Medicaid Program

You may find that you can no longer afford to pay insurance premiums and are eligible for the Medicaid program. The Medicaid program provides health care coverage for individuals who meet the program's definition of low income. If you do not qualify for the Medicaid program, you may be eligible for several other options based on your income.

If you are eligible for Medicaid, you do not need to buy private health insurance. Medicaid pays almost all of the health costs if you are eligible for the program.

You may qualify for Medicaid if you are a citizen of the United States or an "eligible" alien, meet the financial eligibility requirements, and are in one of the following categories:

  • Age 65 or older
  • Blind or disabled
  • In a family with dependent children

AND

  • You must have low income and few assets, or
  • You must be paying so much money for health care that you have very little income left.

If you bought a Medigap policy after November 5, 1991, and then become eligible for Medicaid, the law permits you to suspend your Medigap insurance for 24 months while you are enrolled in the Medicaid program.

If you lose your eligibility for Medicaid you are allowed to reinstate your Medicare supplement or Medicare select insurance.

Qualified Medicare Beneficiary and Specified Low-Income Medicare Beneficiary Programs

If you are a low-income Medicare beneficiary but do not qualify for the standard Medicaid program, you may be eligible for either the qualified Medicare Beneficiary program (QMB) or the Specified Low-income Medicare Beneficiary program (SLMB). While these programs do not necessarily eliminate your need for private insurance to supplement your Medicare benefits, they could save you hundreds of dollars each year in health care costs if you qualify for assistance.

The QMB program pays Medicare's premiums, deductibles, and coinsurance amounts if you are entitled to Medicare Part A, and your annual income is at or below the national poverty level, and your savings and other resources are very limited. The QMB program, therefore, functions like a Medigap policy and more because it also pays your Part B premium.

The SLMB program pays your Medicare Part B premium if you are entitled to Medicare Part A and your income does not exceed the national poverty level by more than 20%. If you qualify for assistance under the SLMB program, you will be responsible for Medicare's deductibles, coinsurance, and other related charges.

In addition, you may be eligible for a Medicaid program that requires states to pay Medicare Part B premium assistance for low-income Medicare beneficiaries.

For more information on Medicaid eligibility or the QMB or SLMB programs: