Programs can help seniors pay Medicare premiums

Last week we talked about the Tax and Rent Refund program and the Low-Cost Drug Card. This week we’ll get into the Medicare Savings Programs that can save you money.

While most of you may know the services that are allowed by Medicare, Eastern Agency on Aging’s resource and referral department often fields calls from seniors who are unclear on exactly what is and isn’t covered.

Medicare is a federal health insurance plan that helps people 65 and older pay for physician and hospital bills. Disabled individuals are also eligible. There are two parts to Medicare: Part A Hospital Insurance and Part B Supplementary Medical Insurance.

Part A covers inpatient hospital, skilled nursing, home health care and hospice.

Part B covers physicians and other medical services, outpatient hospital care, ambulatory surgical services, home health care, medical tests, diabetes self-management, durable medical equipment, physical therapy services, ambulance and certain preventative services.

The Part B premium is $50 per month and is usually deducted from your Social Security check. There is a $100 deductible per year and some services may require a co-payment.

The following Medicare Savings Programs are designed to help you pay for your Part B premium.

QMB or “Quimby” stands for Qualified Medicare Beneficiary. QMB pays your Medicare Part B premiums, deductibles and co-payments. You may be eligible for this program if you qualify for Medicare Part A and your monthly income does not exceed $791 for one person, and you have less than $4,000 in savings and assets. A couple must have an income of less than $1,068 a month, and less than $6,000 in saving and assets.

SLMB or “Slimby” refers to the Specified Low-Income Medicare Beneficiary program. If your income is too high to qualify for QMB, you may be eligible for SLMB, which will pay for your Part B premiums. Your income cannot exceed $934 for one person or $1,261 per couple. Savings and asset limits are the same as for QMB.

If you do not meet the monthly income guidelines for SLMB, you could qualify for QI-1, which stands for Qualified Individual-1 Program.

This program also pays for your Part B premiums, like QMB and SLMB. But funds are limited, so it is best to apply as early in the year as possible. If you are receiving Medicaid, you are not eligible for QI-1.

Your monthly income for QI-1 must be less than $1,042 for one person, or $1,407 for a couple to be eligible. Savings and assets limits are $4,000 for an individual, or $6,000 for a couple.

Finally, the last Medicare Savings Program is QI-2 – for Qualified Individual-2 Program. QI-2 pays a small piece of your Part B premium and is paid just once per year.

Funds are limited and are dispersed on a first-come, first-served basis, so apply early in the year. The monthly income guidelines are $1,328 for an individual or $1,794 for a couple. Savings and asset limits are the same as for the other programs.

“If a person’s income, savings or assets seem a little too high for any one of these programs, they should still apply,” said Deb Chapman, director of outreach services at Eastern Agency on Aging.

“There may be exceptions,” she said. “No one should count himself or herself out without talking to one of our consultants. If there is any question about eligibility, it is always best to apply and see what happens.”

If you have been denied benefits in the past, think about reapplying. The rules or criteria of the program may have changed since then. These changes could make you eligible now.

Carol Higgins is the director of communications at Eastern Agency on Aging. For information on these programs or others, call Chuck or Marilyn at 941-2865. Check out our Web site at www.eaaa.org for more information on EAA.