Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond

Table 1: Comparison of Budgetary Effects of Options to Add an Annual Out-of-Pocket Spending Limit to Medicare, Assuming Full Implementation in 2021
Budget Effects (in billions)
Out-of-pocket spending limit Limit applies to Net change in Medicare liability for Part A/B services Net change in total Medicaid liability Net change in federal Medicaid liability Net change in state Medicaid liability Total Federal Budget Effects in 2021 Total 10-Year Federal Budget Effects (2020-2029)
$5,000 Beneficiary OOP $6.0 -$0.8 -$0.4 -$0.3 $8.3 $114.1
Beneficiary OOP and Medicaid $12.5 -$5.9 -$3.4 -$2.5 $15.0 $205.5
All non-Medicare spending $19.4 -$6.0 -$3.5 -$2.5 $24.6 $332.9
$6,700 Beneficiary OOP $3.8 -$0.5 -$0.3 -$0.2 $5.4 $74.1
Beneficiary OOP and Medicaid $9.2 -$4.6 -$2.7 -$1.9 $10.9 $150.3
All non-Medicare spending $14.7 -$4.8 -$2.8 -$2.0 $18.6 $253.5
Income-related
(% of FPL):
0-150%: $3,350
151-800%: $6,700
801-900%: $7,500
901-1,000%: $8,500
1,001%+: $9,500
Beneficiary OOP $5.9 -$1.0 -$0.6 -$0.4 $8.2 $118.7
Beneficiary OOP and Medicaid $13.9 -$7.3 -$4.2 -$3.1 $16.2 $228.0
All non-Medicare spending $20.0 -$7.5 -$4.3 -$3.1 $24.7 $345.1
NOTE: OOP is out-of-pocket. FPL is federal poverty level.
SOURCE: KFF summary of Medicare benefit modeling data from Actuarial Research Corporation.
Table 2: Eligibility for Medicare Savings Programs in 2020

Beneficiary Group

Level of Medicaid Benefits FPL Threshold Monthly Income Limit Asset Limit Benefits
Individual/ Married Individual/ Married Part A Premiums Part B Premiums Part A & B Cost sharing
Qualified Medicare Beneficiary (QMB)
QMB-plus Full ≤100% $1,084/
$1,457
$2,000/
$3,000
QMB-only Partial ≤100% $1,084/
$1,457
$7,860/
$11,800
Specified Low-Income Medicare Beneficiary (SLMB)
SLMB-plus Full 101-120% $1,296/
$1,744
$2,000/
$3,000
SLMB-only Partial 101-120% $1,296/
$1,744
$7,860/
$11,800
Qualifying Individual (QI)
QI Partial 121-135% $1,456/
$1,960
$7,860/
$11,800
Qualified Disabled and Working Individuals (QDWI)
QDWI Partial ≤200% FPL* $4,339/
$5,833
$4,000/
$6,000
NOTE: FPL is federal poverty level. Alaska and Hawaii have higher income eligibility limits. Income limits include $20 monthly income disregard. Resource limits do not include $1,500 for burial expenses. *QDWI income thresholds are based on 200% of FPL and do not count half of income earned from work. Full-benefit dually eligible beneficiaries qualify for full Medicaid benefits and receive financial assistance through the Medicare Savings Programs. Partial-benefit dually eligible beneficiaries receive only financial assistance through the Medicare Savings Programs, but do not receive full Medicaid benefits.
SOURCE: KFF summary of information from National Council on Aging, “Medicare Savings Programs Eligibility and Coverage Chart, 2020,” updated March 2020; Medicaid and CHIP Payment and Access Commission, “Report to Congress on Medicaid and CHIP, Chapter 3: Improving Participation in the Medicare Savings Programs,” June 2020.
Table 3: Eligibility for Medicare Savings Programs (MSPs) in States with Different Income and/or Asset Limits than Federal Limits in 2020
State Monthly Income Limit Asset Limit
QMB SLMB QI
United States $1,084/ $1,457 $1,296/ $1,744 $1,456/ $1,960 $7,860/ $11,800
Alabama Same as federal No limit
Arizona Same as federal No limit
Connecticut $2,245 / $3,032 $2,458 / $3,319 $2,617 / $3,535 No limit
Delaware Same as federal No limit
DC* $3,190/ $4,310 N/A* N/A* No limit
Illinois Same as federal plus $25 disregard Same as federal
Indiana $1,615 / $2,175 $1,827 / $2,463 $1,987 / $2,678 Same as federal
Louisiana Same as federal No limit
Maine $1,670 / $2,255 $1,882 / $2,543 $2,043 / $2,758 $58,000 / $87,000
Massachusetts $1,402 / $1,888 $1,615 / $2,176 $1,774 / $2,391 $15,720 / $23,600
Minnesota Same as federal $10,000 / $18,000
Mississippi Same as federal plus $50 disregard No limit
New York Same as federal No limit
Oregon Same as federal No limit
Vermont Same as federal No limit
NOTE: QMB is Qualified Medicare Beneficiary. SLMB is Specified Low-Income Medicare Beneficiary. QI is Qualifying Individual. Monthly income includes $20 monthly income disregard, except in those states that have higher income disregards or no disregard: CT includes no standard disregard; ME increased income disregard to $75 for single and $100 for couples. Maine’s asset limits apply to liquid assets only. *QMB is the sole program in DC.
SOURCE: KFF summary of information from National Council on Aging, “Medicare Savings Programs Eligibility and Coverage Chart, 2020,” updated March 2020; Medicaid and CHIP Payment and Access Commission, “Report to Congress on Medicaid and CHIP, Chapter 3: Improving Participation in the Medicare Savings Programs,” June 2020.
Table 4: Eligibility for Part D Low-Income Subsidy (LIS) Program in 2020
Beneficiary Group Monthly Income Limit Asset Limit Premium Cost Sharing
Individual/ Married Individual/ Married Deductible Initial Coverage Catastrophic
Full Low-Income Subsidy
Full-benefit duals income ≤100% FPL State Medicaid/ MSP State Medicaid/ MSP $0 $0 $1.30 generic; $3.90 brand $0
income >100% FPL State Medicaid/ MSP State Medicaid/ MSP $0 $0 $3.60 generic; $8.95 brand $0
Non-full-benefit duals (QMB-only, SLMB-only, QI) OR non-duals income ≤135% FPL & lower asset levels $1,456/ $1,960 $7,860/ $11,800 $0 $0 $3.60 generic; $8.95 brand $0
Partial Low-Income Subsidy
Non-duals income ≤135% FPL & higher asset levels $1,456/ $1,960 $7,860 to $13,110/ $11,800 to $26,160 $0 $89 15% coinsurance $3.60 generic; $8.95 brand
income between 135%-150% FPL $1,615/ $2,175 $13,110/   $26,160 Scaled $89 15% coinsurance $3.60 generic; $8.95 brand
NOTE: FPL is federal poverty level. Alaska and Hawaii have higher income eligibility limits. Income limits include $20 monthly income disregard. Resource limits do not include $1,500 for burial expenses.
SOURCE: KFF summary of information from National Council on Aging; “Part D LIS/Extra Help Eligibility and Coverage Chart, 2020” updated January 2020; Centers for Medicare & Medicaid Services, “Letter to All Part D Plan Sponsors: 2020 Resource and Cost-Sharing Limits for Low-income Subsidy (LIS),” November 1, 2019.
Report Methodology

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