The Qualified Individual (QI) program is a specific form of federal aid designed to help low-income Medicare beneficiaries manage their healthcare costs. It is one of four distinct Medicare Savings Programs (MSPs) administered through state Medicaid offices, though QI beneficiaries do not receive full Medicaid coverage. The purpose of QI is to provide targeted financial assistance for Medicare Part B premiums. It acts as a bridge for those whose income is slightly too high for other, more comprehensive MSPs, but still need help affording their monthly premiums.
Who Qualifies for the Program
To be eligible for the Qualified Individual program, an applicant must be entitled to Medicare Part A. The program is specifically for individuals with incomes that fall between 120% and 135% of the Federal Poverty Level (FPL). For 2025, this generally translates to a monthly income limit of $1,781 for an individual and $2,400 for a married couple in the contiguous United States.
These federal income thresholds are subject to change annually and are slightly higher in Alaska and Hawaii to account for the increased cost of living. When calculating eligibility, a standard income disregard of $20 is applied to the applicant’s monthly income before the limit is enforced. Applicants must also meet a resource limit, which in 2025 is set at $9,660 for an individual and $14,470 for a married couple.
Resources that count toward this limit include assets like bank accounts, stocks, and bonds. Certain assets are legally excluded from the resource calculation, such as the applicant’s primary residence, one vehicle, household goods, and burial funds up to $1,500. While these are the federal standards, state Medicaid agencies may use slightly different methodologies for income calculation or choose to have higher limits or no asset limits.
Specific Financial Assistance Provided
The central benefit of the Qualified Individual program is the complete payment of the beneficiary’s monthly Medicare Part B premium. If approved, the state Medicaid agency assumes responsibility for this cost, paying the premium directly to Medicare. For example, if the standard Part B premium is $185 per month in 2025, the QI program provides an annual savings of $2,220 for the beneficiary.
This financial assistance is authorized by federal law under Title XIX of the Social Security Act. Receiving the QI benefit also automatically grants the beneficiary enrollment in the Medicare Part D Low-Income Subsidy (LIS), also known as Extra Help, which significantly reduces prescription drug costs. This secondary benefit helps lower or eliminate Part D premiums, deductibles, and copayments for covered medications.
It is important to understand the limitations of the QI program compared to other Medicare Savings Programs, such as the Qualified Medicare Beneficiary (QMB) program. QI only covers the Part B premium and does not extend to other out-of-pocket Medicare costs. The program does not pay for Medicare Part A deductibles, Part B deductibles, copayments, or coinsurance. This strict limitation to the Part B premium payment is a key distinction from the more comprehensive QMB program.
How to Apply for QI Benefits
The application process for the Qualified Individual program is managed at the state level by the State Medicaid Agency or local social services office. Interested beneficiaries should contact their local office to request an application and receive guidance specific to their state’s requirements. Although the program is federally established, the administration and specific processing steps vary by state.
When applying, individuals must provide documentation to verify eligibility, including proof of current income, resource statements, and evidence of Medicare Part A entitlement. Since the income limits are based on the Federal Poverty Level, the state office reviews documents like bank statements, tax returns, and Social Security award letters. The state determines the effective date of the benefit and can sometimes provide retroactive coverage for up to three months prior to the application date if the individual was eligible.
It is recommended to apply promptly if a beneficiary believes they meet the financial criteria. The QI program operates with a capped federal funding allocation for each state. Once a state’s allocated funds are exhausted for the year, no new applicants can be accepted, meaning benefits are granted on a first-come, first-served basis.