These programs pay for some of the cost of Medicare for seniors and people with disabilities who are not otherwise eligible for Medical Assistance. Medicare Part A covers hospital services. There is no monthly premium but there are co-pays and deductibles. Medicare Part B covers doctors’ visits and other medical costs. There is monthly premium for Medicare Part B which is usually deducted from the individual’s Social Security check. For 2024, the standard monthly premium is $174.70. 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 $9,430 for an individual and $14,130 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 ($9,430) 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 RIPIN for assistance (401-270-0101).
Monthly Income Guidelines
Medicare Premium Payment Programs (2023)
| Program | Individual Income Limit | Couple Income Limit | What’s Covered |
|---|---|---|---|
| Qualified Medicare Beneficiary (100% FPL) | $1,255 | $1,703 | Medicare premiums, co-pays, and deductibles |
| Specified Low Income Beneficiary (120% FPL) | $1,506 | $2,044 | Medicare Part B premium |
| Qualifying Individual (135% FPL) | $1,694 | $2,300 | Medicare Part B premium (limited # of eligibles) |
*Note Income limits include the $20 disregard for unearned income.