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Programs that help low-income people afford their Medicare, including the Medicare Savings Programs and the Part D Low Income Subsidy (also called LIS or Extra Help) have income and resource eligibility guidelines that change yearly.

The Federal poverty level (FPL) guidelines for 2014 were published in the Federal Register on January 22, 2014.[1]  These guidelines provide the baseline for income eligibility levels for the Part D Low Income Subsidy and the Medicare Savings Program.[2]

Additionally, CMS issues updated resource limits for the Low Income Subsidy each year.  On November 6, 2013 CMS released guidance on 2014 Resource limits for the Part D Low-Income Subsidy.[3]  Pursuant to the Medicare Improvements for Patients and Providers Act (MIPPA) of 2010, Medicare Savings Program resource limits are aligned with resource limits for LIS.

With the publication of the 2014 Federal Poverty Level, we now have a complete picture of the income and resource levels for Medicare low-income programs in 2014.

The Medicare Savings Program Income and Asset Guidelines

1. Qualified Medicare Beneficiaries (QMBs)

States must pay all Medicare cost-sharing for Medicare beneficiaries with incomes up to 100% FPL and resources below $7,160 ($10,750 if married) in 2014.  A beneficiary must have income below $972.50/month ($11,670/year) for an individual; $1,310.83/month ($15,730/year) for a couple to qualify for the benefit in 2014.

2. Specified Low-Income Medicare Beneficiaries (SLMBs)

States must pay the Medicare Part B premium for Medicare beneficiaries with incomes between 100% FPL and 120% FPL and resources below $7,160 ($10,750 if married). The income limit for this group is $1,167 /month ($14,004/year) for an individual; $1,573/month ($18,876/year) for a couple in 2014.

3. Qualified Individual (QI)

States have a limited amount of money from which they must pay, on a first come, first served basis, the Medicare Part B premium for Medicare beneficiaries with incomes between 120% FPL and 135%FPL and resources below $7,160 ($10,750 if married).  The income limit for this group is $1,312.88/month ($15,754.50/year) for an individual; $1,769.63/month ($21,235.50/year) for a couple in 2014.

4. Qualified Disabled and Working Individual (QDWI):

States must pay the Medicare Part A premium for certain working disabled Medicare beneficiaries who have exhausted their entitlement to premium-free Part A benefits and whose incomes do not exceed 200% FPL and resources are below $4,000 for an individual ($6,000 for a couple).  The limit for this group is $1,945/month ($23,340/year) for an individual; $2,621.67/month ($31,460/year) for a couple.

5. $20 Income Disregard

Add $20 to each of the monthly amounts listed above for the Medicare Savings Programs to determine the actual eligibility limit, since applicants are allowed a $20 "disregard" from any income before their income is measured against the poverty levels.  Couples only get one $20 disregard.  The $20 disregard applies nationally, but states also have the option of increasing the disregard, which has the effect of increasing the eligibility ceiling and, thus, making more people eligible for benefits. [4] Check with your State Medicaid Agency for details on your state's specific policy.

6. A Note About Resource Levels

States have the option to raise or eliminate resource levels for the Medicare Savings Program and several have exercised this option.[5] The resource levels listed above provide the federal floor; no state may choose to have a more restrictive resource level than those listed.

The Part D Low-Income Subsidy

Full Subsidy:  Medicare Part D provides a full drug subsidy with low co-payments to Medicare beneficiaries with incomes up to 135% FPL and resources below $8,660 ($13,750 if married).  For those individuals, the 2014 eligibility limit is $1,312.88/month ($15,754.56 per year) for an individual; $1,769.63/month ($21,235.50/year) for a couple.

Partial Subsidy: Medicare Part D provides a partial subsidy of premium, deductible and co-insurance to Medicare beneficiaries with incomes up to 150% FPL and resources below $13,440 ($26, 860 if married). The income limit for this group is $1,458.75/month ($17,505/year) for an individual; $1,966.25/month ($23,595/year) for a couple.

As with the MSP monthly amounts, applicants should add $20 to account for the income disregard.

It should be noted that while MIPPA required MSP resource levels be aligned with full LIS resource levels, the LIS program allows for an automatic $1,500 burial fund allotment. In practice, this raises the LIS resource levels $1,500 high than MSP resource levels. The resource levels detailed above includes this $1,500 disregard.

Conclusion

For more information on important Medicare low-income programs or to apply, visit:


[1] 79 FR 359345 (January 22, 2014), available at http://www.gpo.gov/fdsys/pkg/FR-2014-01-22/html/2014-01303.htm
[2] The published poverty levels merely state a dollar figure for different-sized family units.  They do not address issues of what income is included, what deductions from income are allowed, who is included in a family unit or other use issues.  These questions are addressed by the individual programs relying on the poverty guidelines.  The amounts given below apply to the 48 contiguous states and Washington, DC.  Rates for Alaska and Hawaii are slightly higher.  A complete list of FPLs is available at http://aspe.hhs.gov/poverty/14poverty.cfm
[3] The Centers for Medicare and Medicaid Services, 2014 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS) (Nov. 6, 2014) available at http://www.coeha.com/2014%20LIS%20Asset%20Levels%20Memo%20to%20Plans.pdf
[4] For example, the District of Columbia has used an expansion of income disregards to effectively raise their income level for QMB to 300% FPL.
[5] According to 2013 data from the Medicare Rights Center, Alabama, Arizona, Connecticut, the District of Columbia, Mississippi, New York and Vermont do not apply a resource limit. http://www.medicareinteractive.org/uploadedDocuments/mi_extra/MSPFinancialEligibiltyGuidelines.pdf

 

 

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