Updated October 29, 2021
Reading time: 4 minutes
If you’re struggling to cover Medicare costs, an SLMB plan may be able to help.
Medicare and Medicaid are crucial federal and state government programs designed to provide affordable healthcare to a wide swath of Americans. However, even with these programs in place, some beneficiaries struggle to cover the costs of regular doctor visits, surgeries, prescription drugs, and simply meeting their monthly premiums.
Fortunately, for those with very limited income, Medicare Savings Programs (MSPs) can provide much-needed financial aid to those who would otherwise be unable to pay for their medical coverage. There are four different Medicare Savings Programs for which you can become a “Qualified Individual”
1. QMB (Qualified Medicare Beneficiary)
QI (Qualifying Individual)
QDWI (Qualified Disabled and Working Individuals)
SLMB (Specified Low-Income Medicare Beneficiary)
While each of these programs offers some level of assistance that could reduce your medical costs, we’ll be focusing on the various facets and details surrounding the SLMB Program.
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SLMB stands for Specified Low-Income Medicare Beneficiary. The SLMB Program is a Medicare Savings Program designed to assist individuals who have low income and struggle to meet the regular costs of healthcare. In its current form, those who qualify for the SLMB Program will have their Medicare Part B Premiums totally covered, in addition to automatically qualifying them for the Medicare Part D Extra Help Program.
The SLMB Program is a Medicare Savings Program that assists individuals who have low-income but are not below the Federal Poverty Line. To qualify you must meet income and asset limits (more below).
When it comes to eligibility requirements, you should pay attention to the income limits that could affect whether you qualify for SLMB:
You must have an annual income between 100 and 120 percent of the Federal Poverty Level ( FPL ).
Your total resources must be equal to or below two times the standard allowed by the SSI program.
Countable resources include money in your checking or savings accounts, stocks, mutual funds, and bonds.
Your primary home, any household items, one vehicle, a burial plot, and up to $1,500 worth of burial expenses (if that’s been set aside) do not count toward your total resources.
If you are an individual, your monthly income must be lower than $1,296, and your total resources must be lower than $7,860.
For married couples, your monthly income must be lower than $1,744, and your total resources must be lower than $11,800.
It should be noted that these requirements are specific to the 48 contiguous states, as both Alaska and Hawaii have slightly higher income limits than the rest of the country. Also, be aware that the FPL can change from year to year, altering the income and asset limits.
For more information regarding SLMB eligibility or income/ resource limits, please contact your local Medicaid office or call the Social Security Administration at 1 (800) 772-1213 (1 (800) 325-0778 for TTY users). There are also resources available at Medicare.gov. Alternatively, you can speak with one of our licensed insurance agents who can provide objective assistance, free of charge. Give us a call at 1-844-965-1378 (TTY 711) Monday-Friday 8am – 8pm ET.
If you’re unsure whether you would qualify for the SLMB program, you’ve got nothing to lose by applying anyway. In some cases, individuals can still qualify for SLMB or another assistance program even if their income and/or assets exceed the established limits. Don’t be discouraged.
As mentioned previously, SLMB will pay for monthly Medicare Part B premiums. Even though Medicare Part A is typically premium-free, Medicare Part B does require a monthly premium. For 2021, the Part B premium will be $148.50, totaling about $1,782 per year.
SLMB can also help individuals qualify for the Medicare Part D Extra Help Program, which provides an estimated $5,000 worth of assistance in paying for prescription drug costs.
Please note that SLMB does not provide assistance in paying for any Medicare coinsurance or co-payment costs.
SLMB and QMB (Qualified Medicare Beneficiary) are two Medicaid programs designed to help pay for medical assistance. The main difference between the two is which Medicare costs they cover and the income limits that applicants can be held to.
The SLMB program pays for:
Medicare Part B monthly premiums and
Allows individuals to qualify for Part D Extra Help.
The QMB program can help pay for:
Medicare Part A ( Hospital Insurance ) premiums,
Medicare Part B (Outpatient Insurance) premiums,
For QMB, the monthly income limits are a bit more stringent. While SLMB requires that applicants have an income that sits between 100 and 120 percent of the Federal Poverty Level, QMB requires that applicants have an income that is equal to or less than 100 percent of the Federal Poverty Level.
To be more specific, the income limits for each are virtually the same; however, SLMB is designed for individuals who earn a low income but aren’t in quite as dire of straits as someone applying for QMB. That being said, if you need financial assistance and have the opportunity, you should still apply to both programs.
While we covered SLMB and QMB, there are two other Medicare Savings Programs that you might be able to take advantage of:
Qualified Disabled and Working Individuals ( QDWI ): This program applies to individuals who have lost their Medicare Part A coverage due to returning to work. QDWI beneficiaries gain assistance in paying for their Medicare Part A premiums.
Qualifying Individuals (QI): This program operates on a “first-come, first-served” basis and receives applications yearly. It can help individuals enrolled in Medicare Part A plans to pay for Medicare Part B premiums. While this program can definitely assist you in paying for Part B premiums, it’s important to note that you will need to reapply each year.
SLMB Plus is something of a category for individuals who qualify for both SLMB and full Medicaid benefits in their state. Those who fall under this category can have Medicaid pay for their Medicare Part B premiums while taking advantage of full Medicaid benefits. It’s important to note that Medicaid will pay for service costs only when both Medicare and Medicaid cover the specific service. SLMB Plus can also offer one additional perk, depending on your state’s Medicaid policies. An SLMB Plus beneficiary can potentially meet the minimum eligibility requirement to join a Medicare Advantage Special Needs Plan.
If you have been struggling to cover your Medicare or Medicaid costs due to COVID-19, any one of the Medicare Savings Programs can help you deal with the costs of Medicare coverage. While each program has different requirements for eligibility, it wouldn’t hurt to apply for them, even if you slightly exceed the income limits.
It’s no secret that getting medical treatment, paying for medications, or even just keeping your insurance plan can get expensive. If you find yourself having to pinch pennies to get the medical coverage you need, it might be time to see if SLMB —or one of the other Medicare Savings Programs —can help lighten the financial and mental loads of keeping yourself healthy.
It doesn’t hurt to apply, even if you’re not quite eligible. If Medicare coverage is tough on your wallet, the Medicare Savings Programs can help. And don’t forget to try the Insurify Medicare comparison tool. With just your ZIP you can review the costs of Medicare plans available in your area to save big!
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J.J. Starr is a health and finance writer with a background in banking, lending, and financial advising. She holds a Series 6, FINRA, and life insurance licensure and a master's degree from New York University. Through her writing, she strives to use her decade of experience to help consumers make sound financial choices. Connect with J.J. on LinkedIn.Learn More