Medicare Savings Programs and Paying for Long Term Care

Page Reviewed / Updated - May 2017

Medicare Savings Programs are discussed here not because they offer any significant long term care resources, but instead to help clear up the misperception that they cover long term care.

Definition

Medicare Savings Programs (MSPs) are designed to help low income Medicare beneficiaries that have financial resources that exceed the maximum allowed by Medicaid, but they still cannot afford to pay their Medicare premiums, deductibles, and co-payments. There are four types of Medicare Saving Programs, and eligibility for each is primarily based on a senior’s financial resources and income.

1) Qualified Medicare Beneficiary (QMB) – helps pay for Medicare Part A & Part B, as well as deductibles, copayments, and coinsurance

2) Specified Low-Income Medicare Beneficiary (SLMB) – helps pay for Medicare Part B only

3) Qualifying Individual (QI) – helps pay for Medicare Part B only

4) Qualified Disabled & Working Individuals (QDWI) – helps pay for Medicare Part A only

While MSPs help elderly individuals with their Medicare premiums, deductibles, and co-payments, Medicare itself offers very few long-term care benefits. Medicare is not a long-term care solution, and therefore, neither are MSPs. Having said that, there are some benefits for seniors with recoverable conditions on a short-term basis.

 

Long Term Care Benefit Summary

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 or room and board.

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. Medicare hospice care is the one notable exception to this rule.

Adult Day Care
Medicare does not pay for adult day care services

Did You Know? All 50 states have programs that help low income seniors in need of eldercare. Many states have multiple programs. Search for assistance in your state.

 

Qualifying / Eligibility Requirements

Age

Seniors must be eligible for Medicare and therefore Medicare Saving Program's eligibility begins at the same age of 65 years old.

Disabilities / Health

The Medicare Savings Programs, QMB, SLMB and QI have no disability requirements. The QDWI program is designed for disabled persons as designated by Social Security.

Financial

Medicare Saving Programs' financial requirements change yearly. As of 2017, generally speaking, in most states if a senior’s monthly income is less than $1377 ($1847 for couples) and their “resources” (assets) less than $7,390 ($11,090 for couples), then they should qualify for the QMB, SLMB, or QI program. QDWI has higher income and asset limits, although this program is not relevant for most elderly individuals. However, income limits are $4,105 / month for individuals and $5,499 / month for couples. The asset limit for an individual is $4,000 and $6,000 for couples. Another important note is that the income limits for these four types of MSPs are slightly higher for residents of Alaska and Hawaii.

For MSPs, “resources” include checking, savings, stocks, and bonds, but not one’s home, a single car, furniture, household / personal items, a burial plot, a maximum of $1,500 for burial expenses. 

2017 Medicare Saving Programs Eligibility Limits
MSP Program Type Single Income Married Income Single Asset Married Asset
Qualified Medicare Beneficiary (QMB) $1,025 $1,374 $7,390 $11,090
Specified Low-Income Medicare Beneficiary (SLMB) $1,226 $1,644 $7,390 $11,090
Qualifying Individual (QI) $1,377 $1,847 $7,390 $11,090



Personal Factors Not Affecting Eligibility

Marital status does not affect eligibility but income and resources requirements change if one's is single or married. 

Veterans discharge status has no impact and state of residence also does not impact eligibility but may change the income and resource limits.

 

Benefits

 Note that these are the benefits of MSPs not of Medicare itself.

Medicare Savings Programs provide reductions in Medicare premiums, deductibles and co-payments for the elderly.  This program does not provide seniors with cash payments.  Type of assistance by program follows:

  • Qualified Medicare Beneficiary (QMB) – Part A and Part B premiums, deductibles, co-insurance, and co-payments, as well as deductibles, copayments, and coinsurance 
  • Specified Low-Income Medicare Beneficiary (SLMB) – Part B premiums only
  • Qualifying Individual (QI) – Part B premiums only
  • Qualified Disabled & Working Individuals (QDWI) – Part A premiums only

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.

 

Costs

Medicare Savings Programs are designed to help seniors lower their Medicare costs. There are no additional costs to apply or increases in monthly premiums.

 

How to Apply

Call 1-800-MEDICARE to get the number of your state Medicare office and ask for an application. Alternatively, most states also make their application available online. Find your state's Medicare Saving Programs office.