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Medicare Savings Programs and Paying for Long Term Care
| Definition |
Qualifications |
Costs |
| Pros & Cons |
Benefit Types & Limits |
How to Apply |
| Overview of Medicare Savings Programs | ||
Medicare Savings Programs (MSPs) are designed to help low income Medicare beneficiaries that have financial resources which exceed the maximum allowed by Medicaid, but still cannot afford to pay their Medicare premiums, deductibles and copayments. There are 4 types of Medicare Saving Programs and eligibility for each is primarily based on a senior’s financial resources and income.
- Qualified Medicare Beneficiary (QMB) – helps pay for Medicare Part A & Part B
- Specified Low-Income Medicare Beneficiary (SLMB) – helps pay for Medicare Part B only
- Qualifying Individual (QI) – helps pay for Medicare Part B only
- Qualified Disabled & Working Individuals (QDWI) – helps pay for Medicare Part A only
Medicare Saving Programs (MSPs) are discussed here not because they offer any significant long term care resources, but instead to help clear up the misperception that they do cover seniors’ long term care needs.
MSPs help elderly individuals with their Medicare premiums, deductibles and copayments, but Medicare itself offers very little in the way of long term care. It is not a long term care solution, but there are some benefits for seniors with recoverable conditions on a short term basis.
Skilled Nursing Facilities
Medicare will pay for 100% of the cost of care for 20 days at a skilled nursing facility and 80% of the cost for 80 more days. The care must be for short term recovery following a hospital stay.
Assisted Living Communities
Medicare does not cover any cost of assisted living. It will pay for some medical costs incurred while the senior is in assisted living, but will pay nothing toward custodial care.
In Home Care
Medicare will cover skilled nursing care given in the home for a limited time period, but not non-medical care. Care must be prescribed by a doctor and needed part-time only. The senior must be “confined” meaning they are unable to leave the home without the assistance of another person.
Adult Day Care
Medicare does not pay for adult day care services.
MSPs help elderly individuals with their Medicare premiums, deductibles and copayments, but Medicare itself offers very little in the way of long term care. It is not a long term care solution, but there are some benefits for seniors with recoverable conditions on a short term basis.
Skilled Nursing Facilities
Medicare will pay for 100% of the cost of care for 20 days at a skilled nursing facility and 80% of the cost for 80 more days. The care must be for short term recovery following a hospital stay.
Assisted Living Communities
Medicare does not cover any cost of assisted living. It will pay for some medical costs incurred while the senior is in assisted living, but will pay nothing toward custodial care.
In Home Care
Medicare will cover skilled nursing care given in the home for a limited time period, but not non-medical care. Care must be prescribed by a doctor and needed part-time only. The senior must be “confined” meaning they are unable to leave the home without the assistance of another person.
Adult Day Care
Medicare does not pay for adult day care services.
Be Aware That:
Medicare Savings Programs do not offer additional medical coverage this is not provided by Medicare; they only reduce some of the premiums and co-pays.
Medicare Savings Programs are Also Known As:
- MSPs
- Medicare Buy-In Programs
- There are 4 different types of Medicare Savings Programs; sometimes they are referred to using these names.
2. Specified Low-Income Medicare Beneficiary (SLMB)
3. Qualifying Individual (QI)
4. Qualified Disabled & Working Individuals (QDWI)
Age Requirements
Seniors are eligible for Medicare and therefore Medicare Saving Programs at age 65.
Disabilities / Health Requirements
The Medicare Savings Programs, QMB, SLMB and QI have no disability requirements. The QDWI program is designed for disabled persons.
Family Status
There are no martial or family status requirements to be eligible for Medicare Savings Programs. However, income and resources requirements changed based on marital status.
Financial Status Requirements
Medicare Saving Programs financial requirements change yearly and by state. Roughly speaking, if a senior’s monthly income is less than $1200 ($1600 for couples) and their “resources” less than $4,000 ($6,000 for couples), then they should qualify for one of the programs. It is important to note that the definition of “resources” is different for Medicaid than for Medicare Saving Programs. For MSPs, “resources” include checking, savings, stock and bonds but not homes, cars, furniture, or other household items.
Veteran Status Requirements
Medicare Savings Programs are available to both Veteran and non-Veterans.
Geographic Requirements
Medicare benefits are not available outside the US. Incomes and resources for Medicare Savings Programs eligibility is determined by state.
Other Requirements
To be eligible for Medicare Savings Programs, a senior must be enrolled in or applying for Medicare.
Types of Benefit Payout
Medicare Savings Programs provide reductions in Medicare premiums, deductibles and co-payments to the elderly.
Restrictions on How Payout Can be Used
Medicare Savings Programs do not provide seniors with cash payments, rather seniors will be required to make less premiums, deductibles and co-payments.
Benefits Amounts & Limits
Medicare Savings Programs’ benefits are limited to premiums, deductibles and co-payments. By program their limits are as follow:
-QMB - Part A and Part B premiums, deductibles, co-insurance and co-payments.
-SLMB - Part B premiums only
-QI - Part B premiums only
-QDWI - Part A premiums only
Note that these are the benefits of MSPs not of Medicare itself. Medicare benefits will help pay for short term residence at a skilled nursing facility, but is not a long term care solution for those with Alzheimer's, dementia or requiring assisted living.
Time to Receive Benefits
Coverage in Medicare Savings Programs typically begins one month after a senior has been approved for Medicare. Application processing varies by state but is typically less than 60 days.
This Source Can Help For
Medicare Savings Programs helps seniors with Medicare premiums, deductibles and co-payments.
Medicare Savings Programs are designed to help seniors lower their Medicare costs. There are no additional costs to apply or increases in monthly premiums.
Call 1-800-MEDICARE to get the number of your state Medicare office and call them for an application. Alternatively most states also make their application available online.
Some individuals find it helpful to work with an advisor to determine how the state will calculate their income and assets prior to application. An advisor can help structure resources to increase the likelihood of acceptance in a Medicare Saving Program. We offer a directory of eldercare financial planners here.
