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Medicare Savings Plans

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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.

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)



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.



Medicare Savings




Dual Qualified or Dual Eligible


What are the Medicare Savings Programs?

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.



Hi, my name is Rhonda Kraus. I am the Owner and Director of Client Services at Senior Benefit Advantage. I am excited to announce that I have opened a satellite office in Coshocton at 801 Walnut St. (the old fire station) to better serve you. For those of you who do not know me- 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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