Medicare Savings Programs (MSPs)

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Medicare offers several Medicare Savings Programs (MSPs) that assist people with low income and assets: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI) and Qualified Disabled Working Individual (QDWI). California also offers the 250% California Working Disabled (CWD) program.

You must meet certain income and asset limits to qualify for these programs, which are administered by Medi-Cal (the California health program known as Medicaid in other states). This section provides information on eligibility and how to apply.

Topics on this page:

  1. Qualified Medicare Beneficiary (QMB)
  2. Specified Low-Income Medicare Beneficiary (SLMB)
  3. Qualified Individual (QI)
  4. Qualified Disabled Working Individual (QDWI)
  5. 250% California Working Disabled (CWD)
  6. How to Apply

See also:

1. Qualified Medicare Beneficiary (QMB)

The Qualified Medicare Beneficiary (QMB) program helps pay for the following Medicare costs:

  • Medicare Part A premium. Note: Some people are required 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 (approx. 10 years of working full-time, four quarters per year). People who worked 30-39 quarters may buy Part A coverage and pay a monthly premium of $234 in 2014. People who worked fewer than 30 quarters may also buy Part A coverage and pay a higher monthly premium of $426 in 2014.
  • Medicare Part B premium ($104.90 per month in 2014)
  • Deductibles for both Part A ($1,216 per benefit period in 2014) and Part B ($147 annually in 2014)
  • Coinsuranceunder both Part A and Part B. For example, under Part A, QMB pays the $304 per day for hospital days 61-90, and the $608 per day for the 60 hospital lifetime reserve days in 2014. Under Part B, QMB pays the remaining 20% coinsurance after Medicare pays 80% of the covered outpatient medical services such as physician visits, as long as you see doctors and other providers who accept Medi-Cal. Note: This is because Medi-Cal administers the MSPs and will only pay providers who accept Medi-Cal.

How to Qualify

To qualify for QMB, your monthly income cannot exceed $973 if you are single ($11,670/year) or $1,311 ($15,730/year) if you are part of a couple.

Note: A $20 "disregard" is subtracted from your monthly income (earned or unearned). When you apply for QMB, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $7,160 for an individual or $10,750 for a married couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

  • One home
  • Household goods and personal belongings
  • One car
  • Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

See also: Quick Medicare Savings Program (MSP) Reference Chart – Qualifications at a Glance

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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. This premium would ordinarily be deducted from their monthly Social Security checks.

How to Qualify

To qualify for SLMB, your monthly income cannot exceed $1,167 if you are single ($14,004/yr.) or $1,573 ($18,876/yr.) if you part of are a couple.

Note: A $20 "disregard" is subtracted from your monthly income (earned or unearned). When you apply for SLMB, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $7160 for an individual or $10,750 for a married couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

  • One home
  • Household goods and personal belongings
  • One car
  • Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

See also: Quick Medicare Savings Program (MSP) Reference Chart – Qualifications at a Glance

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3. Qualified Individual (QI)

The Qualified Individual (QI) program helps people with low income pay for their Part B premiums, with a higher income limit than QMB or SLMB programs.

How to Qualify

To qualify for QI, your monthly income cannot exceed $1,313 if you are single ($15,755/yr.) or $1,770 ($21,236/yr.) if you are part of a couple.

Note: A $20 "disregard" is subtracted from your monthly income (earned or unearned). When you apply for QI, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $7,160 for an individual or $10,750 for a married couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

  • One home
  • Household goods and personal belongings
  • One car
  • Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

See also: Quick Medicare Savings Program (MSP) Reference Chart – Qualifications at a Glance

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4. Qualified Disabled Working Individual (QDWI)

The Qualified Disabled Working Individual (QDWI) program is available to people who had Social Security and Medicare benefits because of a disability, but lost them because they returned to work and their earnings exceeded the allowable limit. QDWI pays for the Medicare Part A premium, but it doesn't pay for Part B.

How to Qualify

To qualify for QDWI, your monthly income cannot exceed $3,975 if you are single or $5,329 if you are part of a couple.

Note: A $20 "disregard" is subtracted from your monthly income (earned or unearned). When you apply for QDWI, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $4,000 for an individual or $6,000 for a married couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

  • One home
  • Household goods and personal belongings
  • One car
  • Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

See also: Quick Medicare Savings Program (MSP) Reference Chart – Qualifications at a Glance

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5. 250% California Working Disabled (CWD)

California offers qualifying residents the 250% California Working Disabled (CWD) program. To qualify, you must be working, disabled and have income too high to qualify for free Medi-Cal. If eligible, you may be able to receive Medi-Cal coverage by paying a small monthly premium, ranging from $20-$250 per month for an individual or from $30-$375 for a couple.

How to Qualify

To qualify for CWD, you must:

  • Meet the medical requirements of Social Security's definition of disability, but are not required to meet the agency'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 or $3,000 for a couple
  • Have countable income less than 250% of the federal poverty level (in 2014, this equates to $2,432/mo. for individuals or $3,278/mo. for couples). These income calculations are different from those for the Medicare Savings Programs (MSPs). Disability income does not count toward the 250% CWD program’s income limit, including:

See also: Quick Medicare Savings Program (MSP) Reference Chart – Qualifications at a Glance

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6. How to Apply

To apply for QMB, SLMB, QI or QDWI, you must also be eligible to receive Medicare Part A and Part B. If you are already enrolled in both Medicare parts, contact your California Department of Health Care Services (DHCS) county office to apply for these programs or the 250% California Working Disabled (CWD) program. Note: Having Medicare is not required to enroll in the CWD program.

If you are eligible for Medicare but not enrolled in Part A and/or Part B, you can enroll in Part B anytime through your local Social Security Administration (SSA) office (1-800-772-1213). However, you can only enroll in Part A during a specific enrollment period. This is important if you are applying for the QMB program. For instance:

  • If you just became eligible for Medicare and are in your Initial Enrollment Period (IEP), you may apply for QMB (through your DHCS county office), and Parts A and B (through the SSA).
  • If you are already enrolled in Part B, and eligible but not enrolled in Part A, you may apply for QMB (through your DHCS county office) and Part A (through the SSA) during the Medicare General Enrollment Period (GEP), which is January 1 to March 31 each year.

When applying for Part A, you may state in writing that you want "Conditional Medicare" under one of the Medicare Savings Plans (MSPs). This means you only want to receive Medicare on the condition that an MSP will pay for your Medicare premiums.

Once you become eligible for Medicare, follow up with your county's DHCS 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.

To apply for the CWD program, contact your county’s DHCS office and specifically request an appointment with a coordinator authorized to work in the 250% CWD program.

Note: If you are eligible for an MSP, you are also eligible to receive "Extra Help," also known as the Low-Income Subsidy (LIS) program, for your Part D Medicare prescription-drug costs.

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Updated Feb 28, 2014

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