Medicare Savings Programs are available to those who qualify. One of these is the QDWI program that helps pay the Medicare Part A premiums.
A working person under age 65 with a disability may not be able to afford all of their healthcare costs.
To help, Medicare offers the Qualified Disabled and Working Individuals (QDWI) program, which pays Part A premiums.
Eligibility for QDWI depends on someone’s income and resources.
The QDWI program is one of four Medicare Savings Programs that help qualifying individuals pay out-of-pocket healthcare costs.
This article introduces Medicare Savings Programs and describes QDWI. Then, it discusses how QDWI relates to each part of Medicare, how it compares to other Medicare Savings Programs, and how to apply.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
While Medicare provides extensive help with healthcare costs, it does not offer 100% coverage.
Out-of-pocket costs include premiums, deductibles, copayments, and coinsurance.
Because these costs can build up, someone with a low income may have trouble paying them.
The four Medicare Savings Programs can help. They include:
- Qualified Medicare Beneficiary (QMB) program
- Specified Low-Income Medicare Beneficiary (SLMB) program
- Qualifying Individual (QI) program
- Qualified Disabled and Working Individuals (QDWI) program
Each program receives money from the federal government for funding, but individual states administer them.
The QDWI program helps pay Part A premiums.
A person may qualify if:
- they are a working individual under age 65 with a disability
- they are not receiving help with medical costs from their state
- they lost their premium-free Part A when they returned to work
- they meet their state’s income and resource limit requirements
Income and resource limits
The 2020 monthly income limit for an individual is $4,339.
The 2020 monthly income limit for a married couple is $5,833.
Aside from limits on income, QDWI also puts limits on countable and uncountable resources.
Countable resources include:
- bonds
- stocks
- money in a savings or checking account
Uncountable resources include:
- one car
- a person’s home
- furniture and other household items
- burial plot
- up to $1,500 earmarked for burial expenses
Medicare offers many parts that provide coverage of different healthcare costs. Below is how QDWI relates to each part.
Original Medicare
One component of original Medicare is Part A, hospital insurance.
Part A covers inpatient care in a hospital, as well as hospice care, home health care, and short-term skilled nursing care.
If a person is not eligible for premium-free Part A, in 2021, the cost is between $259 and $471 per month. This is the only Medicare expense that QDWI helps pay.
The other component of original Medicare is Part B, medical insurance.
Part B covers doctor visits, lab tests, medical equipment, and other outpatient healthcare services. Out-of-pocket costs include a monthly premium, annual deductible, and coinsurance.
The QDWI program does not help with these expenses.
Medicare Advantage
Part C, or Medicare Advantage, is the alternative to original Medicare. It provides all the coverage of parts A and B.
A person with Medicare Advantage pays the monthly Part B premium, along with the premiums, deductibles, copayments, and coinsurance of their plan. However, they do not pay the monthly Part A premium, so QDWI does not work with Part C.
Part D
Part D is prescription drug coverage that a person with original Medicare may buy.
Like Part C, out-of-pocket costs associated with Part D plans include premiums, deductibles, copayments, and coinsurance. The QDWI program does not help with these costs.
Medigap
Medigap is Medicare supplement insurance that helps pay parts A and B out-of-pocket costs.
The only Medigap cost is the monthly premiums, and QDWI does not help with this expense.
Medicare Savings Programs differ in their eligibility requirements. The QDWI program is the only one that can help a working person with a disability.
Eligibility requirements of the other three programs involve only income and resource limits.
The programs also vary in the costs they pay. Of the four, the Qualified Medicare Beneficiary program is the one that offers the most extensive help, as it covers virtually all of a person’s parts A and B costs.
The Specified Low-Income Beneficiary and the Qualified Individual programs cover only Part B premiums.
To qualify for QDWI, a person must have income and resources that fall under the program limits. However, some states figure the limits differently.
In addition, the limits may increase each year, so if someone’s income and resources are slightly higher, they may still apply.
An alternative method of application is by calling Medicare at 800-633-4227.
After Medicare approves a person’s application, they will need to renew their enrollment every year because their circumstances are subject to change.
If someone does not receive a renewal notice in the mail, they can contact the local Medicaid office to find out what to do.
A working person under age 65 with a disability may qualify for QDWI if their income and resources fall below the required limits.
The program helps pay Part A monthly premiums, but it does not help with Part B or other Medicare costs.
The QDWI program is an option for people with original Medicare but not those with a Medicare Advantage plan.