Help with prescription-drug costs is available through the QDWI Medicare Savings Program.
Medicare Savings Programs are Medicaid-administered programs that provide financial assistance to Medicare-eligible beneficiaries who have incomes or assets too high to qualify for Medicaid assistance. Many people who have Medicare coverage find it hard to pay for premiums, deductibles and co-insurance payments, and MSPs can help such people meet the financial requirements of Medicare programs. The federal government provides minimum income and asset guidelines that states must meet when administering their MSPs, although most provide for more generous limits than outlined by federal law. There are four MSPs and each had its own guidelines, both at the federal level and among states.
Qualified Medical Beneficiary (QMB)
You must be eligible for, although not enrolled in, Medicare Part A. Medicare Part A is paid for through Social Security taxes and helps pay for inpatient hospital care, skilled nursing and nursing home care, and hospice care, among other services. Federal guidelines in 2010 for monthly income were $923 ($11,076 annually) for individuals and $1,235 ($14,820 a year) for married couples. Many states have established higher thresholds. Michigan, for example, requires you to earn below 135 percent of the Federal Poverty Level (FPL), which was more than $14,600 in 2010 for an individual. Not only does the QMB program pay for Medicare Part A, but it also provides assistance for Part B premiums for doctor fees; outpatient visits; and medical supplies, services and procedures not covered by Part A. There also are assets limits of $6,600 per individual and $9,910 for couples.
Specified Low-Income Medicare Beneficiary (SLMB)
The SLMB program pays for Part B assistance only -- help with your insurance premiums. The federal limits are $1,103 for individuals and $1,477 for married couples. Asset limits are the same as for QMB qualifiers: $6,600 for individuals and $9,910 for married couples. Again, you must be eligible for, not enrolled in, Medicare Part A to qualify for assistance. You may be eligible for SLMB help even if your income is higher than the federally mandated limit -- if you're working -- or you may have to change to Qualified Individual status.
Qualified Individual (QI)
If you qualify for Medicaid benefits, you cannot enroll in the QI program. The QI program pays for Part B premiums only. You must be eligible for Medicare Part A and you have to apply each year for QI benefits (unlike QMB and SLMB programs, in which you are perpetually enrolled). Qualified Individual applications are awarded on a first-come, first-served basis, and priority status is afforded to applicants who received QI benefits the previous year. The federal income limits are $1,239 and $1,660 for individuals and married couples, respectively. Asset limits are $6,600 for individuals and $9,910 for married couples. Again, states have their own income thresholds. North Dakota, for instance, requires you to have a net income level of more than 100 percent, but less than 135 percent, of the FPL.
Qualified Disabled and Working Individual (QDWI)
The QDWI program is for people who had Social Security Disability Insurance (SSDI) and Medicare coverage, but lost SSDI benefits and free Medicare Part A coverage because they returned to work. If this is the case, and your income level after returning to work exceeds established limits, you may be eligible for QDWI assistance. The federal monthly income standards are $3,695 for individuals and $4,942 for married couples, and asset limits are $4,000 and $6,000, respectively. QDWI pays your Medicare Part A premium (which previously was paid while you were on Social Security). You must be under age 65 and working, but have a continuing disability.
Extra Help
The Extra Help program pays the cost of Medicare prescription drugs (Part D) if you earn less than $16,245 as an individual or $21,855 as a married couple (2010 figures). Drug costs for 2011 are $2.50 or less for each generic drug and $6.30 for brand-name drugs. You must have full Medicaid coverage, be receiving help with your Medicaid Part B premiums from your state Medicaid program and get SSI benefits to qualify.
Tags: Medicare Part, married couples, individuals married, individuals married couples, limits individuals, limits individuals married, Medicare Savings
