The Qualifying Individual (QI) Program is one of several Medicare Savings Programs designed to help lower income beneficiaries potentially get a portion or 100% of their Medicare Part B premiums paid for.

While programs like Qualified Medicare Beneficiary (QMB) are available to only very low-income individuals, the QI Program has far more lenient income and asset requirements. This means that any of your clients that were “close” to the income limits last year may qualify for QI.

The primary difference between QI and other Medicare Savings Programs is that it is a block grant program, so once the grant funds are exhausted, no more enrollments are accepted that year. It is imperative to help your clients access this potential benefit early in the year, before the program fills up.

Additionally, eligibility for QI also automatically qualifies beneficiaries for Extra Help, a program that can limit their out of pocket prescription costs and drug plan premiums. Not only can this help clients lower their overall costs, but it can also provide them with a potential SEP opportunity to find a more appropriate plan to meet their needs.

Key Takeaways:

• QI is a time-sensitive program, that is no longer available once the grant funds are allocated
• This can also help reduce out of pocket costs by getting clients Extra Help with Part D costs.
• Extra Help allows an SEP to change plans
• This is NOT for dual-eligible clients, it is for clients who make too much money to qualify for other MSPs (QMB and SLMB)

Program helps pay for:
Part B premiums only

How to apply:
Contact the state Medicaid agency

NOTE: QI must be re-applied for each calendar year

Reference Links:

https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs

https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/lower-prescription-costs