California Medicare Savings Program Benefits: What You Need to Know

California’s Medicare Savings Programs (MSPs) provide vital financial relief for many Medicare beneficiaries. Here’s what you need to know about their benefits — what they cover, who gets help, and the latest changes.

What Are the MSPs?

The Medicare Savings Programs are state-level programs through Medi‑Cal in California that help qualified individuals pay some or all Medicare costs. These include help with premiums, deductibles, coinsurance, and copayments depending on which program you qualify for. (DHCS)

There are four main programs:

• Qualified Medicare Beneficiary (QMB)

• Specified Low‑Income Medicare Beneficiary (SLMB)

• Qualifying Individual (QI‑1)

• Qualified Disabled & Working Individual (QDWI) (DHCS)

What Benefits Do MSPs Provide?

Here are the specific benefits you may receive, depending on the program:

Program What It Helps Cover QMB Part A & Part B premiums, Medicare deductibles, coinsurance, and copayments. Basically, most of the costs Medicare does not cover. (Medicare) SLMB Pays only the Part B premium for eligible beneficiaries. (Medicare) QI‑1 Also helps with the Part B premium, similar to SLMB, but has slightly higher income limits. You’ll need to reapply each year. (Medicare) QDWI Covers Part A premium for certain disabled people who are working, but lost premium‑free Part A because of working status or income. (Medicare)

Recent & Important Changes in California

• As of January 1, 2024, the state removed the asset test for all Medicare Savings Programs. That means assets (bank accounts, savings, etc.) are no longer counted when determining eligibility. You only need to meet the income limit now. (DHCS)

• Beginning January 1, 2025, California is implementing a “Medicare Part A Buy‑In” policy. This means for certain MSP‑eligible people who are part of Medi‑Cal and enrolled in Part B, the state will automatically enroll them in Part A (and pay the Part A premium) if they qualify under the QMB program. (DHCS)

Why These Benefits Matter

These MSP benefits can dramatically reduce your medical expenses. Here’s how:

• You may pay no Part A or Part B premiums (for QMB), which alone can save you hundreds each month.

• Many of the out‑of‑pocket costs like copays, deductibles, and coinsurance are eliminated or reduced depending on the program.

• Removing the asset limit and automatic Part A buy‑in makes it easier for many people who would previously have been excluded to receive help.

Things to Know / Limitations

• Even with MSPs, some costs (like prescription drugs beyond the MSP benefit, non‑Medicare services, or healthcare not covered by Medicare) may still apply.

• You must meet income limits (which vary by household size) to qualify. With assets now not considered, income becomes the key factor. (DHCS)

• For some programs like QI‑1, availability depends on state funding and you need to reapply each year. (Medicare)