There are 3 Medicare Savings Programs:
- Qualified Medicare Beneficiary Program (QMB)
- Specified Low Income Medicare Beneficiary Program (SLMB)
- Qualified Individual (QI)
All 3 MSP Programs will pay your Part B premium if you are eligible.
The QMB Program will also pay for the Part A premium if you are not eligible for free Medicare Part A and you Medicare Part A and B copayments and deductibles.
Who qualifies for these programs:
- You must be age 65 or older;
- You must have or be eligible for Medicare Part A and B benefits;
- If you are not eligible for free Medicare Part A benefits, you must be a U.S. citizen or legal resident and have lived in the United States for at least five years.
To qualify for one of the three Medicare Savings Programs, you must meet specific income and resource limits.
* Monthly income limits include a $20 standard deduction.
** Resource limits include $1,500 burial allowance for a single person and $3,000 for a married couple.
Countable resources include: cash, money in bank accounts, stocks and bonds.
- The MSP Program income limits do not count in-kind support.
- The MSP Program resource limits do not count life insurance of any value, your home, the number of cars you own.
This program provides financial assistance with Medicare Part D Prescription Drug Coverage.
Persons who qualify for this financial assistance program are enrolled into Medicare Part D Prescription Drug Plans (PDP) and Medicare Advantage Prescription Drug Plans (MAPD).
- Persons who qualify for full Medi-Cal automatically qualify for this program and pay $1.30 for generics and $3.90 for brand name drugs.
- Persons who are enrolled into any of the Medicare Savings Programs also automatically qualify for this program and receive financial help with their prescriptions.
- Persons who meet the Medicare Part D Extra Help income and resource limits and apply for the program.
The two charts below outline the Medicare Part D Extra Help income and resource limits to receive the Medicare Part D Full Subsidy and the Partial Subsidy levels of assistance.
Full LIS Extra Help
If you qualify for Full LIS Extra Help you pay:
- No Part D drug plan annual deductible
- Your Part D drug plan copayments will be $3.60 for generics and $8.95 for brand name drugs.
- When your total Part D drug plan costs are greater than $6,350, Medicare pays 100% of covered costs.
Partial LIS Extra Help
If you qualify for Partial LIS Extra Help you pay:
- $0 - $89 Part D drug plan annual deductible
- 15% of your Part D drug plan costs
- When your total Part D drug plan costs are greater than $6,350, you pay $3.60-$8.95 or 5% of the drug cost
- You will receive financial assistance with your Part D covered prescriptions.
- You will be able to change your Part D drug plan once every three months for the first 9 months of the year.
- If you are disenrolled from your Part D drug plan or Medicare Advantage plan, you will have access to a safety net program called LI Net Humana. This program will provide you with access to prescription drugs even though you are not in a Part D plan. Call the Center for Health Care Rights for more information about how the LI Net program works.
- If you are disenrolled from your Part D plan, Medicare will assign you to a new Part D plan if you do not select a plan.