Q-1000, Medicare Savings Programs Overview
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Revision 25-1; Effective March 1, 2025
The Medicare Savings Programs (MSPs) help Medicare beneficiaries with limited income and resources pay for all or some of their out-of-pocket Medicare expenses. These expenses include premiums, deductibles and coinsurance.
There are four MSPs:
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individual (QDWI) Program
The income limits for the MSPs are based on the federal poverty level (FPL), which is adjusted annually.
The resource limits for the MSPs, except QDWI, are updated annually based on the Consumer Price Index (CPI). The QDWI resource limits are based on the current SSI resource limits. All regular Medicaid for the Elderly and People with Disabilities (MEPD) policies for resources, income and non-financial eligibility apply to this program, except those specifically identified in this chapter.
Transfer of assets, spousal impoverishment and co-payment policy and procedures do not apply to MSPs.
A person is not eligible for MSP coverage if they:
- are in the custody of penal authorities; or
- are over 20 but under 65 years and live in an institution for mental diseases (IMD).
Note: Children under 19 who are certified for MSP will receive 12 months of continuous eligibility, with limited exceptions. Refer to continuous Medicaid coverage policy for exceptions.
Related Policy
Medicare Savings Program Information, Appendix IX
Medicare Savings Programs, A-8000
Continuous Medicaid Coverage, B-6600
Q-1100, Reserved for Future Use
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Revision 24-4; Effective Dec. 1, 2024
Q-1200, Medicare Improvement for Patients and Providers Act of 2008
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Revision 22-3; Effective September 1, 2022
MIPPA added requirements for processing MSP applications for people applying through the Social Security Administration (SSA) for the Low Income Subsidy (LIS) program, also referred to as the Extra Help program. LIS provides prescription assistance for Medicare beneficiaries enrolled in Medicare Part D who have limited income and resources. The MSP programs included in MIPPA are:
- Qualified Medicare Beneficiary (QMB) Program;
- Specified Low-Income Medicare Beneficiary (SLMB) Program; and
- Qualified Individual (QI) Program.
The Qualified Disabled and Working Individual (QDWI) Program is not part of MIPPA.
Texas receives a list of people who applied for LIS from SSA. The list includes whether the people were approved or denied. The date the Texas Health and Human Services Commission (HHSC) receives the list is the application date for MSP and starts the 45-day clock for timely processing of the applications for each person on the list. The date the application was made with SSA is a protected file date for MSP eligibility. Form H1200-EZ, Application for Assistance — Aged and Disabled is sent to each person on the list. HHSC sends denied LIS applicants a denial notice with the right to appeal if they are denied because they:
- live outside the United States;
- have excess resources; or
- have excess income (couples will not auto deny).
Additionally, TIERS will deny anyone identified as living outside of Texas.
Q-1300, MSP Resource Limits
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Revision 26-1; Effective March 1, 2026
QMB, SLMB and QI Resource Limits
The resource limits for the following Medicare Savings Programs (MSP) are based on the annual consumer price index (CPI). They are updated in January of each year:
- Qualified Medicare Beneficiary (QMB);
- Specified Low-Income Medicare Beneficiary (SLMB); and
- Qualified Individual (QI).
Use the following resource limits to determine eligibility for these programs.
| Date Range | Individual | Couple |
|---|---|---|
| Jan. 1, 2026 to Present | $9,950 | $14,910 |
| Jan. 1, 2025 to Dec. 31, 2025 | $9,660 | $14,470 |
| Jan. 1, 2024 to Dec. 31, 2024 | $9,430 | $14,130 |
| Jan. 1, 2023 to Dec. 31, 2023 | $9,090 | $13,630 |
| Jan. 1, 2022 to Dec. 31, 2022 | $8,400 | $12,600 |
| Jan. 1, 2021 to Dec. 31, 2021 | $7,970 | $11,960 |
| Jan. 1, 2020 to Dec. 31, 2020 | $7,860 | $11,800 |
| Jan. 1, 2019 to Dec. 31, 2019 | $7,730 | $11,600 |
| Jan. 1, 2018 to Dec. 31, 2018 | $7,560 | $11,340 |
| Jan. 1, 2017 to Dec. 31, 2017 | $7,390 | $11,090 |
| Jan. 1, 2016 to Dec. 31, 2016 | $7,280 | $10,930 |
| Jan. 1, 2015 to Dec. 31, 2015 | $7,280 | $10,930 |
| Jan. 1, 2014 to Dec. 31, 2014 | $7,160 | $10,750 |
| Jan. 1, 2013 to Dec. 31, 2013 | $7,080 | $10,620 |
| Jan. 1, 2012 to Dec. 31, 2012 | $6,940 | $10,410 |
| Jan. 1, 2011 to Dec. 31, 2011 | $6,680 | $10,020 |
| Jan. 1, 2010 to Dec. 31, 2010 | $6,600 | $9,910 |
| Jan. 1, 1989 to Dec. 31, 2009 | $4,000 | $6,000 |
QDWI Resource Limits
The resource limits for Qualified Disabled and Working Individuals (QDWI) are twice the resource limits for the SSI program.
Use the following resource limits to determine eligibility for the QDWI program:
- $4,000 for an individual; and
- $6,000for a couple.
Related Policy
Resource Limits, F-1300
Medicare Savings Program Information, Appendix IX
Budget Reference Chart, Appendix XXXI
Q-1400, MSPs and Cost-of-Living Adjustments
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Revision 20-3; Effective September 1, 2020
The income limits for QMB, SLMB and QI are based on the federal poverty level (FPL), which is adjusted annually. The Social Security cost-of-living adjustment (COLA) is excluded through the month in which the annual revision of the FPL is published. To determine eligibility for applications and redeterminations, use the pre-COLA benefit amount during those months.
For example, if the FPL is published in February, exclude the RSDI COLA for the months of January and February.
Reminder: The COLA exclusion does not apply when determining eligibility for the QDWI program.
Related Policy
Deeming Income, E-7000
QDWI Cost-of-Living Adjustment, Q-6300
Q-1500, MSPs and Medicare Part B-ID
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Revision 25-1; Effective March 1, 2025
A person diagnosed with end-stage renal disease (ESRD) may be entitled to Medicare benefits. If the person receives a kidney transplant, Medicare entitlement ends after 36 months, unless the person is otherwise entitled to Medicare based on age or disability.
Medicare beneficiaries who lose Medicare eligibility after a kidney transplant may be eligible for the limited Medicare Part B immunosuppressive drug (Medicare Part B-ID) benefit. Medicare Part B-ID beneficiaries are not entitled to Medicare Part A, cannot be eligible for Medicare on another basis, and must not have any other comprehensive health care coverage that covers immunosuppressive drugs, such as Medicaid or the Children’s Health Insurance Program (CHIP). A Medicare Part B-ID beneficiary may be eligible for Community Attendant Services (CAS) or the Healthy Texas Women (HTW) program because these types of assistance do not cover immunosuppressive drugs.
The Medicare Part B-ID benefit only covers immunosuppressive drugs. Medicare does not cover any other items or services, including hospital stays, physician services, supplies or medications.
Eligible Part B-ID beneficiaries receive a new Medicare card that shows Medicare coverage for immunosuppressive drugs only.
Part B-ID beneficiaries with limited income and resources may be eligible for a Medicare Savings Program (MSP) even though they are not entitled to Medicare Part A. If the person meets all other eligibility requirements, the MSP will cover all or some of the person’s Medicare premiums, deductibles or coinsurance associated with the Part B-ID benefit.
Identification
Identify Medicare Part B-ID individuals by accessing State Online Query (SOLQ) or viewing the person’s Medicare card. In SOLQ, the Ledger Account File (LAF) code will display Active Title XVIII status only. Medicare Part B will reflect a start date with a premium amount lower than the standard Medicare Part B premium. The 2025 Part B-ID premium is $110.40. In addition, Medicare Part A will reflect a stop date with the option code None-No longer under renal disease provision.
Regular MSP and Part B-ID MSP in TIERS
Regular MSPs are Qualified Medicaid Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI-1) benefits based on entitlement for Medicare Part A. Part B-ID MSPs are QMB, SLMB or QI-1 benefits based on entitlement for Medicare Part B-ID. Part B-ID MSPs help with Medicare Part B-ID premiums, deductibles and co-insurance costs associated with immunosuppressive drugs only. A person approved for Part B-ID QMB does not receive regular QMB benefits. The Medicaid card for Part B-ID QMB recipients shows Part B-ID only in the upper righthand corner.
A regular MSP recipient who loses Medicare Part A entitlement based on ESRD and transfer to Part B-ID MSP receives a new Eligibility Determination Group (EDG) number in TIERS. The new EDG keeps the same review due date, packet sent date and packet received date as the old EDG, if the person is certified for the same type of assistance (TOA).