Medicare Savings Programs help manage costs for beneficiaries with reduced income and resources to pay for their insurance coverage. Eligibility for these programs is different in Hawaii than in other states, but benefits and general rules are the same.
To be eligible for any of the Medicare Savings Programs in Hawaii, you must be a legal Hawaii resident. You must also:
- Be eligible for Medicare.
- Be a U.S. citizen or legal immigrant residing in the U.S. for five years or longer.
- Provide proof of your identity.
- Provide a Social Security Number.
- Not live in a public institution.
Qualified Medicare Beneficiary (QMB)
The QMB program covers the most costs of the four programs, including your Part A premiums. A premium is a monthly fee that, traditionally, you would have to consistently pay to maintain your coverage. Many people avoid the Part A premium–if you work for ten or more years while paying Social Security taxes, you are exempt. However, many QMB enrollees are missing this qualification, so having this coverage is vital. Without it, the standard Part A premium for 2021 is between $259 and $471.
The QMB savings program also covers your Part B premium, which is set at a standard $148.50 a month in 2021. It also covers your Part A and B deductibles. A deductible accrues once every year–you must pay the deductible before you access your benefits for the first time during that year. For Part A, the deductible is $1,484 in 2021. For Part B, it is $203. But, as a QMB, you pay $0.
Finally, the QMB program covers all cost-sharing fees. Cost-sharing, including coinsurance and copayment fees, is typically a requirement for Medicare beneficiaries. You are required to pay a percentage (typically 20%) of the total cost of the covered item or service. If you are a QMB and are wrongfully charged a cost-sharing fee, contact your Medicare provider.
Specified Low Income Medicare Beneficiary (SLMB)
The SLMB program accepts those with more resources than QMBs. As a result, it only pays for your Part B premium.
Eligibility for these programs is determined by your individual and/or married income limit, as well as your individual and/or married resource limit. This is where the Medicare Savings Programs differ in Hawaii from other states. For eligibility in the QMB program, the typical income limit for individuals/married couples is $1,094 and $1,472, respectively. In Hawaii, this number currently sits at $6,600 for an individual, $9,910 for a couple, and $500 for each additional legally dependent family member for eligibility in the QMB, SLMB, and QI-1 programs.
Qualifying Individual-1 (QI-1)
The QI-1 program covers your Part B premiums like SLMBs but is issued on a first-come, first-serve basis. You must apply annually to this program, and priority is given to those previously enrolled. Income limits (i.e., eligibility) are, once again, the same for QMBs and SLMBs.
Qualified Disabled and Working Individual (QDWI)
The QDWI program has a few additional requirements aside from income and resource limits, you must:
- Be under age 65.
- Have lost Social Security disability insurance payments because of earned income.
- Continue to have a disabling condition.
Income limits for QDWIs in Hawaii require that you must not exceed $4,000 for an individual, $6,000 for a couple, and $500 for each additional legally dependent family member.
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