If your clients have limited income and resources, they may qualify for programs that significantly reduce their Medicare-related expenses. These are known as Medicare Savings Programs (MSPs) and are tied to the Low-Income Subsidy (LIS) structure.
Let’s break down the four key MSPs and what each one covers.
What Are Medicare Savings Programs (MSPs)?
MSPs are state-run programs that help individuals pay for certain Medicare costs. These may include premiums, deductibles, coinsurance, and copayments. Clients who qualify are often automatically enrolled in Extra Help, which assists with prescription drug costs.
MSP Breakdown: What Does Each Program Cover?
🟢 Qualified Medicare Beneficiary (QMB) – Full Dual Eligible
- Covers: Medicare Part A & Part B premiums, deductibles, coinsurance, and copayments.
- Important Note: If enrolled, clients should not be billed for Medicare-covered services by participating providers.
- ✅ Best coverage level – protects the client from almost all out-of-pocket Medicare costs.
🔵 Specified Low-Income Medicare Beneficiary (SLMB) – Partial Dual
- Covers: Medicare Part B premium only.
- Helpful for reducing monthly Medicare costs but does not cover copayments or deductibles.
🟠 Qualifying Individual (QI) – Partial Dual, First-Come First-Served
- Covers: Medicare Part B premium.
- Similar to SLMB but funding is limited, so it’s awarded on a first-come, first-served basis.
- Ideal for clients who are just over the SLMB income threshold but still need assistance.
🔴 Qualified Disabled and Working Individuals (QDWI)
- Covers: Medicare Part A premium.
- Designed for individuals under 65 who lost premium-free Part A due to returning to work after qualifying for disability.
- Offers essential coverage to help maintain access to Medicare after rejoining the workforce.
Key Tip for Agents
Only QMB qualifies as a full dual eligible level—meaning the client gets maximum financial protection. The other three are partial duals, helping with specific costs.
Agents can verify eligibility by:
- Using a carrier portal with the client’s Medicare number.
- Contacting the carrier directly.
- Referring clients to their state Medicaid office for application assistance.
Talking Points for Clients
“Based on your income and assets, you may qualify for help paying your Medicare premiums—and in some cases, more. These programs aren’t well-known, but they can save you hundreds of dollars every year.”
Final Thought
Understanding LIS levels helps you offer better guidance and better options. For clients facing cost barriers, these programs can mean the difference between going without care—and getting what they need.
📞 Want help identifying which of your clients might qualify for LIS or MSP programs?
Contact National Insurance Markets—we’re here to help you serve your book better.
