A Guide to Cost-Saving Programs
At OneGroup, we understand that navigating the complexities of Medicare can be overwhelming. That’s why we’re here to help you make informed decisions about your healthcare coverage and maximize your savings. In this blog post, we’ll explore various cost savings programs available to Medicare beneficiaries, including Medicare Savings Programs (MSPs), the Elderly Pharmaceutical Insurance Coverage (EPIC) program, the Low-Income Subsidy (LIS), and Pharmaceutical Patient Assistance Programs.
Medicare Savings Programs: FBDE vs. QMB vs. QI1
Medicare Savings Programs (MSPs) are designed to help individuals with limited income and resources pay for Medicare premiums, deductibles, and other out-of-pocket expenses. There are three main types of MSPs:
- Full Benefit Dual Eligible (FBDE): This program provides comprehensive coverage for individuals who qualify for both Medicare and Medicaid. FBDE beneficiaries receive assistance with Medicare Part A and Part B premiums, as well as cost-sharing for services covered by both programs.
- Qualified Medicare Beneficiary (QMB): The QMB program helps pay for Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments. To qualify, individuals must meet specific income and resource limits. For 2025, the income threshold for QMB is $1,753 per month for an individual and $2,371 per month for a couple.
- Qualified Individual (QI1): The QI1 program assists with Medicare Part B premiums for individuals with slightly higher incomes than those eligible for QMB. The income limit for QI1 in 2025 is $2,355 per month for an individual and $3,189 per month for a couple. Unlike QMB, QI1 is a limited program, and applications are approved on a first-come, first-served basis.
EPIC and LIS: Additional Support for Prescription Costs
In addition to MSPs, there are other programs available to help with prescription drug costs:
- Elderly Pharmaceutical Insurance Coverage (EPIC): EPIC is a New York State program that provides seniors with additional coverage for prescription drugs. It works alongside Medicare Part D to lower out-of-pocket costs for medications. To qualify, individuals must be 65 or older, reside in New York State, and have an annual income below $75,000 for individuals or $100,000 for couples.
- Low-Income Subsidy (LIS): Also known as “Extra Help,” LIS is a federal program that helps low-income individuals pay for Medicare Part D premiums, deductibles, and copayments. Eligibility is based on income and resource limits, and those who qualify can receive significant savings on their prescription drug costs.
Pharmaceutical Patient Assistance Programs
Many pharmaceutical companies offer Patient Assistance Programs (PAPs) to provide free or low-cost medications to individuals who cannot afford them. These programs typically have specific eligibility criteria based on income and insurance status. By enrolling in a PAP, you can access the medications you need at a reduced cost or even for free.
Maximizing Your Savings with OneGroup
At OneGroup, we’re committed to helping you navigate the various cost savings programs available to Medicare beneficiaries. Our team of experts is here to provide personalized guidance and support, ensuring you make the most of your healthcare coverage. If you have any questions or need assistance with enrollment, don’t hesitate to reach out to us.
Stay informed, stay healthy, and let OneGroup be your trusted partner in navigating Medicare. Click here to get in touch OneGroup’s Medicare team for more information.
We are not a government agency. We are licensed insurance agents who discuss insurance programs such as Medicare Advantage, Medigap, and Medicare Part D Prescription Drug Coverage. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare to get information on all of your options.
This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.
Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.