SHINE: Serving the Health Insurance Needs of Everyone

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Written by Lorraine York-Edberg, Western Mass Regional SHINE Program Director

Published: May 4, 2018

Medicare Buy-In Programs help save money

Lorraine York EdbergMedicare 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 and assets. 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 $1,032 monthly and less than $7,560 in assets
  • Couple $1,392 monthly and less than $11,340 in assets

• SLMB is at 120 % Federal Poverty Level as follows for an:
  • Individual $1,234 monthly and less than $7,560 in assets
  • Couple $1,666 monthly and less than $11,340 in assets

• QI-1 is at 135% federal Poverty Level as follows for an:
  • Individual $1,386 monthly and less than $7,560 in assets
  • Couple $1,872 monthly and less than $11,340 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 Qualified Medicare Beneficiary (QMB), this program will pay for your Part A (Hospital insurance) deductible and Part B deductible of $183 annually. The 2018 Part B standard premium is currently $134 monthly and the hospital deductible is $1340 for each hospitalization.

If you are eligible as a Specified Low Income Medicare Beneficiary (SLMB) or the Qualified Individual Medicare Beneficiary (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, and they can send it 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 assist.

The SHINE (Serving Health Insurance Needs of Everyone…on Medicare) Program 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.