Covering the Cost of Medicare
If you cannot afford the additional expense of purchasing a Medicare supplement policy to supplement your Medicare coverage, there are a couple of programs you should be aware of. The Medicaid-sponsored Medicare Savings Programs (MSP) may pay Medicare premiums, deductibles, and coinsurance amounts for eligible Medicare beneficiaries. These programs allow you to better direct your savings to cover health care expenses.
Medicaid is a state/federal assistance program that provides health care for people who meet income eligibility requirements. The Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, the Qualified Individuals (QI-1), and the Qualified Disabled Working Individuals (QDWI) are all called Medicare Savings Programs. All MSP income figures include a $20 disregard.
2015 Income/Resource Eligibility Requirements
|Program||Gross Monthly Income Limit*||Countable Resource Limit*|
|Supplemental Security Income (SSI)||$733||$1,000||$2,000||$3,000|
|Long-term care Medicaid||$2,163||$4,326||$2,000||$3,000|
*Note: Income limits changes annually. For more information, visit www.dads.state.tx.us/handbooks/mepd/
Your income must be below the figures shown for SSI and QI-1. Your income can be equal to or less than the figure shown for QMB, SLMB, and long-term care Medicaid. Some income disregards (amounts deducted from your income before eligibility is determined) may apply. QDWI is for disabled working individuals who must not receive other Medicaid services.
The following items do not count toward the resource limit:
- homestead lived in by the applicant or the applicant´s spouse regardless of size or value (an Intent to Return Home, DHS form 1245, will also exclude the homestead)
- vehicle used to get to work or needed to get to medical care (if not, the first $4,500 in value can be excluded)
- household possessions and clothing
- $1,500 face value whole life insurance; burial items already paid for (plot, casket, grave markers).
- SSI: Monthly cash payment for persons who are at least 65 years old or disabled or blind ($1 for every $1 below the income limit) and regular Medicaid
- QMB: Payment of all Medicare premiums, coinsurance, and deductibles the Medicare enrollee would otherwise have to pay
- SLMB: Payment of the Medicare Part B premium
- QI-1: Payment of the Medicare Part B premium
- QDWI: Payment of the Medicare Part A premiums
- Long-term care Medicaid: Nursing home or community-based (in-home) nursing care and related services.
Where to Apply
For an SSI application, call the Social Security Administration
For all other programs, call the Texas Health and Human Services Commission
For more information or assistance, call your local Area Agency on Aging
Where to Go for Additional Information
The Texas Department of Insurance (TDI), the Texas Department of Aging and Disability Services (DADS), the Texas Legal Services Center, and local Area Agencies on Aging are partners in the Texas Health Information, Counseling and Advocacy Program (HICAP). HICAP is part of a nationwide network of state Health Insurance Assistance Programs.
To learn more about Medigap plans, call TDI's Consumer Help Line or visit the website
To get free one-on-one counseling in your community from a benefits counselor familiar with programs in your area, contact the DADS Benefits Counseling Program or visit the website
For information about your legal rights and public assistance programs, call the Legal Hotline for Texans or visit the website
For more information contact:
Last updated: 05/05/2015