Medicare Savings Programs (MSPs) are state programs that help pay for out-of-pocket costs such as coinsurance, copays, deductibles, premiums, and prescription drug costs. These programs have a subset of benefits under Medicaid that pay for coverage gaps in Medicare. Some MSPs will even eliminate late-enrollment penalties you may have incurred due to delaying your enrollment into Medicare.
Three Types of Medicare Savings Programs
Medicare Savings Programs were created to help low-income individuals afford their out-of-pocket medical costs once they become eligible for Medicare. Each program has its own set of income limits, benefits, and eligibility requirements.
Qualified Medicare Beneficiary
Specified Low-Income Medicare Beneficiary
Qualifying Individual
Qualified Medicare Beneficiary
The Qualified Medicare Beneficiary (QMB) program is the program that pays the most. Those eligible will have their Part B premium paid for in addition to any cost-sharing paid for under Part B. If you did not qualify for premium-free Part A, then the QMB program will pay your Part A premium as well.
Specified Low-Income Medicare Beneficiary
The Specified Low-Income Medicare Beneficiary (SLMB) program is one level down from QMB. It will cover your Part B premium, but nothing else. You will be responsible for any cost-sharing under Part B. SLMB will not cover costs under Part A.
Qualifying Individual
The Qualifying Individual (QI) program works the same as the SLMB program, only the income limits are a little higher. If you make just above the income limits for SLMB and therefore do not qualify, you could qualify for the QI program.
Those who qualify for any of the three Medicare Savings Programs will automatically qualify for Extra Help. Extra Help will help cover your out-of-pocket costs for your prescription medications.
FYI: If you don’t qualify for a Medicare Savings Program, then you can still offset your costs through Medicare supplemental insurance. Read our picks for this year’s best Medigap providers to learn more.
Medicare Savings Program Income and Asset Limits
To be eligible for a Medicare Savings Program, your income must meet the following criteria:
2023 Monthly Income Limits for Medicare Savings Programs*
Medicare Savings Program
Monthly Income Limit for Individuals
Monthly Income Limit for Married Couples
QMB
$1,235
$1,663
SLMB
$1,478
$1,992
QI
$1,660
$2,239
QDWI
$4,945
$6,659
* These income limits are subject to change in 2022.
In addition to meeting the above income criteria, your countable resources must be under the below limits:
2021 Resource Limits for Medicare Savings Programs*
Medicare Savings Program
Resource Limit for Individuals
Resource Limit for Married Couples
QMB
$7,860
$11,800
SLMB
$7,860
$11,800
QI
$7,860
$11,800
QDWI
$4,000
$6,000
* These income limits are subject to change in 2022.
Countable resources include any monies in your bank accounts, stocks, and bonds. Items that do not count against your countable resources include burial expenses, personal belongings, your home, one car, and a burial plot.
Medicare Savings Program Benefits
The benefits of each program are standardized, and the only difference from state to state is sometimes the name of the program. For example, in Connecticut, QI is called ALMB; in Wisconsin, QI is called SLMB Plus.
Medicare Savings Programs and the Part B Buy-in
Those who don’t qualify for a Medicare Savings Program may qualify for a Part B buy-in. In the same regard, if you do qualify for an MSP, you won’t qualify for a Part B buy-in. A Part B buy-in is also known as a Part B give-back benefit.
A Part B give-back benefit is offered through Medicare Advantage plans only. To entice you to enroll in a plan, carriers offer to reduce your Part B premium so that you get more money back in your Social Security check. Make sure to do your research thoroughly before enrolling in one of these plans. You may like the extra money back in your Social Security check, but you won’t like how much you could end up paying out of pocket as you use the benefits.
Applying for a Medicare Savings Program
To apply for a Medicare Savings Program, you can apply through your Social Security online dashboard, or you can call your state’s Medicaid office to apply.
Medicare Savings Program Budgeting
Depending on what program you qualify for, that will determine how well you can budget for your expenses. For example, if you have QMB, you won’t have to pay anything out of pocket for your medical services, regardless if they’re inpatient or outpatient. If you qualify for either SLMB or QI, budgeting will be more difficult because you won’t know what your cost-sharing will be under Part B. All you know is that your premium for Part B will be covered.
If you choose a Medicare Advantage plan, you will have the same issue regarding not being able to predict your out-of-pocket costs.
If you can afford a Medigap plan, then that will give you the flexibility to budget better since you know what you will pay out of pocket.
If you became eligible for Medicare due to a disability and incurred late-enrollment penalties under Part B and Part D, those penalties will be eliminated if you qualify for a Medicare Savings Program.
Bottom Line
If you are in a lower income bracket, there is help available to you when you become eligible for Medicare. Depending on how low your income is, you could have most or all of your costs covered under Medicare. This includes hospital, doctor, and prescription drug costs.
Since each state may have its own labeling for its Medicare Savings Programs, it’s recommended to reach out to your local Medicaid/Medicare department or insurance department to learn about all your options.
To learn more about Medicare, its costs, and its coverage, be sure to check out our helpful series of guides:
Essentially, there is no difference. The correct terminology is Medicare Savings Program. A Medicare Savings Program is a subset of benefits under Medicaid that help you pay for your Medicare costs.
For QMB, income limits are $1,235 for an individual and $1,663 for a married couple. For SLMB, income limits are $1,478 for an individual and $1,992 for a married couple.
Social Security will count as income; however, the state will not count up to $20 of additional income if you’re collecting Social Security when determining your eligibility.
Written By
Lindsay Malzone
As the Medicare expert for Medigap.com, Lindsay Malzone has ample experience helping seniors understand the ins and outs of their Medicare coverage and navigating the complex world of supplemental insurance. She has written for a variety of web publications based on her Medicare expertise. Ultimately, her passion lies in helping people find the right healthcare for their needs.
