Medicare Savings Programs

Medicare Savings Programs (MSP), also known as the Medicare Buy-In Programs, help pay for Medicare premiums (monthly costs for coverage), coinsurances, drug costs, and deductibles. A deductible is an amount of your health care costs you are responsible for before your benefits start. For example, if you have a $100 deductible, you are responsible for the first $100 of your health care costs before your benefits start.

The Michigan Department of Health and Human Services (MDHHS) decides if you qualify for most MSPs. Medicare decides if you qualify for the program known as “Extra Help” which helps with drug costs. More information about the different MSPs is in the sections "MSPs through MDHHS" and "Medicare Extra Help Program" below.

To learn more about Medicare in general, read An Overview of Medicare.

Who Is Eligible?

Some programs are related to your income (money you get) and assets (things you own). Depending on the program, other requirements have to do with where you live, your immigration status, and reporting information to MDHHS.

Income

The income requirements are set on a tier system based on how much income someone has. When someone is eligible for a program at a lower tier, meaning they have lower income, they must enroll in that program. They cannot enroll in a program with a higher income limit if they qualify for a program with a lower income limit. Some people may want to enroll in a higher-tiered program because of its coverage and the coverage start date.

The Qualified Medicare Beneficiaries (QMB) program has the lowest income limit. The Qualified Disabled Working Individuals (QDWI) has the highest limit. To learn more about these programs, read the section "MSP Programs through MDHHS" below.

To learn about specific income information, visit Medicare Savings Programs on the Medicare website. You can select one of the programs and learn what the income limit is for the current year.

If you have questions about the income limits for MSPs, you can speak with someone at the Michigan Medicare/Medicaid Assistance Program (MMAP). MMAP is a free, state-wide counseling service designed to help people with questions about health care.

Assets (Also Known as Resources)

The asset limits for each program are similar to those used for Medicaid eligibility. Some examples of assets that count are:

• Cash on your person and in checking and savings accounts
• Real property (land and anything on it)
• Trusts and bonds

Some examples of assets not commonly counted are:

• The home you live in
• One car (if you only own one)
• Burial space
• Personal belongings and household goods
• Life insurance policies with a combined value of $1,500 or less

To learn about specific asset information, visit Medicare Savings Programs on the Medicare website. You can select one of the programs and learn what the asset limit is for the current year.

If you have questions about asset limits for MSPs, you can speak with someone at MMAP.

Other Eligibility Requirements

Along with income and asset limits, you may have to meet other requirements to be eligible for an MSP. Depending on your situation, you might have to:

• Be a Michigan resident
• Have a Social Security number or work with MDHHS to get one
• Be a U.S. citizen or an immigrant with a specific status
• Report certain information to MDHHS
• Apply for any state or federal benefits you could be eligible for

Michigan Resident

Being a Michigan resident means you live in Michigan. You are allowed to leave the state as long as you plan to come back. For example, if you leave Michigan to spend part of the winter in a warmer place, you are a Michigan resident if you plan to come back.

If you are homeless, you may still be eligible for an MSP. Not having a permanent address does not affect your status as a Michigan resident. You can’t be denied coverage just because you are homeless. To learn more, you can speak with someone at MMAP.

Citizenship and Immigration Requirements

You must be a U.S. citizen or have a specific immigration status to get coverage through an MSP. Being a “qualified alien” could mean you have the specific immigration status that makes you eligible for an MSP. Some examples of qualified aliens are lawfully admitted permanent residents (LPRs, or green card holders), asylees, and refugees.

To learn more about immigration statuses and MSPs, you can speak with someone at MMAP. You can use the Guide to Legal Help to find immigration lawyers and legal services lawyers who may be able to help answer your questions.

You do not have to be a U.S. citizen or have a specific immigration status to get coverage for emergency medical services.

Report Information to MDHHS

You need to report information to MDHHS to get coverage through an MSP. Here are some examples of information you may need to report:

• Information about your income and assets
• Information needed to establish paternity of your children
• Information from third-party resources

A third-party resource is a person, entity, or program that is or could be liable to pay for part or all of your medical expenses.

MSPs through MDHHS

There are multiple MSPs offered through MDHHS. These programs help with costs from specific parts of Medicare. To learn more about the different parts of Medicare, read An Overview of Medicare.

Qualified Medicare Beneficiaries (QMB)

This program pays for Medicare Part A and B premiums, coinsurances, and deductibles. If you are getting Medicaid and you are eligible for Medicare Part A, you may qualify for automatic QMB. To learn more about this, you can speak with someone at MMAP.

If you qualify, your coverage will start the month after the month MDHHS determines you’re eligible. QMB only covers months going forward. MDHHS will not pay you for months from before your coverage began.

Divestment

A divestment is any transfer of money or an asset for less than its fair market value. MDHHS has rules about divestments when deciding if you qualify for QMB. To learn more about this, read the section "Divestments" of Income and Asset Limits for Medicaid.

You can also speak with someone at MMAP to learn more.

Specified Low-Income Medicare Beneficiaries (SLMB)

This program pays for Medicare Part B premiums only. To qualify, you must be getting premium-free Medicare Part A.

SLMB coverage will cover months after MDHHS determines you’re eligible, as well as previous months your income made you eligible. You will only be covered for months your income is more than the QMB income limit but still under the SLMB limit. To learn about these limits, visit Medicare Savings Programs on the Medicare website. You can select the programs and learn what the income limits are for the current year.

If you have questions about the income limits or SLMB coverage in general, you can speak with someone at MMAP.

Additional Low-Income Medicare Beneficiaries (ALMB); Also Known as Qualified Individual (QI)

This program only pays for Part B premiums when there is funding available to do so. To qualify, you must be getting premium-free Medicare Part A.

ALMB is only available starting with the year MDHHS determines you are eligible. So even if you applied for ALMB in December of last year, if MDHHS approves you in January of this year, your coverage is only good for this year moving forward. Another example is if you apply in March of this year, and MDHHS finds you’re eligible in April, your coverage can go back to January of this year. This is different from SLMB that covers all previous months you were income eligible, and QMB that only covers months after you are eligible.

Annual Review

MDHHS reviews ALMB eligibility every year. This review must happen before the end of the calendar year. MDHHS may contact you as early as September of each year for this review.

Qualified Disabled Working Individuals (QDWI)

This program helps pay for Part A premiums. To be eligible, all of these must be true:

• You get or are eligible to enroll in Medicare Part A based on a disability
• You are under 65
• You are not eligible for Medicaid

The disability that qualifies you for QDWI must meet Social Security standards. You can qualify for QDWI based on your disability or the disability benefits of your child or deceased spouse. To learn more about QDWI, you can speak with someone at MMAP.

Medicare Extra Help Program

A Medicare program called “Extra Help” can help people with limited income and assets pay for their Medicare drug costs. To be eligible, you must join a Medicare drug plan and meet certain income and asset limits. You may be automatically eligible if any of these are true:

• You have full Medicaid coverage
• You get help from Medicaid to pay for your Medicare Part B premiums
• You get Supplemental Security Income (SSI)
• You qualify for QMB, SLMB, or ALMB

To learn more about Extra Help, go to Save on drug costs on the Medicare website.

If you have questions about Extra Help, you can speak with someone at MMAP. You can also contact Medicare for help.

How Do I Apply?

If you want to apply for an MSP through MDHHS, submit an application to MDHHS. The fastest way to apply is online through the MI Bridges Portal. If you apply online, you will have proof of your application. You can also apply in person at your local MDHHS office. Your local MDHHS office has to give you a paper application form if you ask for it. You can also print an application form and fill it out before going to MDHHS.

If you want to apply for Extra Help through Medicare, go to Extra Help With Medicare Prescription Drug Plan Costs page on the Social Security Administration website. You will find application links, phone numbers, and other important information there.

Getting Coverage

If you are approved for an MSP, you will get a letter explaining your coverage. If you have questions about your coverage, you can call member services using the number on your letter. MMAP may also be able to help answer your questions about coverage.

Mistakes in Billing

Understanding what your policies cover is the easiest way to spot mistakes in billing and correct them. If you have questions or concerns about a bill, you can contact MMAP. A lawyer may also be able to help you. Use the Guide to Legal Help to find lawyers in your area.