Do you or a loved one depend on Medicare? As you may know, Medicare is federal health insurance that’s reserved for people who are over 65. It may also cover younger individuals who have specific disabilities. Across the United States, over 65 million people rely on Medicare for their health care coverage.
While Medicare is generally less expensive than private insurance, it can still be costly. If you’re worried about meeting your Medicare payments, you may be eligible for Medicare Savings Programs. In this blog, we’ll review what Medicare cost assistance is, who is eligible and how our Medicare advisors at Wandacare can help you.
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Understanding Medicare Savings Programs (MSPs)
Medicare Savings Programs (MSPs) are state-run programs that help people with limited income or resources pay for Medicare. They may help cover the following expenses:
- Premiums: The monthly amount required to maintain coverage
- Deductibles: The amount you pay out of pocket before Medicare provides coverage
- Co-payments: Fixed amounts you pay after the deductible is met
- Coinsurance: A percentage of costs that you pay for certain services
There are two main parts of Medicare: Part A and Part B. Part A covers inpatient hospital stays (including skilled nursing and hospice care), while Part B covers outpatient care (including doctor’s visits and preventative care). Those who have paid Medicare taxes may be eligible for premium-free Part A coverage; however, Part B typically requires premiums. MSPs can offer support for both Part A and Part B, helping ensure comprehensive coverage.
Types of Medicare Savings Programs
Now that you know what Medicare cost assistance is, you might be wondering: How does it work? The exact coverage varies depending on the program. There are four types of MSPs:
- Qualified Medicare Beneficiary (QMB): QMB offers the most extensive coverage, which includes Part A and Part B premiums, deductibles, co-payments and coinsurance. To qualify, you must meet the income and resource limits of your state.
- Specified Low-Income Medicare Beneficiary (SLMB): SLMB only covers Part B premiums (although you must have Part A and Part B to qualify). It’s available to people whose income falls above the QMB limit, but below a certain threshold.
- Qualifying Individual (QI): Like SLMB, QI offers coverage for Part B premiums. To be eligible, you cannot qualify for any other Medicaid benefits. Funds are available on a first-come, first-serve basis.
- Qualified Disabled and Working Individuals (QDWI): QDWI provides Part A premium coverage. It’s specifically for disabled individuals who are under 65 and have lost their Medicare premium part A coverage because they’ve returned to work.
Who Qualifies for a Medicare Savings Program?
As mentioned above, you can qualify for a Medicare Savings Program if meet certain income and resource limits set by your state. Here are the general eligibility requirements:
- Income Limits (2025 estimates): Income includes wages, Social Security benefits, pensions and other earnings
- QMB Program: Monthly income limit of about $1,325 for individuals or $1,783 for married couples
- SLMB Program: Monthly income limit of about $1,585 for individuals or $2,135 for married couple
- QI Program: Monthly income limit of about $1,781 for individuals or $2,400 for married couples
- QDWI Program: Monthly income limit of about $5,302 for individuals or $7,135 for married couples
- Resource Limits (2025 estimates): Resources include savings, investments and real estate (excluding your primary home, one car, and household items)
- Most MSPs: Resource limits for QMB, SLMB and QI programs are about $9,660 for individuals or $14,470 for married couples
- QDWI Program: Resource limits are about $4,000 for individuals or $6,000 for married couples
If your income and resource levels are higher than these limits, you can still apply for MSPs. Some states don’t count certain types of income and resources, which means you could still be eligible in your area. Your state will ultimately determine which programs you qualify for.
Other Financial Assistance Options for Medicare Beneficiaries
MSPs aren’t the only form of financial assistance; Medicare beneficiaries may also qualify for the following:
- Extra Help: This program provides coverage for Medicare Part D (prescription drug costs).
- Medicaid: Medicaid is a joint federal and state program that offers coverage for low-income individuals. Those who are eligible for both Medicare and Medicaid usually have most health care costs covered.
- Program for All-Inclusive Care for the Elderly (PACE): PACE provides medical and social services to people who are over 55 and qualify for nursing home care, but can live safely at home.
Need Help Navigating Medicare Savings Programs? Let Wandacare Handle the Process for You
Are you overwhelmed by the MSP requirements? From determining your income to submitting your application, there are lots of steps to getting funding. Fortunately, you don’t have to go through it alone. At Wandacare, we have Medicare advisors who will help you determine eligibility, navigate the complex application process and secure the benefits that you deserve. Schedule a consultation today!
