Navigating the complexities of health insurance can often feel like a daunting task.

With so many options and programs available, it’s easy to feel overwhelmed.

One question that frequently arises for those eligible for both Medicare and Medicaid is: Can Medicaid assist with my Medicare Part B premium?

The simple answer is yes, but there are certain conditions and criteria to meet.

Medicare and Medicaid are two separate, but sometimes interconnected, health insurance programs.

Medicare is a federal program that offers health coverage to individuals aged 65 and older, as well as to younger people with certain disabilities.

Medicaid, on the other hand, is a joint federal-state program designed to help with medical costs for some people with limited income and resources.

It’s important to understand that while both programs provide essential health coverage, they each have their own set of rules and benefits.

However, for eligible individuals, these two programs can intersect to provide more comprehensive coverage.

One way that Medicaid can assist those with Medicare is through the Medicare Savings Programs (MSPs).

These state-administered programs are designed to help low-income individuals with some of their Medicare costs.

These programs can be a lifeline for those struggling to afford their healthcare costs.

Our aim is to provide a clearer picture of how Medicaid and Medicare can work together to help alleviate some of your healthcare expenses.

The Role of Medicare Savings Programs

Medicare Savings Programs (MSPs) are state-run programs designed to assist low-income individuals with some of their Medicare costs. 

There are four types of MSPs:

The Qualified Medicare Beneficiary (QMB) Program, the Specified Low-Income Medicare Beneficiary (SLMB) Program, the Qualifying Individual (QI) Program, and the Qualified Disabled and Working Individuals (QDWI) Program. Each of these programs has its own eligibility criteria and benefits.

MSPs That Cover Part B Premiums

The QMB, SLMB, and QI programs can all help with Medicare Part B premiums. If you qualify for any of these programs, the state will pay your Part B premium each month.

Key Aspects of the QMB Program

Coverage:

The QMB program covers Medicare Part A and Part B premiums. It also pays for deductibles, coinsurance, and copayments for services covered under Part A and Part B.

Eligibility:

To be eligible for the QMB program, an individual must be enrolled in Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) and have income and resources below certain thresholds.

Income Limits:

The income limits for the QMB program are set at monthly income limit and resource limit. In 2023, this is a monthly income limit of $1,235 for an individual and $1,663 for a married couple.  With.  However, these numbers can vary slightly from state to state.

Resource Limits:

The resource limits for the QMB program are also defined by the government. As per the data from 2023, the individual resource limit is $9,090 and a married couple’s resource limit is $13,630.  The resource limits are set by the federal government and can vary slightly from state to state.

Resources, in this context, typically include:

• Money in a checking or savings account
• Stocks
• Bonds

Certain things are not counted as resources, such as:

• Your home
• One car
• Furniture

Other household and personal items

• A burial plot
• Up to $1,500 for burial expenses if you have put that money aside
• Life insurance policies

It’s important to note that these are general guidelines and individual states might have different rules about what counts as a resource. Therefore, it’s a good idea to check with your state’s Medicaid office for the most accurate information.

Application:

Applications for the QMB program are processed through your state’s Medicaid office. The exact application process can vary by state.

Extra Help:

If you qualify for the QMB program, you automatically qualify for the Extra Help program, which helps with costs related to Medicare prescription drug coverage (Part D).

The Specified Low-Income Medicare Beneficiary (SLMB) Program is a Medicare Savings Program that helps low-income individuals pay for their Medicare Part B premiums.

Here are some key aspects of the SLMB program in 2023:

Coverage:

The SLMB program specifically assists with the payment of Medicare Part B premiums. However, unlike the Qualified Medicare Beneficiary (QMB) program, the SLMB program does not cover Medicare Part A premiums, deductibles, coinsurance, or copayments.

Eligibility:

To be eligible for the SLMB program, an individual must be enrolled in Medicare Part A and Part B. They must also meet certain income and resource limits set by the federal government. These limits might vary slightly from state to state.

Income Limits:

In 2023, the income limit for the SLMB program is $1,478 for an individual and $1,992 for a married couple living together.

Resource Limits:

In 2023, the resource limit for eligibility is $9,090 for an individual and $13,630 for a couple. Resources include things like money in a checking or savings account, stocks, and bonds. Some items, like your home or car, are not counted as resources.

Application:

Applications for the SLMB program are processed through your state’s Medicaid office. The exact application process can vary by state.

Extra Help:

If you qualify for the SLMB program, you automatically qualify for the Extra Help program, which helps with costs related to Medicare prescription drug coverage (Part D).

Please note that these figures are subject to change and may vary slightly depending on the state. Always check with your state’s Medicaid office for the most accurate information.

The Qualifying Individual (QI) Program is one of the four Medicare Savings Programs that assist low-income individuals with their Medicare costs. The QI program, like the Specified Low-Income Medicare Beneficiary (SLMB) Program, provides help specifically for Medicare Part B premiums.

Key Aspects of the QI Program

Coverage:

The QI program offers financial assistance to cover the cost of Medicare Part B premiums. However, it does not cover Medicare Part A premiums, deductibles, coinsurance, or copayments.

Eligibility:

To be eligible for the QI program, an individual must be enrolled in Medicare Part A and Part B and meet certain income and resource limits. The individual should not be receiving Medicaid.

Income Limits:

For 2023, the income limit for the QI program is $1,660 for an individual and $2,239 for a married couple living together.

Resource Limits:

The resource limit for eligibility is $9,090 for an individual and $13,360 for a couple. Resources include things like money in a checking or savings account, stocks, and bonds. Some items, like your home or car, are not counted as resources.

Availability:

Unlike other Medicare Savings Programs, the QI program has a limited enrollment and benefits are granted on a first-come, first-served basis. Additionally, priority is given to those who received QI benefits in the previous year.

Application:

Applications for the QI program are processed through your state’s Medicaid office. The exact application process can vary by state.

Extra Help:

If you qualify for the QI program, you automatically qualify for the Extra Help program, which helps with costs related to Medicare prescription drug coverage (Part D).

Please note that these figures are subject to change and may vary slightly depending on the state. Always check with your state’s Medicaid office for the most accurate information.

Contact Your State Medicaid Office

If you believe you may qualify for an MSP, you should apply through your state’s Medicaid office. State-specific factors affecting Medicaid eligibility may include family size, age, pregnancy status, disability status, among others.

For example, some states may cover adults up to a certain income level, pregnant women up to a higher income level, and children up to an even higher level. The eligibility rules can be complex, and specifics vary widely among states.

Here is a list of state Medicaid programs with their websites:

1. Alabama Medicaid Agency: medicaid.alabama.gov
2. Alaska Department of Health and Social Services: dhss.alaska.gov/dhcs
3. Arizona Health Care Cost Containment System: azahcccs.gov
4. Arkansas Department of Human Services: humanservices.arkansas.gov
5. California Department of Health Care Services: dhcs.ca.gov
6. Colorado Department of Health Care Policy & Financing: colorado.gov/hcpf
7. Connecticut Department of Social Services: portal.ct.gov/dss
8. Delaware Department of Health and Social Services: dhss.delaware.gov/dhss/
9. District of Columbia Department of Health Care Finance: dhcf.dc.gov
10. Florida Agency for Health Care Administration: ahca.myflorida.com
11. Georgia Department of Community Health: dch.georgia.gov
12. Hawaii Department of Human Services: humanservices.hawaii.gov
13. Idaho Department of Health and Welfare: healthandwelfare.idaho.gov
14. Illinois Department of Healthcare and Family Services: illinois.gov/hfs
15. Indiana Family and Social Services Administration: in.gov/fssa
16. Iowa Department of Human Services: dhs.iowa.gov
17. Kansas Department of Health and Environment: kdheks.gov
18. Kentucky Cabinet for Health and Family Services: chfs.ky.gov
19. Louisiana Department of Health: ldh.la.gov
20. Maine Department of Health and Human Services: maine.gov/dhhs
21. Maryland Department of Health: health.maryland.gov
22. Massachusetts Executive Office of Health and Human Services: mass.gov/eohhs
23. Michigan Department of Health and Human Services: michigan.gov/mdhhs
24. Minnesota Department of Human Services: mn.gov/dhs
25. Mississippi Division of Medicaid: medicaid.ms.gov
26. Missouri Department of Social Services: dss.mo.gov
27. Montana Department of Public Health and Human Services: dphhs.mt.gov
28. Nebraska Department of Health and Human Services: dhhs.ne.gov
29. Nevada Division of Health Care Financing and Policy: dhcfp.nv.gov
30. New Hampshire Department of Health and Human Services: dhhs.nh.gov
31. New Jersey Department of Human Services: state.nj.us/humanservices
32. New Mexico Human Services Department: nmmedicaid.portal.conduent.com
33. New York Department of Health: health.ny.gov
34. North Carolina Department of Health and Human Services: ncdhhs.gov
35. North Dakota Department of Human Services: nd.gov/dhs
36. Ohio Department of Medicaid: medicaid.ohio.gov
37. Oklahoma Health Care Authority: okhca.org
38. Oregon Health Authority: oregon.gov/oha
39. Pennsylvania Department of Human Services: dhs.pa.gov
40. Rhode Island Executive Office of Health and Human Services: eohhs.ri.gov
41. South Carolina Department of Health and Human Services: scdhhs.gov
42. South Dakota Department of Social Services: dss.sd.gov
43. Tennessee Bureau of TennCare: tn.gov/tenncare
44. Texas Health and Human Services: hhs.texas.gov
45. Utah Department of Health: health.utah.gov
46. Vermont Agency of Human Services: humanresources.vermont.gov
47. Virginia Department of Medical Assistance Services: dmas.virginia.gov
48. Washington State Health Care Authority: hca.wa.gov
49. West Virginia Department of Health and Human Resources: dhhr.wv.gov
50. Wisconsin Department of Health Services: dhs.wisconsin.gov
51. Wyoming Department of Health: health.wyo.gov

If you’re having difficulty paying your Medicare Part B premium, it’s worth investigating whether you’re eligible for a Medicare Savings Program. By doing so, you could potentially save hundreds of dollars every year on healthcare costs.

Please remember that this blog post is intended to provide a general overview of how Medicaid can help pay for Medicare Part B premiums.

For specific information about your situation, please contact your state’s Medicaid office.

Working with a licensed health insurance sales agent can be a great way to navigate the complex coverage options available. They can also explain the differences between plans and help you figure out which plan fits your needs and budget.

Ultimately, a licensed insurance sales agent can help you make an informed decision about the coverage that suits your health needs.

Get the answers you need by calling Apollo Insurance Group for a free plan comparison with no obligation to enroll at (913) 279-0077.  By calling this number you will reach a licensed insurance sales agent.

Sources:

• “Medicare Savings Programs.” Medicare.gov.
• “Get help with your Medicare costs.” Medicare.gov.
• “How to get drug coverage.” Medicare.gov.

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