Washington

Medicare Savings Programs: Help Paying For Medicare Costs

Authored By: Columbia Legal Services
Contents
Download Information Related

Download

Information

1. Are you eligible for help paying for Medicare premiums or deductibles?

If you're on Medicare, you may qualify for help with Medicare premiums, deductibles, and cost-sharing. There are four programs that can help. They are called "Medicare Savings Programs" or "MSPs."  The MSPs are:

  • Qualified Medicare Beneficiary (QMB)

  • Specified Low Income Medicare Beneficiary (SLMB)

  •  Qualified Individual (QI-1)

  •  Qualified Disabled Working Individual (QDWI)

2. Do I have to be 65 years old?

No, with one exception. As long as you are on Medicare, your age does not matter except for QDWI. For QDWI, you must be under 65 and not eligible for free Part A.

3. What are the names of the MSPs? Am I eligible?

A Summary Table of the income and resource limits for each MSP is on the last page.

Qualified Medicare Beneficiary  (QMB) Program:

QMB pays for most premiums, deductibles, co-payments and coinsurance. QMB does not pay prescription co-pays.  QMB pays for your Medicare Part A hospital deductible, hospital coinsurance, and nursing home coinsurance.  QMB also pays for your Part B monthly premium, deductible, and coinsurance. If you don't have free Part A coverage, QMB will pay your Part A premium.

QMB starts paying for your Part A and Part B premiums the first of the month after you are found eligible. For example, if you are found eligible on May 10th, QMB starts paying on June 1.

QMB only pays for deductibles, coinsurance, and copayments for services that Medicare would cover and only up to the Medicare allowed amount.

Who qualifies for QMB?

Your income must be at or below 100% of the federal poverty level (FPL). This number changes once a year in April. As of April 2014, you qualify if your income is $973 per month or less if you are single and $1,311 or less for a married couple. Your countable resources must be less than $7,160 if you are single and $10,750 for a couple.

Specified Low Income Medicare Beneficiary (SLMB) Program:

SLMB pays for your Medicare Part B premiums.  And, if you are eligible, SLMB pays premiums for up to three months before you are found eligible. For example, you apply for SLMB on April 1 and are declared eligible on April 15. It turns out you were eligible for SLMB during March, February, and January, too. SLMB will pay for your Part B premiums starting in January. You will get a refund from Social Security for the premiums you already paid for January-March.

Who qualifies for SLMB?

Your income must be at or below 120% of the federal poverty level (FPL). This number changes once a year in April. As of April 2014 you qualify if your income is $1,168 per month or less if you are single and $1,574 or less for a couple. Your countable resources must be less than $7,160 if you are single and $10,750 for a couple.

Qualified Individual (QI-1) Program:

QI-1 pays for your Medicare Part B premiums  unless you already receive Medicaid.  If you are eligible, QI-1 pays for premiums for up to three months before you are found eligible. For example, you apply for QI-1 on April 1 and are declared eligible on April 15. It turns out you were eligible during March, February, and January, too. QI-1 will pay for your Part B premiums starting in January. You will get a refund from Social Security for any premiums you already paid for January – March.

You may still be eligible for the QI-1 program so long as you are not eligible for any other Medicaid program.

Who qualifies for QI-1?

Your income must be at or below 135% of the federal poverty level (FPL). As of April 2014, you qualify if your income is $1,314 per month or less if you are single and $1,770 or less for a couple. Your countable resources must be less than $7,160 if you are single and $10,750 for a couple.

Qualified Disabled Working Individual (QDWI) Program:

QDWI is available to people who had Social Security and Medicare benefits because of a disability, but lost them because they went back to work and earned more than Social Security allows. QDWI pays for your Medicare Part A premiums, if you have to pay them, but does not pay for Part B premiums. QDWI can pay for your Part A premiums for up to three months before you are found eligible. For example, you apply for QDWI on April 1 and are declared eligible on April 15. It turns out you were eligible during March, February, and January, too. QDWI will pay for your Part A premiums starting in January.
You may still be eligible for the QDWI program so long as you are not eligible for any other Medicaid program.

Who qualifies for QDWI?

You must be under age 65. Your income must be no more than 200% of FPL. As of April 2014, 200% of FPL is $1,946 for an individual and $2,622 for a couple.  A client must be working to qualify for QDWI.  Countable resources must be less than $4,000 for a single person and $6,000 for a couple.

4. What if I'm on Medicare, but my spouse and minor children are not?

If you are on Medicare, but your spouse is not, the state will treat you as single for purposes of determining your eligibility for MSPs. If your spouse has income, some or all of it may be counted as your income.

First example: 66-year old Nancy lives with her 64-year old husband, Ted. Nancy is on Medicare. Ted isn't. Nancy's income is $1,215 per month from Social Security. Ted has no income. Nancy is not eligible for QMB (or SLMB) because the state treats her as if she is single. The QMB income limit for a single person is $973 per month and the SLMB income limit for a single person is $1,168. Nancy is eligible for QI-1 because the QI-1 income limit for a single person is $1,314.

Second example:  67-year old Bill is on Medicare and lives with his 64-year old wife, Jane. Bill is on Medicare. Jane isn't. Bill's income is $850 from Social Security. Jane earns $400 per month from part time work. Bill is not eligible for QMB (or SLMB) because the state treats him as if he was single even though the state "counts" Jane's income. The fact that Jane's income is "counted" is what makes him ineligible. The QMB income limit for a single person is $973 per month and the SLMB income limit for a single person is $1,168. Bill is eligible for QI-1 because the QI-1 income limit for a single person is $1,314.

The state also does not take into consideration whether you have minor children. For example, a single mom, Sally, lives with her 13-year old daughter, Linda. Sally is disabled. She gets $995 in Social Security disability. She is on Medicare. Linda gets $200 per month Social Security dependent benefits. Sally's household income is $1,195 per month, but she is not eligible for QMB (or SLMB) because the state treats Sally as if she wasn't a mom with a child for purposes of determining Sally's eligibility for an MSP. The QMB income limit for a single person is $973 per month and the SLMB income limit for a single person is $1,168. Sally is eligible for QI-1 because the QI-1 income limit for a single person is $1,314.

There is a question whether the state's refusal to look at household income is correct. Some states look at family size and household income. In those states, Nancy, Bill, and Sally would be eligible for QMB which is a program with more benefits. Washington State takes the position that Nancy, Bill, and Sally are not eligible for QMB.

You can discuss your MSP eligibility, including the family size issue, at no cost with an advocate. Call the Northwest Justice Project or contact them online.

People under 60, call: 1-888-201-1014.
People over 60, call: 1-888-387-7111.
Contact online at:
https://waoi.legalserver.org/modules/a2j/intake.php

5. What income and resources count?

What counts as income? What doesn't count?

Income is usually money, either earned through working, or unearned, such as Social Security or pensions.  Income also includes interest earned on savings accounts or certificates of deposit, as well as dividends on stocks. 

Income does not include cash assistance from the state  or in-kind federal, state, or local government assistance for medical care or for needs other than food, shelter, or clothing.

What counts as a resource? What doesn't count?

Cash, liquid assets, and real or personal property are all resources.

 The following resources are not counted when figuring eligibility:

  • Your home and surrounding land, household goods and personal effects, life insurance with cash value less than $1,500, burial spaces, and burial funds of less than $1,500. 

  • A vehicle of any value is not counted if it is necessary for employment, getting to medical treatment, modified for handicapped use, or necessary for transportation due to climate, terrain or distance. If a vehicle cannot be excluded based on these exceptions, then it can be excluded if its current market value is $5,000 or less.  A vehicle can be anything used to transport people on land, by air, or by water.

  • Trust or restricted Indian property.

  • Up to $6,000 in land or personal property used to produce goods and services essential to everyday living.

6. What about Medicare Part D?

The MSPs do not pay for Medicare Part D prescription drug coverage. But, eligibility for QMB, SLMB, or QI-1 means you are eligible for the Part D federal Low-Income Subsidy. This subsidy allows you to sign up for some Part D Plans with no premiums, deductibles or gaps in coverage, and with low copayments. 

You enroll in a Part D Plan through Medicare, not through DSHS. More information is available at: www.ssa.gov/prescriptionhelp/

You can also get free help from a Statewide Health Insurance Benefits Advisor. Call 1-800-562-6900 to get information about your local SHIBA or visit: http://www.insurance.wa.gov/about-oic/what-we-do/advocate-for-consumers/shiba/find-a-local-shiba-office/

7. How do I apply?

You can apply at the local Department of Social and Health Services (DSHS) office or online at:
www.washingtonconnection.org

DSHS is listed in the blue pages in the phone book under the State of Washington listings. 

If DSHS say you are not eligible and you don't agree, you can appeal by asking for a hearing.  To ask for a hearing, write to the Office of Administrative Hearings at P.O. Box 42489, Olympia, Washington 98504-2489.  To find out more, see our publication Representing Yourself at an Administrative Hearing.

8. Is there Estate Recovery for Medicare Savings Programs?

No, there is no estate recovery.

SUMMARY TABLE

 

                  

People

          MSPs                        

1

2

QMB

100% FPL

973/mo

1,311/mo

SLMB

120% FPL

1,168/mo

1,574/mo

QI-1

135% FPL

1,314/mo

1,770/mo

QDWI                                                   Must be employed

200% FPL

1,946/mo

2,622/mo

QMB, SLMB, QI-1 Resources

 

QDWI Resources

7,160

 

 

4,000

10,750

 

 

6,000

 


 

 

MSP Q&A 11-2014

 

Prepared by COLUMBIA LEGAL SERVICES

  

 

 

 

5210EN

 

This publication provides general information concerning your rights and responsibilities. It is not intended as a substitute for specific legal advice. This information is current as of December 2014.

(Permission for copying and distribution granted to the Alliance for Equal Justice and individuals for non-commercial use only.)