D-SNP/Dual Eligible

CMS offers some Medicare Savings programs (MSP) to help low-income beneficiaries. Depending on their income and resources, they are divided into 4 categories: QMB, SLMB, QI, and QDWI based on the following criteria (for 2019).

QMB (Qualified Medicare Beneficiary): monthly income (individual/married couple) below $1,061/$1,430, resource below $7,730/$11,600. Program will help pay for parts A&B premiums, as well as deductibles, coinsurance, and copayment. These beneficiaries also pay no more than $3.8 (2019) for each part D prescription drug.

SLMB (Specified Low-income Medicare Beneficiary): monthly income (individual/married couple) below $1,269/$1,711, resource below $7,730/$11,600. Program will help pay for part B premium only.

QI (Qualified Individual): monthly income (individual/married couple) below $4,249/$5,722, resource below $7,730/$11,600. Program will help pay for part B premium only. (Only limited fund is allocated to this program, first-come first-serve.)

QDWI (Qualified Disabled & Working Individual, under age 65): monthly income (individual/married couple) below $1,426/$1,923, resource below $4,000/$6,000. Program will help pay for part A premium only.

D-SNP plans are for people who are eligible for both Medicare and Medicaid (i.e., QMB). By the above rules, QMB beneficiaries do not have to have private fee-for-service plans since MSP already pay for deductibles, coinsurance, copayment, and premiums. Insurance carriers offer D-SNP to include additional ‘value added’ benefits such as dental, vision, over-the-counter allowance, silver sneakers, transportation for doctor visits, etc, depending on the carrier, as well as your location.

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