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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