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The Specified Low-Income Medicare Beneficiary (SLMB) Program helps eligible individuals save on Medicare costs. It is a part of the broader Medicare Savings Programs (MSPs) aimed at supporting low-income older adults and individuals with disabilities.
Ahead, we dive into the SLMB Program, exploring its history, eligibility criteria, application process, and the specific benefits it offers. We aim to empower you with the knowledge needed to determine if you or someone you know may benefit from this program.
Medicare Savings Programs (MSPs), including the Specified Low-Income Medicare Beneficiary (SLMB) program, use Medicaid funds to help low-income Medicare beneficiaries cover out-of-pocket expenses.
The primary purpose of the SLMB program is to cover the monthly premium for Medicare Part B, saving participants up to $1,978.80 annually in 2023. This benefit allows enrollees to utilize funds for other medical expenses or essential needs. Besides premium assistance, the program offers the possibility of retroactive reimbursement for Part B premiums up to three months before enrollment.
fIn addition to the Specified Low-Income Medicare Beneficiary (SLMB) Program, there are three other Medicare Savings Programs (MSPs) designed to help individuals with limited income and resources manage Medicare-related costs:
The Specified Low-Income Medicare Beneficiary (SLMB) Program is designed for individuals who meet certain financial conditions and need help with Medicare Part B premiums. Applicants must be eligible for Medicare Part A and adhere to income and asset guidelines specific to the SLMB. All rules regarding citizenship and residency must also be satisfied to qualify.
To qualify for the SLMB program, applicants must have Medicare Part A hospital insurance. Medicare Part A can be applied for at any time, independent of previous enrollment refusals, provided the applicant meets the specific income and resource criteria.
Monthly income limits for the SLMB program are critical for eligibility. In 2024, the monthly income cap is set at $1,255 for individuals and $1,506 for couples. Eligible individuals must have a countable income above 100% but below 120% of the federal poverty level. This program offers assistance specifically to those who are not financially eligible for Medicaid.
SLMB applicants must stay within specific resource limits, which are $10,930 for individuals and $17,130 for married couples. Countable assets include cash, bank deposits, stocks, and other investments. Certain resources, like the primary residence, one vehicle, and burial plots, are exempt. Additionally, up to $1,500 for burial expenses can be excluded from asset assessment.
Applicants for the SLMB program must be U.S. citizens or legal residents of the state where they apply. State-specific asset thresholds must also be respected.
The Specified Low-Income Medicare Beneficiary (SLMB) Program can grant retroactive benefits up to three months before the month of application. This allows eligible individuals to receive reimbursement for prior Part B premiums they have paid. Once approved for SLMB, benefits typically begin in the month following the eligibility determination.
In some cases, individuals may also receive reimbursement for premiums paid over the calendar year before their SLMB coverage start date if they meet eligibility criteria. Participants often get refunds for any Part B premiums paid after their enrollment date, though it may take one to three months for Social Security adjustments to reflect the changes.
During the adjustment period, a person's Social Security payment may remain unchanged while the necessary modifications are processed. This ensures that all financial adjustments related to SLMB benefits are accurate and do not disrupt regular Social Security payments.
Key points:
Applying for SLMB incurs no costs, allowing applicants to assess eligibility without a financial burden. States have specific requirements and processes, making it important to understand local guidelines. The State Health Insurance Assistance Program (SHIP) offers help with eligibility and starting applications. BenefitsCheckUp® is a free online tool to assist individuals in determining SLMB eligibility by entering their ZIP Code.
To apply for the SLMB program, documentation of countable assets and monthly income under specified limits is required. Applicants must also provide proof of Medicare Part A entitlement, along with income and asset evidence. State-specific processes might require additional documents, so checking local guidelines is crucial.
The appeal process for Medicare Savings Programs can be started online, by mail, or by phone. State program officials should be contacted for steps and necessary documentation for an appeal. Understanding income and resource limits is crucial in forming a compelling appeal. Countable resources, such as vehicles, properties, and cash, must be accurately represented.
The Specified Low-Income Medicare Beneficiary (SLMB) program is designed to assist individuals with limited income by covering the costs of Medicare Part B premiums. As of 2023, enrolling in this program can save a beneficiary approximately $1,978.80 annually. This program also offers retroactive reimbursement for Part B premiums paid up to three months before the SLMB enrollment date.
Recipients of SLMB benefits are eligible for the Medicare Part D Low Income Subsidy (LIS) program, potentially providing an additional assistance of about $5,300 per year. However, it's important to note that the SLMB program does not cover other Medicare expenses such as copayments, deductibles, or Part A premiums.
Here's a summary of SLMB benefits:
Enrolling in the SLMB program provides essential financial relief for people with limited income while helping them manage their healthcare costs effectively.
Dual eligibility occurs when individuals qualify for both the Specified Low-Income Medicare Beneficiary (SLMB) program and full Medicaid benefits, earning them the title of dual-eligible beneficiaries. This status allows access to combined benefits from both programs, such as assistance with Medicare premiums and expanded healthcare services.
SLMB Plus (SLMB+) beneficiaries meet the monthly income limits for SLMB and are eligible for full Medicaid. As a result, they gain access to benefits from both the SLMB program and state Medicaid, including additional healthcare services like vision, hearing, and dental care not covered by Medicare. Moreover, they may join a Medicare Advantage Special Needs Plan (D-SNP), designed specifically for dual-eligible beneficiaries.
Eligibility for SLMB is evaluated at specific times, such as when there's a change in income or annually when income limits are updated. Maintaining awareness of these criteria is crucial to maximizing benefits. By understanding eligibility requirements and timelines, dual-eligible individuals can better manage their healthcare coverage efficiently.
The Specified Low-Income Medicare Beneficiary (SLMB) program covers Medicare Part B premiums for those eligible for Medicare Part A with limited income and resources. In 2021, the individual monthly income limit for the SLMB program was $1,308 and $1,762 for a married couple. For 2024, these limits are set at $1,526 for individuals and $2,064 for married couples.
The resource limits for SLMB are $10,930 for an individual and $17,130 for a married couple. Countable resources include money in checking or savings accounts, stocks, and bonds, but exclude a person's home and one car. Eligibility is aided by a $20 income disregard, potentially allowing qualification if adjusted gross income falls below the program's limits.
Enrolling in the SLMB program automatically qualifies individuals for the Medicare Part D Low Income Subsidy (LIS). This subsidy can save participants up to $5,300 annually on prescription drug costs, as it may eliminate premiums and deductibles for Part D plans. However, it's important to note that the SLMB program does not cover Medicare copayments, deductibles, or Part A premiums, as its focus is solely on Part B support.
Eligibility for SLMB is restricted; individuals receiving SSI/SSP benefits are not eligible, emphasizing the necessity of meeting specific financial criteria. This ensures that assistance is directed at those with limited income and resources. Understanding these limitations and benefits can help potential beneficiaries navigate their options more effectively.
