Medicare Savings Program

(Also called "Medicare Premium Assistance")

English, Spanish (PDF, 71 KB)

Wisconsin's Medicaid program may be able to help pay for certain Medicare costs if you are eligible to in a Medicare Savings Program. Medicare Savings Programs are for those who receive Medicare benefits and who have limited countable income and assets. See the tables below for these limits.

If you are eligible to enroll in a Medicare Savings Program, Medicaid may pay your required premiums, coinsurance, and deductibles for both Part A (hospital-related costs) and B (physician-related costs), depending on the program.

Medicare Savings Programs

Qualified Medicare Beneficiary (QMB)

The first day of the month after your application is approved, Medicaid pays Medicare Part A and B premiums, deductibles and coinsurance, if you:

  • Are entitled to Medicare Part A,
  • Have countable assets at or below the program limit, and
  • Have countable monthly income at or below 100% of the federal poverty level (FPL), after certain credits are applied.

Specified Low Income Medicare Beneficiary (SLMB)

Up to three months before your application date, Medicaid pays Medicare Part B premiums if you:

  • Are entitled to Medicare Part A,
  • Have countable assets at or below the program limit, and
  • Have countable monthly income between 100% and 120% of the federal poverty level, after certain credits are applied. 

Specified Low Income Beneficiary Plus (SLMB+)

Up to three months before your application date, Medicaid pays Medicare Part B premiums if you:

  • Are entitled to Medicare Part A,
  • Have countable assets at or below the program limit, 
  • Have countable monthly income between 120% and 135% of the federal poverty level, after certain credits are applied, and
  • Are not enrolled in full-benefit Medicaid. 

Qualified Disabled and Working Individual (QDWI)

Up to three months before your application date, Medicaid pays Part A premiums if you: 

  • Are disabled and employed,
  • Are entitled to Medicare Part A, 
  • Have countable assets at or below the program limit, 
  • Have countable monthly income less than 200% of the federal poverty level, after certain credits are applied, and
  • Are not enrolled in full-benefit Medicaid.

2017 Net Monthly Income Limits*

Group Size

100% of FPL

120% of FPL

135% of FPL

200% of FPL

1 $990.00 $1,188.00 $1,336.50 $1,980.00
2 $1,335.00 $1,602.00 $1,802.25 $2,670.00

2017 Asset Limits (QMB, SLMB, SLMB+)*

Group Size Asset Limit
1 $7,390
2 $11,090

2017 Asset Limits (QDWI)*

Group Size Asset Limit
1 $4,000
2 $6,000

*Not all of your income and assets will be counted in determining if you can enroll in a Medicare Savings Program. Income and asset limits may change each year. For current income and asset limits, call 1-800-362-3002 or go to dhs.wi.gov/medicaid/fpl/fpl.htm.

You May Already Be Getting Medicare Savings Program Benefits

Medicaid should already be paying your Medicare Part A and B costs (meaning you do not need to apply for Medicare Savings Program benefits) if you receive Medicare and Medicaid and either of the following apply to you:

  1. You are enrolled in the Supplemental Security Income (SSI) program
  2. You were enrolled in SSI but lost it:
  • While you were getting Old Age Survivors Disability Insurance (OASDI), or
  • Because you are the disabled adult child of parents who died or became disabled, causing you to get an increased or initial Social Security payment that made you unable to get SSI, or
  •  Because you are the disabled or elderly spouse of a person who died, causing you to get a Social Security benefit that made you unable to get SSI.

If you think Medicaid should be paying your Medicare Part A and B costs, but Medicaid is not, contact the Wisconsin Medigap Helpline at 1-800-242-1060.

When Will Payments Begin?

If you are eligible to enroll in a Medicare Savings Program, please allow at least two months for payments to begin. This is the time needed for payments to be adjusted by Wisconsin Medicaid, Medicare, and the Social Security Administration.

When Medicaid starts paying your Medicare costs, your Social Security check will increase and you will get a notice from the Social Security Administration. The Social Security Administration will give you a refund for any payments you made after the date you were enrolled in a Medicare Savings Program.

How to Apply

You can apply online at ACCESS.wi.gov, over the telephone, by mail, or in person with your agency. To find the address or phone number for your agency, go to dhs.wisconsin.gov/forwardhealth/resources.htm or call Member Services at 1-800-362-3002. They can also send you an application and answer questions you may have about the application or these programs.

Questions

Wisconsin offers a variety of resources to help Medicare beneficiaries understand options and solve problems related to their health insurance benefits. These resources are funded through the federal State Health Insurance Assistance Program (SHIP). For more information:

If you have a disability and need to access this information in an alternate format, or need it translated to another language, please contact 608-266-3356 (voice) or  711 (TTY). All translation services are free of charge. For civil rights questions, call 608-266-9372 (voice) or 711 (TTY).

P-10062 (01/2017)

Last Revised: January 27, 2017