Medicare Savings Plans Programs FAQs
I’m eligible for Medicare and was told to contact Medicaid about paying my monthly premium. How can I do this?
You may qualify for one of the Medicare Savings Plans programs. Based on your income, the MSP program may pay your Medicare premium, co-insurance and deductible. Other MSP programs pay only your Medicare premium. Contact or visit your county Department of Family Family and Children Services (DFCS) office for an application or you may apply online at www.gateway.ga.gov to see if you qualify for one of the MSP programs.
You may qualify for help with certain Medicare costs under one of the Medicare Savings Plans (MSP) programs below if:
- you receive Medicare;
- your income is limited; and
- your resources are not more than $7,390 for one person or $11,090 for a couple.
What is the Qualified Medicare Beneficiary (QMB) Program?The Qualified Medicare Beneficiary (QMB) program was designed to fill the gaps in Medicare coverage by eliminating out-of-pocket expenses for Medicare covered services. The QMB program helps low–income Medicare beneficiaries by paying Medicare premiums, deductibles and coinsurance.
What is the Specified Low–Income Medicare Beneficiary (SLMB) Program?The SLMB programs will pay monthly Medicare Part B premium only.
What is the Qualifying Individual Program (QI)?The QI program pays the monthly Medicare Part B premium only. QI has a higher income limit than SLMB but provides the same benefit.
What is the Qualified Disabled Working Individual Program (QDWI)?
The QDWI program will pay monthly Medicare Part A premiums. If you are under age 65, disabled and no longer entitled to free Medicare Hospital Insurance Part A because you successfully returned to work, you may be eligible for a program that helps pay your Medicare Part A monthly premium.
To be eligible for QDWI, you must:
- continue to have a disabling impairment;
- sign up for premium Hospital Insurance (Part A);
- have limited income;
- have resources worth less than $4000 for an individual and $6,000 for a couple not counting the home where you live, usually one car and certain insurance; and
- not already be eligible for Medicaid
Who is eligible for these programs?
Medicare beneficiaries are eligible for these programs if all of the following criteria are met:
- You must be a citizen or legal resident of the United States and the State of Georgia and be enrolled in Medicare Part A or be eligible to enroll in Medicare Part A.
- You can participate in these programs even if you are not covered now by Medicare Part A or Part B, as long as you are eligible to enroll. To be eligible to enroll, you must be a citizen of the U.S., or a permanent legal resident for at least five years and be at least 65 years old or disabled.
- You do not exceed the asset limits.
- For the Medicare Savings Plans programs: A single person can have no more than $7,390 in liquid assets ($11,090 for a married couple). Some assets are not counted, such as your home, a car, an irrevocable burial account up to $10,000 each for you and your spouse, and life insurance with a cash value of $1,500 or less.
- You must have limited income.
See our tables of income limits for applying for Georgia Medicaid programs to find out where your income is, in relation to these income benchmarks.
How do I apply for these programs?
To apply, you only need to complete a short application form. The eligibility worker may request additional information if they have questions. You can call or visit your local DFCS office for an application (form 700) or apply online at www.gateway.ga.gov
Effective January 1, 2010, an application for the Low Income Subsidy (LIS) or Extra Help with the Social Security Administration is also an application for the MSP programs. Beginning January 1, 2010, you do not need to complete a separate application to apply for assistance with payment of your Medicare premium.
When do benefits start?
QMB benefits start the month after the month of eligibility determination. However, in certain cases, SLMB, QI and QDWI benefits may be granted up to three months before the month of application. This means that you could get back up to three months' worth of all or some of the premiums that you paid out before you applied for these programs.
If you have additional questions about the Medicare Savings Plans Programs, please contact DFCS at 877-423-4746, GeorgiaCares at 866-552-4464 or Medicare at 800-MEDICARE (800-633-4227).