Medicare is a federal system of health insurance for people over 65 years old and/or for certain younger people with disabilities. There are a variety of eligibility requirements for Medicare.
Medicare Advantage Plans
Medicare has 4 parts, Part A, B, C, and D. Part A of Medicare consists of Hospital Insurance and helps to pay for things such as home health care, hospice care, nursing facilities, and hospital inpatient care as well. Medicare Part B refers to Medical Insurance.
Under this part of Medicare, someone may be covered if they receive services from doctors and health care providers, home health care, outpatient care, durable medical equipment, shots/ vaccines, yearly “Wellness” visits, and screenings. Medicare Advantage Plans, also known as Part C, is a Medicare-approved plan that comes from a private company offering an alternative to Original Medicare for your health and drug coverage.
This type of plan is a bundled plan which typically includes Parts A, B, and D. It may even offer extra benefits that an original plan doesn’t cover such as vision, hearing, and dental services. Within Part D of Medicare is Drug Coverage. This portion assists in covering the cost of prescription drugs. As a bonus, you may join a Medicare drug plan in addition to Original Medicare or a Medicare Advantage Plan that includes drug coverage.
Since Medicare works with private insurance companies to offer ways to get your health coverage, they can choose to offer a consumer-directed Medicare Advantage Plan as mentioned earlier. This Medicare Advantage Plan is also called a Medicare Medical Savings Account (MSA) Plan. The purpose of these plans is to give you control over your health care dollars and make provisions for important coverage in your favor and against the high healthcare costs.
People with both Part A and Part B can generally join a Medicare MSA Plan. Medicare savings programs could potentially pay Medicare Part A which incorporates Hospital Insurance and Medicare Part B which incorporates Medical Insurance.
A plan such as this combines a health insurance plan you may have with a medical savings account which can be utilized to pay for your health care costs.
Medicare Savings Plans
Medicare Savings Plans have 2 parts which include a high deductible health plan and a medical savings account. The high deductible health plan will only begin to cover your costs once you meet a high yearly deductible, which can vary by plan. The medical savings account deposits money into your account.
Money from this account can be chosen to be used to pay your health care costs before you meet the deductible. It is important to research and determine eligibility to make an accurate and beneficial decision when it comes to your healthcare.
There are also 4 different types of Medicare savings plans to choose from. Qualifications for these programs are dependent on income and resource limits. The countable resources included are Money in a checking or savings account, Stocks, and Bonds.
The first plan is called the Qualified Medicare Beneficiary (QMB) Program. This program is for individuals with an individual monthly income limit of $1,153 or a married couple with a monthly income limit of $1,546.
Also for individuals with a resource limit of $8,400 or a married couple with a resource limit of $12,600. This program helps pay for Part A premiums, Part B premiums, deductibles, coinsurance, and copays for services and items which Medicare covers.
The next plan is the Specified Low Income Medicare Beneficiary (SLMB) Program. The SLMB program is a state program that helps pay Part B premiums for people who have Part A and more limited income and resources. For an individual to qualify for the Specified Low-Income Beneficiary Program they must have a monthly income of under $1,379 and a resource limit of $8,400.
For a married couple, the limits are $1,851 in monthly income and $12,600 in resource limit. This program pays for Part B premiums only. A Qualifying Individual (QI) Plan is a state program that helps pay Part B premiums for people who have Part A and limited income and resources. This program requires yearly application that is on a first-come, first serve basis.
QI priority is given to those who received QI benefits the prior year. The monthly income limit for a Qualifying Individual Program is $1,549 for individuals and $2080 for a married couple. The resource limit is $8,400 for an individual and $12,600 for a married couple.
The program helps pay for Part B premiums only. Lastly, The QDWI or Qualified Disabled Working Individuals program helps pay the Part A premium. Someone may if they have a disability, are working, and have lost their Social Security disability benefits and premium-free Part A because they returned to work.
The QDWI income limits are $4,615 for an individual and $6,189 for married couples. The resource limits for an individual are $4,000 and $6,000 for a married couple. This program helps pay only for Part A.
When considering a Medicare Savings Program ask yourself if you have or are eligible for Part A.
Closing Thoughts
Does your income for the current year fall at or below the income limits for one of the four programs? Also, do you have limited resources that are below the limits? If these questions fit your status, call your State’s Medicaid Program to see if you qualify for a Medicare Savings Program in your state.
Additionally, even if your income is higher you should still call and complete an application if you think you could qualify. If interested and needed, check to see if one of these Medicare Saving Program Plans may be the right fit for you.
