Many Medicare beneficiaries who struggle to afford the cost of their coverage do not realize there are programs that can help them offset their out-of-pocket expenses associated with Medicare Parts A, B and D premiums, deductibles, coinsurance, and copayments. These include four Medicare Savings Programs (MSPs) federally funded administered by state Medicaid agencies, and Extra Help Low Income Subsidy program (LIS) administered by Social Security.
These programs are designed for people with limited income and resources. Each program has different benefits and eligibility requirements. Being educated on how these programs work is essential so you can assist your clients who may qualify. These programs could have a significant impact on their financial and physical well-being.
Medicare Educators agents and many others offer this service free of charge. Educate your clients to beware of those who charge to help them file this application.
There Are Four Different MSPs
Qualified Medicare Beneficiary Program (QMB)
QMB can help pay for Part A and B premiums, deductibles, coinsurance, and copayments for applicants who meet income and financial resource limit requirements. Eligibility begins on the first day of the month after being certified for benefits.
Specified Low Income Medicare Beneficiary Program (SLMB)
SLMB can help pay Part B premiums. Medicaid recipients may also receive SLMB benefits. Eligibility begins the month of application if income and financial resource limits are met but could be retroactive for the three months prior if the requirements were met during those months.
Qualifying Individual Program (QI-1)
QI-1 helps pay Part B premiums for people who meet the income and resource limits. Applicants cannot receive regular Medicaid and the QI program coverage at the same time. Participants in this program must apply every year for benefits. Applications are granted on a first-come, first-served basis, with priority given to people who received QI benefits the previous year. Eligibility may begin the month of application and could be retroactive the three months prior if all requirements were met in those three months, and if those three months do not extend into the previous calendar year.
Qualified, Disabled and Working Individual Program (QDWI)
QDWI pays for the Part A premium for those who meet the income and resource limits. Applicants must be under the age of 65, have a disabling impairment, and still be working. They cannot be eligible for Medicaid. Eligibility may begin the month of application and could be retroactive the three months prior if all requirements were met in those three months.
How to Qualify for MSPs in Texas
All income and financial resources are used to calculate eligibility.
What is considered a financial resource:
- Bank accounts and Certificates of Deposit (CDs)
- Individual Retirement Accounts (IRAs)
- Investments in stocks and bonds
- Land or buildings (real property)
- Oil, gas, or mineral rights
- Jewelry and antiques
- Cars and vehicles
- Boats and recreational vehicles
What is considered income:
- Social Security benefits
- Railroad, state, or local retirement benefits
- Investment interest or dividends
- Gifts or contributions
- Civil service annuities
- Veteran or private pension benefits
- Earnings, wage, royalties, and rental income
- The value of food, clothing, or shelter paid by someone else, including your spouse
What can be excluded:
- Your primary residence
- Life insurance if valued at $1,500 or less
- Separately identifiable burial funds of $1,500 for you and your spouse
- The value of burial plots
- One car
In the state of Texas, you cannot qualify for QMB or QI status if you are between the ages of 20 and 64 and institutionalized for mental illness. People of any age who are in prison or jail are automatically disqualified.
How to Apply for Medicare Savings Programs in Texas
If your client believes they meet the income and resource limits, they can fill out an application online at Your Texas Benefits or call the Texas Health and Human Service Commission Medicaid office at (512) 424-6500.
Low Income Subsidy Program (LIS) / Extra Help Prescription Cost Savings
LIS or Extra Help can help pay for Medicare Part D premiums, deductibles, copays, and coinsurance. It also covers the prescription “donut hole”. If qualified, applicants must enroll in a Part D prescription plan. Those who qualify don’t have to pay a late enrollment penalty. Applicants who qualify for QMB, SLMB or QI programs will automatically qualify for Extra Help. This program is administered by the Social Security Administration. Applicants can apply online or call SSA at 1-800-772-1213.
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