Medicare Savings Programs

What are the Medicare Savings Programs (MSPs)?

There are four different programs. QMB, SLMB, and QI are called “buy-in programs” because they pay the Part B premium for people with limited incomes who otherwise might not be able to afford Medicare. QMB can also pay the Part A premium. QDWI pays only the Part A premium but not the Part B premium.

They are a type of Medicaid, administered by the state Medi-Cal agency.

How Does One Apply?

• To apply for the MSP program, complete a paper application and submit it to the County Medi-Cal office. The Health Insurance Counseling & Advocacy Program (HICAP) has applications and envelopes, if needed.

Criteria for Qualifying

• Individuals must be eligible for, although not necessarily enrolled in, Medicare. It’s possible to apply for Medicare via the Social Security Administration while also applying for the MSP program at the County.
• Income is gross income before the Part B premium is deducted from their Social Security check.
  • Note: A $20 “disregard” is subtracted from your monthly income (earned or unearned). The QDWI program also has an additional $65 disregard that applies when there is earned income.
• Unlike the non-MAGI Medi-Cal programs, other health insurance, such as dental, etc, cannot be used as a deduction. Therefore, in some cases, it may be easier to qualify for a non-MAGI Medi-Cal program, which also pays the Part B premium (but not Part A).

MSP income limits for 2025:

What are the Other Benefits?

• All programs automatically provide full Low-Income Subsidies (LIS) for drug costs for the year
• Recipients can change drug or Medicare Advantage plans quarterly

Qualified Medicare Beneficiary (QMB)

• This program pays the Part A premium. It also pays the Part B premium and protects one from all Medicare Parts A and B deductibles and copays. Although it is against the law for providers to bill QMB recipients for Medicare deductibles and co-pays, it may be best to use providers who take both Medicare and Medi-Cal.
• Allows immigrants and others with very low incomes who don’t qualify for free Part A to get it at no cost.
• Someone can conditionally apply for Part A contingent upon being approved for QMB.
• Those with Medi-Cal should still apply for QMB if they don’t get free Part A because only QMB, not Medi-Cal, pays the Part A premium.

Specified Low-Income Medicare Beneficiary (SLMB) & Qualifying Individual (QI)

• Only pays Part B premium.
• Does not pay for any other Part B coinsurance or for Part A. The Qualifying Individual (QI) program allows a slightly higher income.

Qualified Disabled Working Individual (QDWI)

• Only pays Part A premium.
• Does not pay for Part B premium or coinsurance.
• Available to people who had Social Security and Medicare benefits because of a disability but lost them because they returned to work and their earnings exceeded the allowable limit. For more information on Social Security Disability, visit ssa.gov/disability.

This project was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $117,760 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS, or the U.S. Government.