Q & A: Medicare

Q:  I understand that anyone with an income below $12,000 per year is eligible to have their Medicare Part B premiums returned.  Can you tell me if this is true, when it started, and is it automatic or does one need to apply? 

A: There are three programs that cover the Part B premiums for lower-income Medicare beneficiaries.  If you qualify, the Part B premium of $93.50 (in 2007) is not deducted from your Social Security check, but is paid for by your state Medicaid program.  Seniors with incomes in 2007 at or below the limits listed below may be able to qualify:


Medicare Savings Programs Individual Monthly Income Limit in 2007 Married Couple Monthly Income Limit in 2007 Helps Pay Your:
Qualified Medicare Beneficiary (QMB) $871 $1,161 Part A and Part B premiums, deductibles, coinsurance and copayments
Specified Low-income Medicare Beneficiary (SLMB) $1,041 $1,389 Part B premiums only
Qualifying Individual (QI-1) $1,169 $1,561 Part B premiums only

In addition to the income limits, individuals must have assets or savings at or below $4,000, and couples must have no more than $6,000.  When assets are counted the government DOES NOT INCLUDE your home, car, burial plot, up to $1,500 in burial expenses, furniture or other household items.  Some states, including Alaska and Hawaii, have income and asset limits that are slightly higher.

 The programs have been available for years, but millions of eligible seniors are not receiving benefits.  QMB was enacted in 1986, SLMB became effective in 1993 and the QI program become effective in 1998.  In 1999 the Government Accountability Office (GAO) reported that 43% of beneficiaries eligible for QMB and SLMB were not enrolled.  Today, as many as one out of three eligible beneficiaries are not enrolled in the programs, according to the National Academy of Social Insurance.

Many, if not most, Medicare beneficiaries simply are not aware of the programs.  In addition, TSCL believes that many beneficiaries whose incomes are otherwise low enough are disqualified by the overly restrictive asset test.  Unlike the income limits which are adjusted annually, the asset restrictions have never been adjusted for inflation, and thus each year, as the value of the dollar grows, fewer and fewer seniors who have modest savings are able to qualify.

In addition, enrollment is NOT automatic, you must apply.  If you think you or someone you know might be eligible, call your local Medicaid office.  You may also call your local Agency on Aging and ask for more information about the programs.  Check the numbers in your local phone book, or the following two websites:

  • The Eldercare Locator links those who need assistance with state and local area Agencies on Aging and community-based organizations that serve older adults and their caregivers.  You may find the information resources at www.eldercare.gov/Eldercare/Public/Home.asp  or you may speak to an Eldercare Locator  information specialist by calling toll-free at 1-800-677-1116 weekdays, 9:00 a.m. to 8:00 p.m. (ET).
  • The National Council on Aging's (NCOA) BenefitsCheckUp®, is a free and confidential online service, that helps seniors or people who care about them determine what benefits they qualify for and how to apply.  Using this service, millions of older Americans can find out if they qualify for help with their prescription drug costs, Medicare premiums, health care or in-home services.  For more information on BenefitsCheckUp, visit http://www.BenefitsCheckUp.org.

Sources:  “If You Need Help Paying Medicare Costs,” CMS, Pub. No. 10126, May 2007.  “Medicare Savings Programs,” GAO, March 2004, GAO-04-363.