Medicaid/Extra Help/Medicare Savings
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MEDICARE SAVINGS (BUY-IN) PROGRAM
The Medicare Savings/Buy-In Programs help Medicare beneficiaries with limited income and resources pay their Medicare costs. There are 3 programs—the Qualified Medicare Beneficiary (QMB) program, the Specified Low-income Medicare Beneficiary (SLMB) program, and the Qualifying Individual-1 (QI-1) program.
Who is eligible for the Medicare Savings Programs?
Those who receive Medicare Part A Hospital Insurance and have limited income and resources.
What is Qualified Medicare Beneficiary (QMB)?
QMB can pay for:
- Monthly Medicare Part B Medical Premium ($96.40 for 2009)
- Annual Medicare Part B Medical Deductible ($135 for 2009)
- Monthly Medicare Part A Hospital Premium ($443 for less than 30 quarters *if beneficiary does not received Part A free of charge due to work history*)
- Coinsurance costs - the 20% of approved charges for doctor’s services that Medicare does not pay
What is Specified Low-income Medicare Beneficiary (SLMB)?
If a beneficiary’s income is too high to qualify for QMB, SLMB can pay the monthly Medicare Part B Medical premium ($96.40 for 2009).
What is Qualifying Individual-1 (QI-1)?
If a beneficiary’s income is too high for SLMB, QI-1 can pay the monthly Medicare Part B Medical premium ($96.40 for 2009). *There are limited funds available for this program. Applications are approved on a first-come, first served basis*
Income & Resource Limits:
2009 Poverty Guidelines |
QMB |
SLMB |
QI-1 |
Federal Poverty Level (FPL) |
100% + $20* |
120% + $20* |
135% +$20* |
Individual: |
$1,148.00 |
$1,373.00 |
$1,543.00 |
Couple: |
$1,538.00 |
$1,841.00 |
$2,069.00 |
*$20 = amount of the monthly SSI income disregard*
Resources: $4,000—Individual; $6,000—Married Couple
Where do I apply for the Medicare Savings (Buy-In) Program?
The beneficiary should contact their local Division of Public Assistance (DPA) office at toll free 1-800-478-3537 and submit a standard Medicaid application.
Public Assistance Offices Contact List: http://hss.state.ak.us/dpa/features/org/dpado.htm
Printable Medicaid Application: http://www.hss.state.ak.us/dpa/forms/gen50b-packet.pdf
LOW-INCOME SUBSIDY (LIS) OR “EXTRA HELP” PROGRAM
A federal program that helps Medicare beneficiaries with the Medicare prescription drug plan costs.
Medicare beneficiaries who qualify for LIS get the following:
- Help paying the Medicare drug plan’s monthly premium
- Help paying the Medicare drug plan’s yearly deductible (if applicable)
- Help paying coinsurance and copayments for prescription drugs that are covered by the plan
- No coverage gap (also known as the “donut hole”)
What are the Income and Resource Limits for LIS?
LIS is based on the Federal Poverty Guidelines (FPL). To qualify, a Medicare beneficiary must be at or below 150% FPL. See the chart below for 2009 annual and monthly guidelines:
2009 Annual Guidelines (Alaska Only) * add $4,680 for each additional member
Family Size |
100% FPL |
120% FPL |
135% FPL |
150% FPL |
1 |
$13,530.00 |
$16,236.00 |
$18,265.50 |
$20,295.00 |
2 |
$18,210.00 |
$21,852.00 |
$24,583.50 |
$27,315.00 |
3 |
$22,890.00 |
$27,468.00 |
$30,901.50 |
$34,335.00 |
*Indicates maximum income to qualify for LIS*
2009 Monthly Guidelines (Alaska Only)
Family Size |
100% FPL |
120% FPL |
135% FPL |
150% FPL |
1 |
$1,127.50 |
$1,353.00 |
$1,522.13 |
$1,691.25 |
2 |
$1,517.50 |
$1,821.00 |
$2,048.63 |
$2,276.25 |
3 |
$1,907.50 |
$2,289.00 |
$2,575,13 |
$2,861.25 |
*Indicates maximum income to qualify for LIS*
2009 Resource Guidelines (Does not include your home, vehicles, personal possessions, burial plots)
Individual $12,510 Married Couple $25,010
Some People Automatically Qualify for LIS. They are:
- Those who have Medicare and full Medicaid coverage (also known as “dual-eligibles”).
- Those who get help from the state Medicaid program with paying Medicare premiums (belong to the Medicare Savings or “Buy-in” program).
- Those who get Supplemental Security Income (SSI) benefits
How do I apply for LIS or “extra help”?
- The fastest way is online: https://secure.ssa.gov/apps6z/i1020/main.html. You will get a letter within a month.
- You can also contact Social Security to complete an application by calling 1-800-772-1213 (Monday through Friday, from 7 a.m. to 7 p.m.).
- Contact us for assistance with MEDICARE in Alaska 1-800-478-6065 or in Anchorage
269-3669
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