The QI Medicare savings program helps those on a low income to pay for their Medicare Part B monthly premiums.
The Qualifying Individual or QI program is a Medicare savings program (MSP). Medicare provides four savings programs with different income and resource limits.
To receive the program benefits, a person must meet financial criteria and reapply annually.
This article explores the QI Medicare savings program, eligibility, income limits, and how to apply.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The government provides help for individuals to pay their Medicare premiums and, sometimes, the cost-sharing expenses.
To qualify, a person must meet certain conditions. Employed individuals may apply if their income is within specified limits.
Four kinds of MSPs exist:
- Qualified Medicare Beneficiary (QMB) program
- Specified Low-Income Medicare Beneficiary (SLMB) program
- Qualifying Individual (QI) program
- Qualified Disabled and Working Individuals (QDWI) program
Different income limits apply to each of the savings programs, and a person can contact their state Medicaid office to see if they qualify.
If an individual qualifies for the QMB, SLMB, or QI program, they can also get help to pay for their prescription drug coverage through the Extra Help program.
The Qualifying Individual (QI) program is the third level of MSPs. If an individual does not qualify for QMB or SLMB programs, they should consider the QI program.
The QI program covers Part B premiums only. However, most people do not pay a premium for Part A.
A person must reapply each year to continue receiving MSP benefits.
The programs do not have unlimited funding, and priority goes to the people who received QI benefits the previous year.
To receive QI benefits, people must have Part A or be eligible and have income and resources below a specified limit.
The eligibility requirements can differ between states and from year to year.
When the Medicaid agency looks at someone’s application for a QI program, they consider the following resources:
- checking and savings accounts
- mutual funds
- Individual Retirement Accounts (IRAs)
These resources must total less than $7,860 in 2020 if a person is single, or $11,800 in 2020 if a person is married. However, the resource limits are based on the federal poverty level (FPL) and they may change for 2021, and affect the limits.
Some resources do not count, including:
- primary home and car
- burial plot and expenses of up to $1,500
- furniture and household items
- personal items
Medicaid agencies use the Federal Poverty Level (FPL) to calculate the QI program’s income limits.
Qualifying individuals can have an income of 120-135% FPL.
The calculations can differ according to the state. Alaska and Hawaii have higher limits than the rest of the USA.
To enroll in the QI program, an individual must meet the monthly income limits. In most states, this includes a $20 general income disregard.
For a single person, the limit is $1,456 per month.
For a married couple, the combined income must be less than $1,960 per month.
Some states have different qualifying limits:
In Alaska, the single person limit is $1,815, or $2,445 for a married couple.
In Hawaii, the single person limit is $1,672 or $2,251 for a married couple.
Exceptions to the general income disregard include:
- Maine ($75)
- Mississippi ($50)
- Illinois ($25)
The QI Medicare savings program provides two significant benefits.
Decreased Medicare costs
In 2021, the Part B premium costs $148.50 per month. Because the QI program covers this cost, a person can save $1,782 annually.
Automatic Extra Help
When someone qualifies for the QI Medicare savings program, they can receive the Medicare Part D low-income subsidy.
Also known as Extra Help, the program provides financial assistance for prescription drugs.
The Social Security Administration values savings for the average person through the Extra Help program at around $5,000 per year.
If someone does not already have a Part D plan, they can enroll with no late enrollment penalty once they qualify for Extra Help.
An individual cannot have Medicaid and a QI plan at the same time. Although the Medicaid agency administers both types of programs, there are differences between them.
Medicaid pays for a range of healthcare services for those with low income and resources, not just the monthly premium.
Each state offers Medicaid programs with varying eligibility criteria and benefits.
For example, in New York, to qualify for the QI program, an individual cannot exceed a gross monthly income of $1,456. For a person to be eligible for Medicaid, the total monthly income limit is $895.
A person may find help to pay for medical expenses through the following resources:
Medicare Plan Finder
The government Medicare Plan Finder tool is a database of available coverage and benefits.
Individuals answer questions to find out the benefit options they have, and which Medicare plans they may like to consider.
The State Health Insurance Assistance Program (SHIP)
This government-funded service provides free advice from volunteers who understand Medicare.
People can ask questions and receive personalized information about saving on their Medicare costs.
The SHIP website provides online help and details of local offices.
The Medicare QI savings program helps those with a lower income to pay their Part B premiums.
People who qualify can also receive Extra Help, which assists with prescription drug costs.
If a person believes they may qualify, they should contact their state Medicaid agency to apply.