Senior Benefit Advantage sunrise at Ohio's  Marblehead Light

Medicare Savings Plans

In order to explain Medicare Savings plans we have to mention Medicaid and how it differs from Medicare. Medicare is a Federal program while Medicaid is a State run health insurance program that pays for wide range of medical services for people with low income and resources. Each state runs its own Medicaid Program so variability in Medicaid is the rule rather than the exception. Each state establishes their own eligibility standards, benefit packages, provider payment policies, and administrative structures under broad federal guidelines. This situation effectively creates 56 different Medicaid programsone for each state, territory, and the District of Columbia. States also differ in Medicaid financing. Learn more about different aspects of Medicaid by following the links below. eligibility varies from state to state as do individual program benefits as far as what is covered and not covered.

Basically services include doctor visits, inpatient and outpatient hospital services, lab tests, x-rays, medical transportation, family planning services, nursing facility services, home health, and nurse practitioner services. Medicaid also administers the federally funded Medicare Savings Programs.

People who have Medicare and can also meet their state’s eligibility criteria to receive Medicaid are often called “dual eligible” or “dual qualified.”  In some cases Medicaid can pay their Medicare part B co-payments, deductibles and many services not covered by Medicare such as vision,  hearing, and  dental. This may be available in your state’s Medicaid program.

                Dual Qualified or Dual Eligible

Medicaid used to pay for prescription drugs for people who were enrolled in Medicare. Now people who have both Medicaid and Medicare will receive help paying for their prescriptions through Medicare Part D. In some states, Medicaid may cover certain drugs that Medicare does not. In addition, people who are enrolled in both Medicaid and Medicare will automatically qualify for the Medicare Part D Low Income Subsidy. Also referred to as LIS (Extra Help)



What are the Medicare Savings Programs?

Medicare Savings Programs (MSPs)  are Medicaid-administered programs specifically for people on Medicare who have limited income and limited resources. These programs help those qualified to afford Medicare. There are four different Medicare Savings Programs, Income and resource eligibility limits change annually.Often times we come into contact with seniors that qualify for one or more of these programs but no one has told them. In many cases we can help you figure out what your best options might be.


                                                Qualified Medicare Beneficiary (QMB):  

Some folks receiving Medicare also  qualify for Medicaid under certain conditions

if they meet proper income and resource levels.


     Specified Low-Income Beneficiary (SLMB):

Seniors or adults with disabilities may qualify if they meet proper income and

resource levels.


Qualifying Individual (QI):

QI is a limited program (funded by block-grant to states), and is available on a first-come, first-serve basis. People with Medicare may qualify if they meet proper income and resource levels.


Qualified Disabled Working Individual (QDWI):

Adults under age 65 and disabled but who recently returned to work and are no longer eligible for premium-free Part A may qualify for QDWI. If they meet proper income and resource levels. If eligible, QDWI will cover their Part A  premium.












                 Worth applying again in 2020!


Income guidelines for Medicare Savings Programs such as QMB (Qualified Medicare Beneficiary) and SLMB (Specified Low Income Medicare Beneficiary) and Qualified Individual (QI), as well as Extra Help with Prescriptions, increased a little over 2% while the COL was at 1.6% in 2020. That doesn’t sound like much, but several of my clients missed qualifying for help last year by as little as $2.00 or $3.00.


Medicare Savings Programs such as Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB), and Qualified Individual (QI) programs help Medicare Beneficiaries with Medicare costs. If you meet income and resource eligibility guidelines for these programs, Ohio will pay your 2020 Part B premium of $144.60 per month. QMB Beneficiaries also have all their Medicare cost-share covered and are not balance billed by Providers.


Extra Help with Prescriptions is estimated by the Social Security Administration to have an annual value of $5,000. If you enrolled late in Part D and qualify for Extra Help, you will have no Part D Late Enrollment Penalty (LEP).


Please call us if you would like our local help to apply for or reverifying these valuable benefits!


Contact Rhonda or Terry at 740-502-2784!

Make an appointment today at the Firehouse: 801 Walnut Street in Coshocton!


I have been an independent insurance broker for 30 years, and I specialize in Medicare and Medicaid Counseling. My agency offers many extra services beyond Medicare Plans. We will serve as Authorized Representative at Jobs and Family Services to assist clients in applying for and re-verifying Medicare Savings Programs. We help clients apply for Extra-Help with Prescription Drugs through Social Security as well as Patient Assistance Programs through Drug Manufacturers and other Organizations. We also help our clients access value added services such as Transportation, Dental, Vision and Hearing, Medical Response Systems, Over-the Counter and More… on their already existing Medicare Plans. Please call me for an appointment at 740-502-2784. Many times seniors or disabled folks have transportation problems and can't travel for an appointment at an office, for any one of several reasons. Call me and I'll do my best to help you. I look forward to serving you! Calling this number will connect you with me, Rhonda Kraus, a licensed insurance agent.




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