Medicare Savings Program
Alabama has different programs for low-income individuals or couples who qualify for Medicare. The services you get depend on how much income you have. These programs pay Medicare premiums and, in some cases, Medicare deductibles and coinsurance.
To be eligible for the Medicare Savings Program, you must:
- Be eligible for Medicare Part A (Hospital Insurance)
- Be living in Alabama,
- Be a U.S. citizen, or
- Be in satisfactory immigration status (You must provide proof of immigrant status), and
- Have a monthly income below a certain limit.
Your Member Service Representative can help you navigate this process. Find your Member Support Representative by clicking the button below.
Medicare Savings Programs
The Qualified Medicare Beneficiary (QMB) Program
Under the QMB Program, Medicaid:
- Pays the Medicare Part B premium, which is $174.70 per month;
- Covers the Medicare deductible, which is $1,632 for the hospital and $240 for doctor and medical visits, when you use a provider who accepts Medicaid;
- Pays the Medicare Part A premium when certain conditions are met. (If you do not have free Part A, you must apply for Conditional Part A at the local Social Security Office between January and March or the month before, after, or on your 65th birthday. Once the Social Security Office establishes your Part A entitlement, they will notify Medicaid to pay your Part A premium. If you receive a bill that states, “You must pay the amount due or your Medicare will terminate,” you will need to call (334) 242-5257 or (334) 242-5268; and
- Makes agreements with providers who accept Medicaid, so you won’t have to pay the Medicare coinsurance, which is the 20 percent that you normally pay after Medicare pays its Part.
QMB Income Limits:
- $1,275.00 per month (gross) for individuals who are single, widowed, divorced, or separated, or
- $1,724.00 per month (gross) for a couple
Specified Low Income Medicare Beneficiary (SLMB) Program
Under the Specified Low-Income Medicare Beneficiary (SLMB) program, Medicaid only pays the Medicare Part B premium, which is $174.70 per month.
You will not receive a Medicaid card for the SLMB Program. Coverage may begin up to three months before the application month if you meet the requirements.
SLMB Income Limits:
- $1,275.01 -$1,526.00 per month (gross) for individuals who are single, widowed, divorced, or separated, or
- $1,724.01 -$2,064.00 per month (gross) for a couple
Qualified lndividual-1 (Ql-1) Program
Under the Qualifying Individual-1 (Ql-1) program, Medicaid only pays the Medicare Part B premium, which is $174.70 per month.
You will not receive a Medicaid card for the Ql-1 Program. Coverage may begin up to three months before the application month if you meet the requirements.
QI-1 Income Limits:
- $1,526.01 -$1,715.00 per month (gross) for individuals who are single, widowed, divorced, or separated, or
- $2,064.01 -$2,320.00 per month (gross) for a couple
Visit the Alabama Medicaid Medicare Savings Program website for the most accurate information on qualifications, applications, and income limits.
FAQs
1. How do I apply for the Medicare Savings Programs?
Complete Form 211 and mail it to the District Office that serves the county where you live. A listing of the District Offices is on the last page of the application.
Applications are available at your Complete Health clinic or by calling 1-800-362-1504 and following the prompts to request a Medicare Savings Programs application. You will be asked to leave your name, mailing address, and your Social Security number. An application will be mailed to you shortly,
OR
Go to www.Medicaid.Alabama.gov. click on “Apply for Medicaid,” “Applications and Forms,” and “Form 211 (Medicare Savings Programs),” then download and print the application.
2. What happens to the application once it reaches the District Office?
Your application will be assigned to a caseworker who will review the information provided. You will be contacted by mail or phone if they have any questions. Please follow the instructions listed on page 1 of the application to avoid delays in processing your application. You will be notified by mail of the status (approval or denial) of your application.
3. How is Medicare Part D affected if I am approved for a Medicare Savings Program?
If you are awarded a Medicare Savings Program, you automatically qualify for “extra help” in paying your Medicare Part D (drug) premiums and deductibles. You may only have to pay a small co-pay for each drug; however, you must choose a Medicare Part D drug plan. If you need help in choosing a drug plan, please call 1-800-633-4227. If you are eligible for Medicare Part A or Part B, Medicaid will not pay for any drugs covered under Medicare Part D. In addition, Medicaid will not pay for any drugs excluded from Medicare Part D coverage, unless you also qualify for full Medicaid benefits.
4. Once I am approved for one of the Medicare Savings Programs, what type of changes am I responsible for reporting to Medicaid?
- Call 1-800-362-1504 to report changes in your address, marital status, or your sponsor’s address.
- Call your caseworker to report changes in your income, if you start or stop paying health insurance premiums, if your check amount increases or decreases, or when you begin receiving a check from another source not already reported.
To find out your caseworker’s name and phone number, call 1-800-362-1504.
5. How long does Social Security take to stop taking the Part B premium out of my check?
Social Security will take two months to stop taking the Part B premium out of your check. Once the premium is stopped, you will get a refund of all the premiums taken out of your check for the months you were deemed eligible for a Medicare Savings Program. If your check is direct deposit, your refund will also be direct deposit. If after two months from the month you were awarded for a Medicare Savings Program, Social Security continues to take out the Part B premium from your check, please contact the Medicaid Agency’s Buy-In Unit at (334) 242-5268.
Source: Alabama Medicaid Agency www.medicaid.alabama.gov, Medicaid Eligibility Handout (01/23) Form210