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.
- 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
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.