If you need help paying for Medicare coverage but are too young or too healthy to qualify for Institutional or Categorically Needy Medicaid, you may be eligible for a Medicare Savings Program. These programs are funded by Medicaid under TennCare and provide varying levels of assistance for Medicare recipients in low income and asset brackets. For someone living on less than $1,000 per month, for example, avoiding the donut hole for prescription medications and having out-of-pocket medical costs covered by the program make a world of difference in a monthly budget.
There are three types of Medicare Savings Programs available to individuals: Qualified Medicare Beneficiary Program, Specified Low-Income Medicare Beneficiary Program, and Qualifying Individual Program.
The Qualified Medicare Beneficiary (QMB) Program covers the Medicare Part A and B premiums and deductibles, 20% coinsurance, cost sharing for Medicare Advantage, and full extra help for Part D plans. To qualify, an individual or couple must earn below the federal poverty line and have limited assets (see chart with figures for 2015 qualification). The income limit for this plan is 100% of the federal poverty level and increases slightly every year.
The Specified Low-Income Medicare Beneficiary (SLMB) Program is available to individuals or couples who earn up to 120% of the federal poverty level (see chart). This program covers only the Part B premium and full extra help for Part D plans. Individuals and couples must meet the same asset value qualifications as the QMB Program. Individuals or couples who earn up to 135% of the federal poverty level may be eligible for the Qualified Individual (QI) Program, which also pays for the Part B monthly premium and full extra help for Part D plans. Those receiving QI benefits must reapply every year, and applications are granted on a first-come, first-served basis. Priority is given to those who received QI benefits in the previous year.
2015 Income and Asset Limits for Medicare Savings Programs
|Monthly Income Limit||
Asset Value Limit
|QMB||$1,001 individual; $1,348 couple||$7,280 individual; $10,930 couple|
|SLMB||$1,197 individual; $1,613 couple||$7,280 individual; $10,930 couple|
|QI||$1,345 individual; $1,813 couple||$7,280 individual; $10,930 couple|
For QMB, SLMB, and QI qualification purposes, assets that may be counted include money in bank accounts, stocks, and bonds. Assets which do not count include the house in which the applicant lives, one car, a burial plot and up to $1,500 in burial expenses, furniture, and household and personal items. Asset transfers do not result in a penalty period for these programs, and there is no estate recovery for these programs either, so there are planning opportunities available for families that may not at first glance meet the asset requirements. For help determining whether or not you may qualify for one of these programs, get in touch with a Medicare planner, financial planner or elder law attorney who is familiar with public benefits programs.