Limited Coverage Medicaid Plans

• Qualified Medicare Beneficiary (QMB)

• Specified Low Income Medicare Beneficiary (SLMB)

• Qualified Individual Group 1 (also called Specified Low-Income Beneficiary Plus (SLMB+)

• Qualified Disabled and Working Individual (QDWI)

• When Will Payments Begin?

• Medicare Saving Plans Calculation

Medicare Savings Program

Wisconsin Medicaid may be able to help pay for certain Medicare costs, if you request and qualify for the Medicare Savings Program (also called Premium Assistance). This program is for those who are eligible to take part in Medicare and who have low income and limited assets.

The asset limits for the following plans are: 

Not all of your income and assets will be counted when determining if you are able to enroll in a Medicare Savings Program. Income and asset limits may change each year. For current amounts, go to dhs.wi.gov/em/customerhelp or call 1-800-362-3002.

Qualified Medicare Beneficiary (QMB)

Medicaid will pay any Medicare Parts A and B premiums, Medicare co-insurance and Medicare deductibles if you meet all of the following:

• Are entitled to Medicare Part A, 

• Have assets at or below the program limit, and

• Have monthly income at or below 100% of the FPL (see Monthly Income Limits Table), after subtracting certain credits.

Specified Low Income Medicare Beneficiary (SLMB)

Medicaid will pay Medicare Part B premiums, if you meet all of the following:

• Currently getting Medicare Part A, 

• Have assets at or below the program limit, and

• Have monthly income between 100% and 120% of the FPL (see Monthly Income Limits Table), after subtracting certain credits.

Qualified Individual Group 1 (also called Specified Low-Income Beneficiary Plus (SLMB+)

Medicaid will pay your Medicare Part B premiums, if you meet all of the following:

• Currently getting Medicare Part A,

• Have assets at or below the program limit,

• Are not enrolled in Medicaid, and

• Have monthly income between 120% and 135% of the FPL (see Monthly Income Limits Table), after subtracting certain credits.

Qualified Disabled and Working Individual (QDWI)

The asset limits for Qualified Disabled and Working Individuals are: 

Medicaid will pay for Part A premiums, if you meet all of the following:

• You have a disability,

• You are employed,

• You are entitled to Medicare Part A,

• You have assets at or below the program limit,

• You have monthly income less than 200% of the FPL (see Monthly Income Limits Table), after subtracting certain credits, and

• Are not enrolled in Medicaid.

When Will Payments Begin?

If you are enrolled in any of the Medicare Savings Program plans, you will need to allow at least two months for payments to begin. This is the time that is needed for payments to be adjusted by Wisconsin Medicaid, Medicare and the Social Security Administration.

When Medicaid starts paying your Medicare premium, your Social Security check will increase. If payments do not begin immediately you may be due a refund from the Social Security Administration.

Medicare Saving Plans Calculation

Calculate your counted income for the Medicare Savings plans as follows.

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Last Revised: April 16, 2013