Revision 21-1; Effective March 1, 2021
This chapter describes the Medicare Savings Programs. The Medicare Savings Programs use Medicaid funds to help eligible persons pay for all or some of their out-of-pocket Medicare expenses, such as premiums, deductibles or coinsurance.
HHSC manages the Medicare Savings Programs, which consists of the following:
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individual (QDWI) Program
Countable resource limits for Medicare Savings Programs (except QDWI) are updated annually based on the Consumer Price Index. QDWI requires a person to have countable resources equal to or less than twice the limits for the SSI program to be eligible based on resources. The treatment of income and resources is based on policy in Chapter E, General Income, and Chapter F, Resources. Application and redetermination policies for Medicare Savings Programs adhere to policy and procedure in Chapter B, Applications and Redeterminations. Transfer of assets, spousal impoverishment and co-payment policy and procedures are not used in the Medicare Savings Programs.
All Medicare Savings Programs require a person to meet non-financial eligibility requirements described in Chapter D, Non-Financial.
A person is not eligible for MSP coverage if they:
- are in the custody of penal authorities; or
- are over age 20 and under age 65 and lives in an institution for mental diseases (IMD).