Medicare is a federally funded health insurance program available to people 65 or older or who have certain disabilities, regardless of income or assets. It pays for health care and medical expenses, such as doctor visits and hospital stays.
The two main ways to obtain Medicare coverage are by enrolling in Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). There is also an option to select additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap).
Help Paying For Medicare Costs – Medicare Savings Programs
If you are on Medicare you may qualify for help paying for your premiums or deductibles. There are four Medicare Savings Programs (MSPs) that can help. The MSPs are:
- Qualified Medicare Beneficiary (QMB),
- Specified Low Income Medicare Beneficiary (SLMB),
- Qualified Individual (QI-1), and
- Qualified Disabled Working Individual (QDWI).
Each MSP has its own income and recourse limits that must be met in order to qualify.
Qualified Medicare Beneficiary (QMB)
QMB pays for most Part A and Part B premiums, deductibles, co-payments, and coinsurance. It does not pay for prescription co-pays. QMB will only pay for the deductibles, coinsurance, and copayments for services that Medicare would cover and only up to the amount that Medicare would cover.
Specified Low Income Medicare Beneficiary (SLMB)
SLMB pays for Medicare Part B premiums only. If you were eligible for the SLMB program for the three months prior to when you are found eligible, then the SLMB benefit will back date. You would then receive a refund from Social Security for the premiums you paid for those months.
Qualified Individual (QI-1)
QI-1 pays for Medicare Part B premiums unless you already receive Medicaid. If you are eligible, the QI-1 program will back date three months just as the SLMB program does.
Qualified Disabled Working Individual (QDWI).
QDWI is available to people who had Social Security and Medicare benefits because of a disability, but lost them because they went back to work and earn more than Social Security allows. It will pay for your Medicare Part A premiums only. To qualify you must meet the income and asset tests and be under age 65.
In Washington State, Medicaid is called Apple Health. To learn more about the eligibility standards and getting help to pay for Medicare costs, visit the Apple Health (Medicaid) Manual for MSPs.
Understanding Your Health Care Options
The compassionate attorneys at Elder Law Group PLLC understand how important it is to you and your family to properly and affordably provide for your health care and living needs. We can help you decide what Medicare, MSPs, or Medicaid benefits are right for you and your family. We know what is necessary to qualify for these benefits and how they will work in conjunction with your existing financial situation.
We invite you to learn more about our team here, and read what our clients have to say about us here.
Contact us or call (509) 468-0551 (Spokane office), or (509) 579-0206 (Tri-Cities office), for personal, compassionate, and competent guidance on Long-Term Care planning, Asset Protection Estate Planning TM, or other legal needs of seniors, the disabled, or vulnerable adults and their families.