What is Medicaid?

Medicaid is a state-run health insurance program that pays for a broad range of medical services for people with low income and resources. Each state runs its own Medicaid program, so eligibility and additional program benefits may vary by state.

Basic services include doctor visits, inpatient and outpatient hospital services, lab tests, x-rays, medical transportation, family planning services, nursing facility services, home health, and nurse practitioner services.

Medicaid also administers the federally funded Medicare Savings Programs.

Can people with Medicare also have Medicaid?

People who have Medicare can also receive Medicaid, if they meet their state’s eligibility criteria. These people are often called “dual eligibles” or “duals.” Medicaid can cover Medicare co-payments and deductibles and services not covered by Medicare that may be available in your state’s Medicaid program, such as vision, hearing, and dental care.

Medicaid is no longer the primary payer of prescription drugs for people who are enrolled in Medicare. People who have both Medicaid and Medicare will receive help paying for their prescriptions through Medicare Part D. In certain states, Medicaid may cover certain drugs that Medicare does not. In addition, people who are enrolled in both Medicaid and Medicare will automatically qualify for the Medicare Part D Low Income Subsidy (LIS/Extra Help).

What are the Medicare Savings Programs?

Medicare Savings Programs (MSPs) are Medicaid-administered programs for people on Medicare who have limited income and resources. These programs help those qualified to afford Medicare. There are four different Medicare Savings Programs, each with a different income and resource eligibility limits (current figures are for 2015):

  • Qualified Medicare Beneficiary (QMB): People may qualify if they have income less than 100% of the Federal Poverty Level (FPL) (annual income below $11,770 if single; $15,930 if married) and resources under $7,280 if single, $10,930 if married. If eligible, QMB will cover the Medicare premiums (Part A, if applicable, and Part B), deductibles, copayments and/or coinsurance. Residents of Alaska and Hawaii have slightly higher income limits: Alaska—$14,720/$19,920 single/married; Hawaii—$13,550/$18,330 single/married.
  • Specified Low-Income Beneficiary (SLMB): Seniors/adults with disabilities may qualify if they have income between 100-120% FPL (annual income below $14,124 if single; $19,116 if married) and resources under $7,280 if single, $10,930 if married. If eligible, SLMB will cover the Medicare Part B premium ($104.90 for most individuals in 2015). Residents of Alaska and Hawaii have slightly higher income limits: Alaska—$17,664/$23,904 single/married; Hawaii—$16,260/$21,996 single/married.
  • Qualifying Individual (QI): QI is a limited program (block-grant to states), and is available on a first-come, first-serve basis. People with Medicare may qualify if they have income between 120-135% FPL (annual income below $15,889.50 if single; $21,505.50 if married) and resources under $7,280 if single, $10,930 if married. If eligible, QI will cover the Medicare Part B premium ($104.90 for most individuals in 2015). Residents of Alaska and Hawaii have slightly higher income limits: Alaska—$19,872/$26,892 single/married; Hawaii—$18,292.50/$24,745.50 single/married.
  • Qualified Disabled Working Individual (QDWI): Adults under age 65 and disabled but who recently returned to work and are no longer eligible for premium-free Part A may qualify for QDWI. Their income must be at or below 200% FPL (annual income below $23,540 if single; $31,860 if married) and their resources under $4,000 if single, $6,000 if married. If eligible, QDWI will cover their Part A premium. Residents of Alaska and Hawaii have slightly higher income limits: Alaska— $29,440/$39,840 single/married; Hawaii—$27,100/$36,660 single/married.

Note: The limits above are federal guidelines. Some states may choose to increase these federal guideline amounts or eliminate the resource test all together. Refer to your state eligibility rules. These income limits also do not include the $20 monthly income disregard.

What are the advantages of Medicare Savings Programs?

Seniors and younger adults with disabilities who may not qualify for full Medicaid may still be able to enroll in the Medicare Savings Programs. There are two major advantages to doing so:

  • Saving money on Medicare costs. Most people pay $104.90 each month in Medicare Part B premiums. Enrollment in MSPs puts an extra $1,258 back into the wallets of seniors/adults with disabilities each year.
  • Automatic Extra Help. Enrollment into MSPs automatically “deems” a person eligible to receive the Medicare Part D Low Income Subsidy (LIS/Extra Help). This benefit helps pay for prescription drugs and is estimated by the Social Security Administration to have an annual value of $4,000. Furthermore, if a senior/adult with disabilities is not already enrolled in Part D, they will have no late enrollment penalty if they receive Extra Help.

I’m a benefits counselor helping seniors apply for Medicare Savings Programs. Where can I get more information?

If you help older adults/persons with disabilities apply for MSPs, you might want to take advantage of several resources offered by NCOA’s Center for Benefits Access. Be sure to check out the following:

Also feel free to share our public service announcement video with your community:

I’m an older adult/person living with a disability who may be eligible for these programs. Where can I get assistance?

If you believe you/someone you know may be eligible for these programs, you can get assistance from:

  • NCOA’s network of Benefits Enrollment Centers (BECs). BECs are in 25 states, and provide help for older adults/persons living with disabilities to apply for all of the benefits they may be missing.
  • Your local State Health Insurance Assistance Program (SHIPs). SHIPs are federally funded to provide free, objective assistance to people with Medicare and their families, and also can help you apply for the Medicare Savings Programs and Part D Low Income Subsidy/Extra Help. Find your SHIP by visiting www.shiptacenter.org or calling 1-877-839-2675.