What Does Medicare Savings Program Cover

What the Medicare Savings Program Covers

The Medicare Savings Program helps low-income beneficiaries pay Medicare premiums and certain cost-sharing. It does not cover services that Medicare itself does not cover, such as most long-term care, dental care, vision exams, and hearing aids. Instead, it pays for the costs that Original Medicare does cover, making them more affordable for people with limited income and resources.

Part A Premiums and Hospital Costs

For beneficiaries who have limited work history and must pay a premium for Medicare Part A, the savings program can pay that premium. It also helps cover Part A hospital coinsurance and copayments for inpatient hospital stays, skilled nursing facility care, hospice, and some home health services.

Part B Premiums and Doctor Costs

The program can pay the monthly Part B premium, which helps beneficiaries keep their doctor and outpatient therapy coverage. It also helps cover Part B coinsurance and copayments for doctor visits, durable medical equipment, outpatient procedures, and some preventive services.

Additional Cost-Sharing Help

Depending on the specific program and income level, the savings program may also help pay the Medicare Part D deductible, late-enrollment penalty, and a portion of prescription drug costs. Some beneficiaries may qualify for full Extra Help with Part D costs, while others receive partial assistance.

Types of Medicare Savings Programs

Federal law establishes four types of Medicare Savings Programs, each with different income and resource limits and levels of coverage. State Medicaid agencies administer these programs, and eligibility rules can vary slightly by state.

Who Qualifies

Eligibility depends on income, resources, and Medicare enrollment status. Applicants must be enrolled in Medicare Part A and, in most cases, Part B. They must also live in the state where they apply and be a U.S. citizen or lawfully present immigrant. States may use modified adjusted gross income or a similar measure to determine eligibility.

What the Program Does Not Cover

The Medicare Savings Program does not replace Medicare coverage. It does not pay for services that Medicare denies or does not cover, such as routine foot care, cosmetic surgery, or private-duty nursing. Beneficiaries should confirm with their state Medicaid office or a licensed insurance counselor what specific costs their program covers.