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Medicare Savings Programs

What are Medicare Savings Programs?

Medicare Savings Programs are programs that pay Medicare premiums/deductibles/co-insurance fees for eligible individuals. You must meet certain income and asset limits to qualify for Medicare Savings Programs.

Both Medicare Part A and Part B have deductibles and co-insurance fees that vary depending on the service. A deductible must be paid before Medicare will make any payments and a co-insurance fee is a percentage charge to the beneficiary.

There are four different Medicare Savings Programs:

  • The Qualified Medicare Beneficiary Program (QMB)
  • The Specified Low-Income Medicare Beneficiary Program (SLMB)
  • The Qualified Individual 1 Program (QI-1)
  • The Qualified Disabled Working Individual Program (QDWI)

What is the Qualified Medicare Beneficiary (QMB) Program?

The Qualified Medicare Beneficiary (also known as QMB) program helps Medicare recipients pay the following Medicare expenses:

  • Medicare Part A premium for those who do not receive it automatically because they are not eligible for Social Security.
  • Medicare Part B premium
  • Deductibles for both Part A and Part B Medicare.
  • Co-insurance under both Part A and Part B Medicare.

What is the Specified Low-Income Medicare Beneficiary (SLMB) Program?

The Specified Low-income Medicare Beneficiary (also known as SLMB) program helps low-income Medicare recipients by paying their Medicare Part B premiums that would otherwise be deducted from their Social Security checks.

What is the Qualified Individual 1 (QI-1) Program?

The Qualified Individual 1 (also known as QI-1) program helps low-income Medicare recipients by paying their Part B premiums.

What is the Qualified Disabled Working Individual (QDWI) Program?

The Qualified Disabled Working Individual (QDWI) program is available to people who were receiving Social Security and Medicare benefits because of disability, and then lost eligibility to the Social Security benefits and free Medicare Part A because they returned to work and their earnings exceed the limit allowed.

How Do I Apply for the Medicare Savings Programs?

If you think you qualify under any of the Medicare Savings Program categories, you can apply for help with your Medicare costs.

In order to be eligible for any of the Medicare Savings Programs you must also be eligible to receive Medicare Part A and Part B.

If you are already on Medicare, and would like to apply for the Medicare Savings Programs, you can contact the Social Services Agency to initiate an application or call 800-281-9799 to receive an application in the mail.

What if I need to apply for Medicare?

If you are not receiving Medicare benefits you can apply at your local Social Security office and state in writing that you are applying for conditional Medicare under one of the Medicare Savings Programs.

Once you become eligible for Medicare, you should follow up with the county Social Services Agency to apply for QMB, SLMB, QI-1, or QDWI benefits or to verify your application status. Current Medi-Cal recipients do not need to complete a new application as they are automatically evaluated for the Medicare Savings Programs.

The rules for these programs can be complicated. If you need help, contact your local Health Insurance Counseling and Advocacy Program (HICAP) at 800-434-0222 or the Orange County Office on Aging.