Medicare’s Qualifying Individual Program

Medicare premiums can be expensive. Fortunately, you can seek financial help from both the federal and state governments if you are having trouble paying the bills. Medicare Savings Programs are an option that may assist you with paying deductibles, co-payments, and co-insurance related to both Medicare Part A (which covers hospital insurance) and Medicare Part B (which covers general medical insurance).

There are four types of Medicare Savings Plans, but today we will focus on the Qualifying Individual Program. Typically patients will apply for the Qualifying Individual Program if they do not qualify for the Qualified Medicare Beneficiary Program (QMB) or the Specified Low-Income Medicare Beneficiary Program (SLMB). Qualifying individual funding is limited by the federal government. As a result, it is necessary to reapply for coverage on an annual basis. Benefits are distributed on a first come, first served basis. However, you are given priority if you received Qualifying Individual benefits during the previous year. Please note that if you qualify for Medicaid, you will not be able to receive Qualifying Individual benefits.

Help with Part B premiums

The Qualifying Individual Program assists with Medicare Part B premiums only. Like other Medicare Savings Plans, it features income and resource limits that are updated on an annual basis. For 2016, the individual monthly income limit is $1,357. If you are married, the monthly income limit is $1,823. The individual resource limit is $7,280. If you are married, the resource limit for couples is $10,930.

Medicare defines resources as money you have have in a checking or savings account as well as stocks, bonds, mutual funds, or individual retirement accounts (IRAs). Medicare does not consider your house, your car, your furniture or household and personal items, a burial plot, or up to $1,500 set aside for burial expenses as countable resources.

If you are at or slightly above these income and resource limits, it is still a good idea to apply for the Qualifying Individual Program. Medicare and the state agencies that manage Medicare Savings Plans have been known to work with patients even if their income is higher than the annual limits. To see if you qualify for a Medicare Savings Plan like the Quality Individual Program, call your state Medicaid office. Be sure that you already have Medicare Part A (or at least that you are eligible for it), and tally your income and resources to see how they compare to the limits listed above.

You should also consult with your Medicare-approved doctor or specialist, and call Medicare directly at 1-800-633-4227 if you have further questions.

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