Medicare Savings Programs help cover a variety of costs, including premiums and co-insurance.
Although Medicare offers fairly competitive pricing compared to many private health care plans, plenty of people out there can still benefit from assistance programs. Luckily, Medicare offers a variety of savings programs for various demographics that need medical assistance. Some of these programs are highly specific and targeted towards individuals with specific health conditions, while others are more general and based on income level and assets.
Most of these programs are federal, or at least available nationally. However, requirements and restrictions on these programs can vary by state, and they interface with Medicaid, which functions at the state level.
In most respects, Florida functions the same as most other states with regards to savings programs. We’ll run through the main types of savings programs out there, as well as the income requirements and other restrictions that you can expect as a Florida resident.
The four types of Medicare Savings Programs
There are four general types of Medicare savings programs that apply to Original Medicare (Medicare Part A and Medicare Part B) and Medicare Advantage (Medicare Part C).
All programs have eligibility standards that depend on things like monthly income limits and asset limits. This is similar to the way that the Medicaid program works in general, but the guidelines are specific to each Medicare Savings Program.
We’ll run through each type of plan one by one, so you can see which you may be eligible for, and which you think is the right fit for your situation.
A note on Extra Help
There are additional programs available that target Medicare Part D prescription drug plans, like Extra Help, also known as the low-income subsidy for Part D. We won't be going over these programs in detail here. If you are interested in more details, you should contact the Social Security Administration (SSA) to learn more. You can also find more information about Extra Help from medicare.gov.
Qualified Medicare Beneficiary (QMB) Program
The Qualified Medicare Beneficiary program, often referred to as QMB, is a program that can help pay for all of your out-of-pocket costs under Original Medicare. If you qualify for a QMB program, they will pay for your deductible, coinsurance co-payments, and monthly premiums for both Part A and Part B.
To qualify for QMB, you must be eligible for Part A, have an income at 100 percent of the federal poverty level (FPL) or lower, and resources that do not exceed twice the limit for Supplemental Security Income (SSI). Benefits.gov provides more details about SSI.
Specified Low-Income Medicare Beneficiary (SLMB) Program
The SLMB program functions in a fairly similar way to QMB but is restricted to Medicare Part B premiums only. If you are part of this savings program, everything aside from the Part B monthly premium will still be your responsibility to pay.
To qualify for SLMB, your income will have to be between 100 percent and 120 percent of the federal poverty level, with resources that don’t exceed twice the SSI limits. You will also have to be eligible for Part A. Under the SLMB program, Medicaid will pay for your Part B premium and you will receive other Medicaid benefits as well.
Qualifying Individual (QI) Program
Qualifying Individual programs function the same way that SLMB programs do, but with a higher income bracket. To qualify for QI programs, you’ll need an income between 120 percent and 135 percent of the federal poverty level, Medicare Part A eligibility, and no enrollment in Medicaid. Medicaid will pay for your Part B premiums, and you’ll receive additional Medicaid benefits.
QI is also distinct in that there is a specific amount of money allocated for use in this program each year. This means that some people may apply and be eligible, but still unable to receive the benefits.
Qualified Disabled and Working Individuals (QDWI) Program
This program is specific to individuals who were eligible for Medicare due to disability, but have since returned to work, thus limiting their Medicare health coverage. Those with an income under 200 percent of the federal poverty level, are eligible and will have their Medicare Part A premiums paid for.
Like the other programs, resources should not exceed twice the federal SSI levels.
Modifications to the standard programs
Most of the programs on this list also have modified forms. The name for the modified program will often be the same, with the addition of a plus, for example, SLMB+. These programs will usually offer the same benefits, plus full Medicaid coverage. If you are eligible for full Medicaid and also satisfy the requirements for a given program, then ask about the “plus” version when you enroll.
Applying in Florida
To qualify for one of these programs in Florida, you must be a Florida resident. Because Medicaid is processed at the state level, it is a good idea to apply for Florida Medicaid at the same time or before you apply for a Medicare Savings Program.
To apply for Medicaid, you’ll need to go through the Department of Children and Family Services, or DCF. You can apply at a local DCF office, or online via myflorida.com. You can also apply at a local Aging Resource Center or ARC. You can find the closest ARC or DCF office by calling 1-800-963-5337, which will connect you to the Elder Helpline.
Remember: You will apply for these programs through Medicaid, not Medicare. Your local state Medicaid office will handle your application and benefits.
When should I apply?
If you’re just becoming eligible for Medicare, then you should try to apply for these programs as soon as possible, ideally before or just at the beginning of your Initial Enrollment Period. Usually, processing your application will take around 45 days. This means that if you apply late, you may have to pay the full into various Medicare Costs before your savings program benefits kick in.
If your income has suddenly changed and you think you will be eligible for a savings program, but weren’t before, try to apply as soon as you can. Your best bet is to contact your local Medicaid office or to contact DCF.
Medicare Savings Program: Things to keep in mind
As you can see, Medicare Savings Programs can offer a lot of help with health insurance costs. These programs are a great resource that not enough people take advantage of, and they’re also fairly simple to use.
If you think you are eligible for a savings program, don’t waste any time. Get in touch with your local Medicaid office ASAP to find out which program you qualify for and how to apply in your state. The savings can be big, and it’s best not to delay it any longer than you need to.