Medicare Premium Payment Program

These programs pay for some of the cost of Medicare for seniors and people with disabilities who are not otherwise eligible for Medical Assistance. People receiving Medicare pay a monthly premium that is usually deducted from their Social Security check. For 2017 the standard monthly premium is $134 (or higher depending on income), but most people pay around $109/month. They also pay co-payments for doctor visits and a deductible for hospitalization. The types of costs covered by the Medicare Premium Assistance Program is determined by the applicant’s income level as shown in the chart below.

Who Qualifies?

  • People that have Medicare Part A (elders receiving Social Security Retirement benefits; people who have received Social Security Disability benefits for two years).
  • Must be citizen or qualified immigrant. Eligible immigrants include: refugee or person granted asylum. Lawful Permanent Residents (LPRs) who entered the U.S. before 8/22/96 or if entered on/after 8/22/96 must be in status for at least 5 years. In addition, immigrants who were in lawful status in the U.S. before 8/22/96 and lived in RI at some time before 7/1/97 may be eligible for coverage.

Income and Resource Limits

The resource limit is $7,390 for an individual and $11,090 for a couple. The home in which the person lives and a car used to get to medical treatment does not count.

*While the resource limit ($7,390) for the Qualified Medicare Beneficiary Program (QMB) is higher than the resource limit ($4,000) for the Medical Assistance (MA) low-income Aged/Disabled program, the income limits are the same.  MA provides more comprehensive coverage, including prescriptions. MA can also pay for the Medicare premiums, co-pays, and deductibles. Therefore, people will generally want to apply for Medical Assistance, and not just QMB, as long as their resources are within the MA limit ($4,000/individual).

How to Apply

You can apply by submitting a paper application which you can download here. You can also request a paper application from a DHS office or by calling: 1-855-697-4347.

A decision must be made within 30 days of application.  If denied, the person can file a written appeal within 30 days of the date on the notice.

RI Legal Services (1-800-662-5034) may provide assistance to families who are denied benefits. You can also contact RIREACH for assistance (855-747-3224).

Monthly Income Guidelines

Medicare Premium Payment Programs (2017)

Program Individual Income Limit Couple Income Limit Coverage
Qualified Medicare Beneficiary (100% FPL) $1,025 $1,374 Medicare premiums, co-pays and deductibles
Specified Low Inc Beneficiary (120% FPL) $1,226 $1,644 Medicare Part B Premium
Qualifying Individual (135% FPL) $1,377 $1,847 Medicare Part B Premium (limited # of eligibles)

Qualified Disabled Working Individuals

This program pays for Medicare Part A Premium for individuals who are under age 65, disabled and working; lost their Medicare Premium-Free Part A when they went back to work; not receiving Medicaid and meet the income and resource requirements. For 2017, the resource limit is $4,000 for an individual and $6,000 for a couple. The income limit is $4,105 for an individual and $5,499 for a couple.