Virginia Medicare Savings Program
Medicare and Medicaid are both healthcare coverage programs with similar names, but they are different programs in terms of eligibility and how the programs are run. Medicare is a national health insurance program for people age 65 years and older and individuals with a disability. Eligibility for Medicare is based on the person’s age or disability status and their work history on record with the Social Security Administration. Eligibility for Medicare is not based on the person’s income or assets.
Medicaid is a medical assistance program jointly administered by the Federal and state governments. Each state operates its own Medicaid program. Eligibility for Medicaid is based on a person’s income and assets (usually referred to as resources for Medicaid purposes). People with Medicare can also be eligible for Medicaid. These people are known as “dual beneficiaries.” Medicare is always the primary coverage for dual beneficiaries. Medicaid works in conjunction with Medicare and a person’s Medicare supplement, if they have one, to help cover leftover expenses.
There are different levels of Medicaid coverage available for dual beneficiaries, according to the person’s income and resources. In Virginia, a person with countable income of no more than 80% of the Federal poverty level and countable resources of no more than $2,000 for an individual or $3,000 for a couple can be eligible for full Medicaid coverage. In 2022, the income limits are $906 per month for an individual and $1,221 per month for a couple. For these people, Medicaid covers some medical expenses that Medicare does not cover as well as the person’s monthly Medicare Part B premiums, their Medicare deductibles, and Medicare copayments.
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
Qualified Medicare Beneficiary (QMB) Program The QMB program covers monthly Medicare Part A premiums (if the person has to pay for Medicare Part A), Medicare Part B premiums, and deductibles, coinsurance, and copayments for services and items Medicare covers. In some cases, you may be billed a small copayment through Medicaid, if one applies.
QMB Income Limits:
- $1,133.00 per month (gross) for individuals with a resource limit of $8,400
- $1,526.00 per month (gross) for a couple with a resource limit of $12,600
Specified Low Income Medicare Beneficiary (SLMB) Program
The SLMB Program pays the person’s monthly Medicare Part B premiums only.
SLMB Income Limits:
- $1,359.00 per month (gross) for individuals with a resource limit of $8,400
- $1,831.00 per month (gross) for a couple with a resource limit of $12,600
Qualified lndividual-1 (Ql-1) Program
The QI Program pays the person’s monthly Medicare Part B premiums only.
QI-1 Income Limits:
- $1,529.00 per month (gross) for individuals with a resource limit of $8,400
- $2,060.00 per month (gross) for a couple with a resource limit of $12,600
Qualified Disabled and Working Individuals (QDWI) Program
- The person has a disability
- The person is working.
- The person lost their Social Security disability benefits and premium-free Part A because they returned to work.
Qualified Disabled and Working Individuals (QDWI) Income Limits:
- $2,265.00 per month (gross) for individuals with a resource limit of $4,000
- $3,005.00 per month (gross) for a couple with a resource limit of $6,000
Visit the Virginia Medicaid Medicare Savings Program website for the most accurate information on qualifications, applications, and income limits.
FAQs
How do I apply for the Medicare Savings Programs?
If you answer yes to these 3 questions, call Cover Virginia toll free at 1-855-242-8282 to see if you qualify for a Medicare Savings Program:
- Do you have, or are you eligible for, Part A?
- Is your income for 2021 at, or below, the income limits listed for any of the programs above?
- Do you have limited resources, below the limits above?
What items are included in the Medicare Savings Program resource limits
Countable resources include:
- Money in a checking or savings account
- Stocks
- Bonds
Countable Resources don’t include:
- Your home
- One Car
- Burial plot
- For QMB, SLMB and QI, up to $3,500 for burial expenses if you have put that money aside. For QDWI, the burial set-aside amount is $1,500
- Furniture
- Other household and personal items
You can also visit Cover Virginia at https://coverva.org for information about how to apply online or at your local department of social services. This fact sheet is based on information available on Medicare.gov.