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 2016 the monthly premium is $121.80 but most people will continue to pay the 2015 amount of $104.90. 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 $7,280 for an individual and $10,930 for a couple. The home in which the person lives and a car used to get to medical treatment does not count.

*The income and resource limits for the Qualified Medicare Beneficiary Program (QMB) and the Low-Income Aged/Disabled program described are the same. Medical Assistance 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 on-line here or 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.

Monthly Income Guidelines

Medicare Premium Payment Programs (2015)

Program Individual Income Limit Couple Income Limit Coverage
Qualified Medicare Beneficiary (100% FPL) $1,010 $1,335 Medicare premiums, co-pays and deductibles
Specified Low Inc Beneficiary (120% FPL) $1,208 $1,602 Medicare Part B Premium
Qualifying Individual (135% FPL) $1,357 $1,823 Medicare Part B Premium (limited # of eligibles)
Qualified Disabled Working Individuals (200% FPL) $4,045 $5,425 Payment of Medicare Part A premium

* Income limits include $20 unearned income disregards and for QDWI additional earned income/disregards.