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SHINE: Serving the Health Insurance Needs of Everyone

Medicare Buy-In programs help save money

Lorraine York EdbergLorraine York-Edberg, Western Mass. Regional SHINE Program Director

Medicare Buy-In programs, also called Medicare Savings Programs, can assist low-income Medicare beneficiaries pay their share of the standard Medicare Part B premium, which is currently $134 monthly. Medicare Beneficiaries may be eligible for different buy-in programs based on their income. The three programs are called QMB (Qualified Medicare Beneficiary), SLMB (Specified Low Income Medicare Beneficiary), and QI-1 (Qualified Individuals).

Eligibility guidelines for these programs are as follows:

  • QMB is at 100% Federal Poverty Level as follows for an:
    • Individual: $1,025 monthly and less than $7,390 in assets
    • Couple: $1,374 monthly and less than $11,090 in assets
  • SLMB is at 120 % Federal Poverty Level as follows for an:
    • Individual $1,226: monthly and less than $7,390 in assets
    • Couple $1,644: monthly and less than $11,090 in assets
  • QI-1 is at 135% federal Poverty Level as follows for an:
    • Individual: $1,377 monthly and less than $7,390 in assets
    • Couple: $1,847 monthly and less than $11,090 in assets

These programs are not subject to estate recovery since January of 2010, so the state will NOT place a lien on your property to recover benefits following your death.

AND BETTER STILL…

If you qualify for any of the three Medicare Savings programs, you will also automatically qualify for a full subsidy under the Medicare Part D Low Income Subsidy (LIS), which is also known as "Extra Help." This program will pay the monthly premiums for your Part D plan, provided you are enrolled in a qualified plan. The LIS will also assist with covering drugs during the Part D deductible and coverage gap.

If you are eligible as a QMB, this program will pay for your Part A (Hospital insurance) deductible and Part B annual deductible of $183 annually. The 2017 Part B standard premium is currently $134 monthly and the hospital deductible is $1316 for each hospitalization.

If you are eligible as a SLMB or QI-1, this program will pay for your Part B (Medical insurance) premium.

To apply, it is an easy, one-page application and simple to fill out. To get this application, you can contact MassHealth at 1-800-841-2900 and request the Medicare Buy-In application, which they can send to you. We also have applications available here at the regional SHINE office upon request. If you need assistance filling it out, we are happy to help.

The SHINE program, (Serving the Health Information Needs of Everyone…on Medicare), provides free, confidential, and unbiased health insurance counseling for Medicare beneficiaries. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555 or contact your local council on aging.