Social Security Medicare Savings Program Benefits
Medicare Savings Programs (MSP) are federally funded programs administered by each individual state. These programs are for people with limited income and resources to help pay some or all of their Medicare premiums, deductibles, copayments, and coinsurance.
There are four Medicare Savings Programs:
- Qualified Medicare Beneficiary
- Specified Low-Income Medicare Beneficiary
- Qualifying Individual
- Qualified Disabled & Working Individuals
Social Security Medicare Savings Program
The Medicare Savings Program (MSP) is a state-based program that assists eligible individuals with limited income and resources in paying for their Medicare premiums. It is not part of the Social Security Administration's programs but is administered by the state Medicaid agencies. The program helps beneficiaries by covering some or all of their Medicare premiums, deductibles, coinsurance, and copayments, depending on the specific program and the state in which the beneficiary resides.
To qualify for the Medicare Savings Program, individuals must meet certain income and asset criteria. The eligibility requirements vary depending on the specific program within the MSP. The four main types of Medicare Savings Programs are the Qualified Medicare Beneficiary (QMB) Program, the Specified Low-Income Medicare Beneficiary (SLMB) Program, the Qualifying Individual (QI) Program, and the Qualified Disabled and Working Individuals (QDWI) Program.
Each of these programs has its own specific eligibility criteria and benefits. It's essential to contact your state Medicaid office or the Social Security Administration for more information on the Medicare Savings Program, including eligibility requirements and the application process.
Social Security Medicare Savings Program Benefits
The Medicare Savings Program (MSP) is a state-based program that helps Medicare beneficiaries with limited income and resources pay for their Medicare premiums. There are four types of Medicare Savings Programs, each with different eligibility criteria and benefits:
- Qualified Medicare Beneficiary (QMB) Program: The QMB program helps pay for Medicare Part A and Part B premiums, deductibles, copayments, and coinsurance. Individuals who qualify for QMB may also be eligible for Medicaid benefits, including help with other costs, such as prescription drug coverage.
- Specified Low-Income Medicare Beneficiary (SLMB) Program: The SLMB program helps pay for Medicare Part B premiums. Individuals who qualify for SLMB may have slightly higher income limits compared to those for the QMB program.
- Qualifying Individual (QI) Program: The QI program also helps pay for Medicare Part B premiums. However, it has more limited funding, and eligibility is on a first-come, first-served basis. Therefore, individuals who qualify for QI may not receive benefits if the funding limit has been reached for the year.
- Qualified Disabled and Working Individuals (QDWI) Program: The QDWI program helps pay for Medicare Part A premiums for certain disabled individuals who have returned to work. To qualify for QDWI, individuals must meet specific income and resource requirements.
The benefits provided by these programs vary depending on the specific program and the state in which the beneficiary resides. It's important to check with your state's Medicaid office or the Social Security Administration to determine your eligibility and the benefits you may receive under the Medicare Savings Program.
Who is eligible for Social Security Medicare Savings Program?
Below are general requirements for the MSP:
- Reside in a state or the District of Columbia.
- Are age 65 or older;
- Receive Social Security Disability benefits;
- People with certain disabilities or permanent kidney failure (even if under age 65); and
- Meet standard income and resource requirements.
For a full list of requirements visit Medicare.gov’s Medicare Savings Program page. Only the state can determine if an individual qualifies for coverage under one of the programs. Many states apply different standards and methods to determine MSP eligibility. Some states, for example, have no resources for these programs or figure the income and resources differently.
If you would like to find out if you are eligible for any of Social Security's benefit programs, use the U.S. Social Security Administration’s (SSA's) Benefit Eligibility Screening Tool. Once you have completed the eligibility screening questionnaire, you will be provided with a list of benefits for which you may be eligible. Print this page for your records before going to the application site.
Documents required for Social Security Medicare Savings Program
The specific documents required for the Social Security Medicare Savings Program (MSP) application may vary depending on your state's regulations and the type of MSP program you are applying for. However, some common documents that may be required for the application process include:
- Proof of identity, such as a driver's license, state-issued identification card, or passport.
- Proof of citizenship or lawful presence, such as a birth certificate, passport, or immigration documents.
- Social Security card or proof of Social Security number for all individuals applying for the program.
- Proof of income, such as pay stubs, W-2 forms, or tax returns.
- Bank statements or financial records to verify your financial resources, if applicable.
- Proof of current Medicare enrollment, which can be obtained from your Medicare card or other Medicare-related documents.
- Any additional documents specific to your state's requirements, which may include residency verification or other supporting documentation.
It is crucial to contact your state's Medicaid office or the Social Security Administration to get a comprehensive list of required documents and to understand the specific application process for the Social Security Medicare Savings Program in your state. They can provide you with detailed guidance on the necessary paperwork and assist you throughout the application process.
Mental Health Residential Rehabilitation Treatment Program BenefitsRequired eligibility for the Social Security Medicare Savings Program
The eligibility requirements for the Social Security Medicare Savings Program (MSP) can vary slightly depending on the specific type of program within the MSP and the state in which you reside. However, the following are general guidelines for eligibility:
Qualified Medicare Beneficiary (QMB) Program:
- Must be enrolled in Medicare Part A (hospital insurance) and have limited income and resources.
- Income limits and resource limits must be within the program's guidelines.
- Eligibility may entitle you to assistance with Medicare premiums, deductibles, coinsurance, and copayments
Specified Low-Income Medicare Beneficiary (SLMB) Program:
- Must be enrolled in Medicare Part A.
- Income limits must be slightly higher than those for the QMB program, and resource limits must also be within the program's guidelines.
- Eligibility may entitle you to assistance specifically with Medicare Part B premiums.
Qualifying Individual (QI) Program:
- Must be enrolled in Medicare Part A.
- Must meet income and resource requirements.
- Eligibility is based on a first-come, first-served basis due to limited program funding, and it provides assistance with Medicare Part B premiums.
Qualified Disabled and Working Individuals (QDWI) Program:
- Must be disabled under Social Security Administration rules and currently working.
- Must meet specific income and resource requirements.
- Eligibility entitles you to assistance with Medicare Part A premiums.
To determine your eligibility and to apply for the Social Security Medicare Savings Program, it is important to contact your state's Medicaid office or the Social Security Administration. They can provide detailed information regarding the specific requirements for each program and guide you through the application process.
How do I apply for Social Security Medicare Savings Program?
Once you know which benefits you may be eligible for, go to the Medicare Benefits page to apply online. You may also call your State Medicaid Program to see if you qualify and to apply. To view a model application in other languages, visit the Centers for Medicare & Medicaid Services Forms and Publications Page to download a model application.
Temporary Assistance For Needy Families ProgramHow To apply for Social Security Medicare Savings Program?
- Online; or
- By calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office. Call ahead to make an appointment.
- If you do not live in the U.S. or one of its territories, you can also contact your nearest U.S. Social Security office, U.S. Embassy or consulate.
You can help by being ready to provide the information and documents listed below.
Information About You
- Your date and place of birth and Social Security number;
- The name, Social Security number and date of birth or age of your current spouse and any former spouse. You should also know the dates and places of marriage and dates of divorce or death (if appropriate);
- The names of any unmarried children under age 18, age 18-19 and in elementary or secondary school, or disabled before age 22;
- Your bank or other financial institution's Routing Transit Number and the account number [more info];.
- Your citizenship status;
- Whether you or anyone else has ever filed for Social Security benefits, Medicare or Supplemental Security Income on your behalf (if so, we will also ask for information on whose Social Security record you applied);
- Whether you have used any other Social Security number;
- If you are applying for retirement benefits, the month you want your benefits to begin; and
- If you are within 3 months of age 65, whether you want to enroll in Medical Insurance (Part B of Medicare).
Information About Your Work
- The name and address of your employer(s) for this year and last year;
- The amount of money earned last year and this year. If you are filing for benefits in the months of September through December, you will also need to estimate next year's earnings;
- A copy of your Social Security Statement or a record of your earnings. If you do not have a Statement, you can view your Social Security Statement online by creating an account and signing in with us. Even if you do not have a record of your earnings or you are not sure if they are correct, please fill out the application. We will help you review your earnings when you apply;
- The beginning and ending dates of any active U.S. military service you had before 1968;
- Whether you became unable to work because of illnesses, injuries or conditions at any time within the past 14 months. If "Yes," we will also ask the date you became unable to work;
- Whether you or your spouse have ever worked for the railroad industry;
- Whether you have earned Social Security credits under another country's social security system; and
- Whether you qualified for or expect to receive a pension or annuity based on your own employment with the Federal government of the United States or one of its States or local subdivisions.
Documents You May Need To Provide
We may need to see certain documents in order to pay benefits. If you apply online, a list of documents we need to see will appear at the end of the application, along with instructions on where to submit them. The documents we may ask for are:
- your original birth certificate or other proof of birth (You may also submit a copy of your birth certificate certified by the issuing agency);
- proof of U.S. citizenship or lawful alien status if you were not born in the United States;
- a copy of your U.S. military service paper(s) (e.g., DD-214 - Certificate of Release or Discharge from Active Duty) if you had military service before 1968; [more info]; and
- a copy of your W-2 form(s) [more info] and/or self-employment tax return for last year.
What If I Don't Have All Of The Documents?
Even if you don't have all the documents we need, you should still submit the application and any documents you do have. You can provide the missing documents later or we may be able to help you get them.
In many cases, your local Social Security office can contact your state Bureau of Vital Statistics and verify your information online at no cost to you. If we can't verify your information online, we can still help you get the information you need. If you delay submitting the application, you could lose some benefits you may be due.
Mailing Your Documents
If you mail any documents to us, you must include the Social Security number so that we can match them with the correct application. Do not write anything on the original documents. Please write the Social Security number on a separate sheet of paper and include it in the mailing envelope along with the documents. If you do not want to mail these documents, you may bring them to a Social Security office.
Do not mail foreign birth records or any documents from the Department of Homeland Security (DHS), formerly the Immigration and Naturalization Service (INS), especially those you (the applicant) are required to keep with you at all times. These documents are extremely difficult, time-consuming and expensive to replace if lost. Some cannot be replaced. Instead, bring them to a Social Security office where they will be examined and returned.
How can I contact someone?
For more information about Medicare, visit Medicare page. Visit SSA's Publications Page for detailed information about SSA programs and policies. You may also contact Social Security by phone at: 1-800-772-1213 (TTY: 1-800-325-0778) / 1-800-633-4227.