Key Takeaways
Medicare's out-of-pocket costs—such as premiums, deductibles, and copayments—can be a financial strain for people with low income.
The Medicare Savings Programs (MSPs) help cover certain out-of-pocket Medicare costs for eligible older adults with limited means.
Use these 5-step checklist for yourself—and share it with those you know who need help with their Medicare expenses.
Medicare provides vital health care coverage for adults age 65 and older. But it doesn’t pay for everything, and there are out-of-pocket costs to consider. These include premiums, deductibles, copayments, and coinsurance.
If you have low income and are struggling to afford Medicare cost sharing, you could qualify for one of the Medicare Savings Programs (MSPs). These are special benefit programs offered by state Medicaid agencies. MSPs were created to relieve some out-of-pocket Medicare expenses for people who have limited income and assets.
If you’re wondering where to start with Medicare Savings Programs, we’re here to help—with this simple 5-step checklist.
5 steps to help you get started with Medicare Savings Programs
1. Learn about the different MSPs and what they cover. There are four Medicare Savings Programs, and each provides a unique level of coverage for Medicare out-of-pocket expenses:
- Qualified Medicare Beneficiary (QMB): Helps pay for the Part A premium and Part B premium, deductibles, coinsurance, and copayments.
- Specified Low-Income Medicare Beneficiary (SLMB): Helps pay for the Part B premium.
- Qualifying Individual (QI): Helps pay for the Part B premium.
- Qualified Disabled Working Individual (QDWI): Helps pay for the Part A premium.
You cannot choose which MSP to enroll in. Rather, you’ll be enrolled in the program that most closely matches your financial needs.
2. Check to see if you meet the eligibility requirements. To qualify for a Medicare Savings Program, you must be enrolled in at least Medicare Part A. You must also meet specific income and asset limits set by the state where you live. These limits are based on the Federal Poverty Guidelines and change every year. Each of the four MSPs has different limits.
3. Contact your state’s Medicaid agency to apply. You can confirm your eligibility and start the Medicare Savings Program application process through your state’s Medicaid office. The contact information for your state can be found on the Medicaid.gov website.
4. Explore other benefits you may qualify for. If you qualify for an MSP, there may be other benefits programs you can enroll in. These programs can help you pay for health care and medications as well as groceries, utilities, and even property taxes. Go to NCOA’s BenefitsCheckUp and enter your ZIP code to learn more about the programs available.
5. Chat with a Medicare expert for free. You have options when it comes to Medicare, and trying to navigate the process can be challenging. But you're not alone. NCOA partners with licensed brokers whose job it is to help older adults make smart decisions about their Medicare coverage. All our partners meet our strict Medicare Standards of Excellence to ensure their advice is unbiased, informative, and personalized to your needs.
You can also contact your State Health Insurance Assistance Program (SHIP). These programs work directly with older adults to help them understand their Medicare coverage choices.
