Medicare Premium Payment Program

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 2021 the standard monthly premium is $148.50. 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 $7,560 for an individual and $11,340 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 ($7,560) 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 (250% FPL)

Medicare Premium Payment Programs (2021)

Program Individual Income Limit Couple Income Limit Coverage
Qualified Medicare Beneficiary (100% FPL) $1,093 $1,472 Medicare premiums, co-pays and deductibles
Specified Low Inc Beneficiary (120% FPL) $1,308 $1,762 Medicare Part B Premium
Qualifying Individual (135% FPL) $1,469 $1,980 Medicare Part B Premium (limited # of eligibles)

*Note Income limits include the $20 disregard for unearned income.

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