Seniors must be eligible for Medicare; therefore, Medicare Savings Program’s eligibility begins at the same age of 65 years old.
Disabilities / Health
The Medicare Savings Programs, QMB, SLMB and QI have no disability requirements. The QDWI program is designed for disabled persons as designated by Social Security.
Financial
Medicare Saving Programs’ financial requirements change yearly. As of 2022, in most states, the following income and resource limits exist for each program:
| 2022 Medicare Saving Programs Eligibility Limits |
|
MSP Program Type
|
Single Income
|
Married Income
|
Single Asset
|
Married Asset
|
|
Qualified Medicare Beneficiary (QMB)
|
$1,153
|
$1,546
|
$8,400
|
$12,600
|
|
Specified Low-Income Medicare Beneficiary (SLMB)
|
$1,379
|
$1,851
|
$8,400
|
$12,600
|
|
Qualifying Individual (QI)
|
$1,549
|
$2,080
|
$8,400
|
$12,600
|
|
Qualified Disabled & Working Individuals (QDWI)
|
$4,615
|
$6,189
|
$4,000
|
$6,000
|
* Note that the income limits for these MSPs are slightly higher for residents of Alaska and Hawaii.
For MSPs, resources/assets include checking, savings, stocks, and bonds. They do NOT include one’s home, a single car, furniture, household / personal items, a burial plot, and a maximum of $1,500 for burial expenses.
Personal Factors Not Affecting Eligibility
Marital status does not affect eligibility but income and resources requirements change if one is single or married.
A veteran’s discharge status has no impact, and state of residence also does not impact eligibility but may change the income and resource limits.
Benefits
Note that these are the benefits of MSPs not of Medicare itself.
Medicare Savings Programs provide reductions in Medicare premiums, deductibles and co-payments for the elderly. This program does not provide seniors with cash payments. Type of assistance by program follows:
- Qualified Medicare Beneficiary (QMB) – Part A and Part B premiums, deductibles, co-insurance, and co-payments, as well as deductibles, copayments, and coinsurance
- Specified Low-Income Medicare Beneficiary (SLMB) – Part B premiums only
- Qualifying Individual (QI) – Part B premiums only
- Qualified Disabled & Working Individuals (QDWI) – Part A premiums only
Coverage in Medicare Savings Programs typically begins one month after a senior has been approved for Medicare. Application processing varies by state but is typically less than 60 days.
Costs
Medicare Savings Programs are designed to help seniors lower their Medicare costs. There are no added costs to apply or increases in monthly premiums.
How to Apply
Call 1-800-MEDICARE to get the number of your state Medicare office and ask for an application. Alternatively, most states also make their application available online. Find your state’s Medicare Saving Programs office.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
