2019 Federal Poverty Levels Released: New Income Limits for Medicare Savings Programs

Medicare Savings Programs (MSP) offer assistance with meeting the costs of Medicare premiums and deductibles. The MSPs include the Qualified Medicare Beneficiary program (QMB), Specified Low-Income Medicare Beneficiary program (SLMB), and Qualified Individual program (QI). All of these help Medicare beneficiaries of modest means pay all or some of Medicare’s cost sharing amounts (ie. premiums, deductibles and copayments). To qualify an individual must be eligible for Medicare and must meet certain income guidelines which change annually.  Please note that the eligibility criteria listed below are federal standards; states may have more, but not less, generous standards.
QMB (Qualified Medicare Beneficiary Program)
Coverage

·         Payment of Medicare Part A monthly premiums (when applicable).

·         Payment of Medicare Part B monthly premiums and annual deductible.

·         Payment of co-insurance and deductible amounts for services covered under both Medicare Parts A and B.

Requirements and Monthly Income Limits for 2019 (up to 100% FPL+ $20)*

·         Must be eligible for Medicare Part A (even if not currently enrolled).

·         Income at or below $1,061 for an individual and $1,430 for a couple in 2019.*

·         Resources below $7,730 for an individual and $11,600 for a couple in 2019.*

·         Must undergo redetermination for the benefit every year.

SLMB (Specified Low-Income Medicare Beneficiary Program)

Coverage

·         Payment of the Medicare Part B monthly premium only.

Requirements and Monthly Income Limits for 2019 (less than 120% FPL+ $20)*

·         Must be eligible for Medicare Part A (even if not currently enrolled).

·         Income between $1,269 for an individual and $1,711 for a couple in 2019.*

·         Resources below $7,730 for an individual and $11,600 for a couple in 2019.*

·         Must undergo redetermination for the benefit every year.

QI (Qualified Individual Program – also known as ALMB)

Coverage

·         Payment – through the SLMB program – of Medicare Part B premium for the calendar year. (NOTE: the funds for this program come from a "block-grant," so are finite. Once they are gone, even eligible individuals will not be able to access the program, so apply early.)

Requirements and Monthly Income Limits for 2019 (less than 135% FPL+ $20)*

·         Income between $1,426 for an individual and $1,923 for a couple in 2019.*

·         Resources below $$7,730 for an individual and $$11,600 for a couple in 2019.*

·         Must re-apply every year for these benefits;

·         Not available to those who qualify for any other kind of Medicaid

* $20 = monthly SSI general income exclusion. Individual states may be more generous with the income and resource amounts above.
Obtaining QMB, SLMB, and QI Benefits
Requests for applications for QMB, SLMB, or QI benefits are made to the state Medicaid agency. Eligibility for QMB is effective on the first day of the month following the month in which the Medicaid agency has all the information and verification necessary to determine eligibility. SLMB and QI entitlement may be retroactive. For more information, please telephone your local Medicaid office. You can find your local Medicaid office at https://www.medicaid.gov/about-us/contact-us/index.html.