Medicare Savings Programs
On this page:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualified Individual (QI)
- Qualified Disabled Working Individual (QDWI)
- How to Qualify
- How to Enroll
1. Qualified Medicare Beneficiary (QMB)
The Qualified Medicare Beneficiary (QMB) program helps you pay for the following Medicare costs:
- Medicare Part A premium. Note: Some people have to pay a premium for Medicare Part A because they do not have enough Social Security credits. Most people do not pay a premium for Medicare Part A because they or their spouse earned enough credits by working 40 or more quarters (about 10 years of full-time work with four quarters per year). People who worked 30-39 quarters may buy Part A and pay a monthly premium of $233. People who worked fewer than 30 quarters may also buy Part A and pay a higher monthly premium of $423.
- Medicare Part B premium ($96.40 per month in 2008).
- Deductibles for both Part A and Part B. The Part A deductible in 2008 is $1,024 per benefit period and the Part B deductible is $135 annually.
- Co-insurance under both Part A and Part B. For example, under Part A, QMB pays the $256 per day for hospital days 61-90, and the $512 per day for the 60 hospital reserve days in 2008. Under Part B, QMB pays the remaining 20% co-insurance after Medicare pays 80% of the covered outpatient medical services such as physician visits, as long as the person sees doctors and other providers who accept Medi-Cal.
2. Specified Low-Income Medicare Beneficiary (SLMB)
The Specified Low-Income Medicare Beneficiary (SLMB) program helps people with low income pay their Part B premiums ($96.40 per month in 2008). (Otherwise this premium would be deducted monthly from their Social Security checks.)
3. The Qualified Individual (QI)
The Qualified Individual (QI) program allows for a higher income limit than the SLMB or QMB programs and it also helps low income people pay for their Part B premiums ($96.40 per month in 2008).
4. The Qualified Disabled Working Individual (QDWI)
The Qualified Disabled Working Individual (QDWI) program is available to people who had Social Security and Medicare because of a disability, but who lost their Social Security benefits and their free Part A benefits because they returned to work and their earnings exceeded the limit allowed. QDWI pays for the Part A premium, but it doesn’t pay for Part B.
Note: California also has the California 250% Working Disabled (CWD) Program. In this program, beneficiaries who are working, disabled, and whose income is too high to qualify for free Medi-Cal, may be able to get Medi-Cal by paying a small monthly premium. Premiums range from a minimum of $20 to a maximum of $250 per month for an individual or from $30 to $375 for a couple.
5. How to Qualify
- For QMB, your monthly income cannot exceed $867 if you are single ($10,400/year). If married, a couple’s monthly income cannot exceed $1,167 ($14,000/year).
- For SLMB, your monthly income cannot exceed $1,040 if you are single ($12,480/year). If married, a couple’s monthly income cannot exceed $1,400 ($16,800/year).
- For QI, your monthly income cannot exceed $1,170 if you are single ($14,040/year). If married, a couple’s monthly income cannot exceed $1,575 ($18,900/year).
- For QDWI, your monthly income cannot exceed $1,733 if you are single ($20,800/year). If married, a couple’s monthly income cannot exceed $2,333 ($28,000/year).
Note: These income amounts do not include a $20 “disregard” – where $20 from any income is not counted towards these income limits. For the QMB, SLMB, QI and QDWI programs, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $4,000 for an individual or $6,000 for married couples. The value of some items is not calculated into your personal asset limit, including but not limited to the value of a home, household goods and personal belongings, one car, a life insurance policy with a face value of $1,500 per person, a prepaid burial plan (unlimited if irrevocable; up to $1,500 if revocable), and a burial plot. For six months after receipt, retroactive Social Security or SSI benefits are also excluded.
To qualify for the California 250% Working Disabled (CWD) Program, you must:
- Meet the medical requirements of Social Security’s definition of disability, but you don’t have to meet Social Security’s income and work requirements.
- Be working and earning income. This can be part-time work.
- Have assets worth less than $2,000 for an individual and $3,000 for a couple.
- Have countable income less than 250% of the federal poverty level ($2,167/month for individuals and $2,917/month for couples in 2008). These income calculations are different from those with the MSPs. Any disability income does not count for the 250% CWD program. This means that Social Security Disability Insurance (SSDI), Worker’s Compensation, California State Disability Insurance, and any federal, state, or private disability benefits are not considered as income for this program.
6. How to Enroll
To enroll in QMB, SLMB, QI, or QDWI you must also be eligible to get Medicare Part A and Part B. If you are already on Medicare, contact your county office of the California Department of Social Services (DSS) to apply for QMB, SLMB, QI, QDWI, or California’s 250% Working Disabled (CWD) program benefits. Note: Having Medicare is not required to enroll in the CWD program.
If you are not presently on Medicare, apply first for Medicare Part A and/or Part B at any Social Security Office and state in writing that you are applying for conditional Medicare under one of the above programs. “Conditional Medicare” means that you only want Medicare on the condition that a MSP will pay for your Medicare premiums.
Once you become eligible for Medicare, you should follow up with your county’s Department of Social Services office to apply for QMB, SLMB, QI, or QDWI benefits, or to verify your application status. (Medi-Cal recipients don’t need to complete a new application.)
Note: If you are eligible for a Medicare Savings Program, you are also eligible for ‘extra help’ (also known as the low-income subsidy program) with your Part D Medicare prescription drug costs. See our section on extra help for more information.
Page updated April 29, 2008