The Specified Low-Income Medicare Beneficiary (SLMB) program helps people with Medicare Part A pay for their Medicare Part B monthly premiums or out-of-pocket costs.
A person is eligible for SLMB if they have income and resources that fall below certain limits. While most states have the same income and resource criteria, there are a few exceptions.
This article discusses the eligibility requirements of the SLMB program. Then, it discusses the other three programs that help people pay their Medicare costs, lists the states with different income and resource limits, and describes how to apply for a program.
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 SLMB is a state rather than a federal program. Its purpose is to help someone pay their Medicare Part B premiums if they meet certain conditions.
One requirement is enrollment in Part A.
The other requirements involve a person’s income and resources. Income limits in most states are as follows: An individual’s monthly income falls under $1,296, or a married couple’s monthly income falls under $1,744.
In addition, a person must have limited countable resources, which include:
- money in a savings or checking account
Countable resources do not include:
- burial plot
- life insurance with a value of less than $1,500
- other household items
Some people with original Medicare buy Medicare supplement insurance called Medigap to help with uncovered costs. However, not everyone can afford Medigap premiums.
To help people with a low income to pay Medicare costs, states offer the SLMB program plus three additional MSPs:
- Qualified Medicare Beneficiary (QMB) program, which helps with Part A and Part B premiums, as well as deductibles, copayments, coinsurance, and prescription drugs
- Qualified Individual (QI) program, which helps with Part B premiums
- Qualified Disabled and Working Individuals (QDWI) programs, which help with Part A premiums
The chart below shows the income and resources limits of each of the three programs, plus SLMB.
|Individual income limits||Married couple income limits||Individual resource limits||Married couple income limits|
Qualified Medicare Beneficiary program
The QMB program helps pay for Medicare Part A and Part B premiums. In addition, it does not permit Medicare to bill a person for deductibles, copayments, and coinsurance if the expenses are associated with covered services and items.
Also, the program does not allow pharmacies to charge more than $3.90 for a prescription that Part D covers. Part D is the Medicare plan that provides prescription drug coverage.
Qualified Individual program
The QI program helps people pay Medicare Part B premiums if they have Medicare Part A, and their income and resources meet the requirements. A person must apply every year for the benefits. When approving applications, Medicare gives priority to someone who had QI the previous year.
Qualified Disabled and Working Individuals program
The QDWI program helps pay Medicare Part A monthly premiums. Someone may qualify if any of the following conditions apply:
- They are a working disabled person under the age of 65.
- They are not getting medical assistance from their state.
- They lost their premium-free Part A when they returned to work.
- They meet their state’s income and resource limits.
Some states vary the income and resources limits.
States with higher income limits include Hawaii, Alaska, District of Columbia (DC), and Connecticut.
States that do not have resource limits include Maine, Arizona, Alabama, Mississippi, Connecticut, New York, Delaware, DC, and Vermont.
To apply for any MSPs, a person can visit this website and click on their state.
Other than having income and resources that fall under the limits of the programs, having Medicare Part A is the eligibility requirement for all four programs. This means that someone with the alternative to original Medicare, which is an Advantage plan, is not eligible.
If someone’s income seems higher than the limits, they should still apply because not all states consider the following items in their calculations:
Also, states don’t count the first $20 of a person’s monthly income. According to the Kaiser Family Foundation, three states differ in this calculation, with the difference being as shown: the first $25 in Illinois, the first $50 in Mississippi, and the first $75 in Maine.
The SLMP program helps people with low income pay Medicare Part B monthly premiums. There are three other state MSPs that help individuals with Medicare costs.
The income requirements for each program are generally consistent across the country. However, some states have higher income limits, and some states do not have resource limits.
With this in mind, a person may wish to apply to the programs even if they believe their income and resources are too high to qualify for any of the programs.