SAMHSA SOAR

Medicare Savings Programs

Recipients of SSDI are eligible for Medicare two years after their SSDI eligibility began. This article provides an overview of programs that can assist individuals with the expenses associated with Medicare, such as premiums, deductibles, and co-pays.

About Medicare Savings Programs

Medicare Savings Programs

Benefit

Eligibility

Benefit

Apply At

Qualified Medicare Beneficiaries (QMB)
  • Income & resource limits apply*
 Medicaid pays:

  • Part B premium
  • Deductibles
  • Copays
 Local Medicaid Office
Specified Low-Income Medicare Beneficiaries (SLMB)
  • Slightly higher income limits than QMB
  • Same resource limits
 Medicaid pays:

  • Part B premium
 Local Medicaid Office
Qualified Individuals (QI)
  • Slightly higher income limits than SLMB
  • Resource limits apply in some states
  • Funds limited to first come, first served
 Medicaid helps pay:

  • Part B premium
 Local Medicaid Office
Qualified Disabled & Working Individuals (QDWI)
  • Working disabled
  • Under 65 years
  • Lost premium-free Medicare Part A due to return to work
  • Not receiving medical assistance from the state
  • Meet state income and resource limits
 Medicaid helps pay:

  • Part A premium
 Local Medicaid Office
Extra Help
  • Medicare AND:
  • Receiving full Medicaid coverage, OR
  • Getting help paying for Part B premiums (in a Medicare Savings Program), OR
  • Receiving SSI benefits
 Helps pay the costs of Medicare prescription drug coverage www.ssa.gov

*Current income and resource limits are available on our SSA Annual Updates page.

Medicare Example: Amelia applied for SSDI on June 1, 2012. She was approved a few months later and DDS determined her date of onset to be January 1, 2011. After taking into account the 5-month waiting period and her eligibility for up to 12 months of retroactive benefits, she was eligible to start receiving benefits on June 1, 2011. SSA calculates the two-year wait for Medicare dating from when her payments would have begun on June 1, 2011, and so she will be eligible for Medicare on June 1, 2013.

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Details

Type:
Article
Date:
October, 2015

Other Details

Topic
Health Care

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