Where One is Eligable or Ineligible for Specific Medigap Programs

Part 3, Chapter 10: Medicare and Medicare Related Programs: Medigap and Secondary Health Insurance Policies Page 4

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Medigap plans sold in three states -- Minnesota, Wisconsin, and Massachusetts -- may not adhere specifically to any of the ten standardized plans. The Medigap program in those states pre-dates the federal standardization of Medigap insurance, and was thus allowed to continue in force after the federal program was put into effect. Check with your state Department of Insurance or Division on Aging to determine which Medigap policies are available in your state.

If you are about to enroll in Part B of the traditional Medicare plan and you are unable to afford a Medigap policy, the federal government may be able to provide some help. For example, the Qualified Medicare Beneficiary program (QMB) and the Selected Low-Income Medicare Beneficiary program (SLMB) may pay for specific Medicare costs under certain conditions.

For eligible individuals, the Qualified Medicare Beneficiary program may provide payment for Medicare deductibles, co-insurance amounts, and premiums. The Selected Low-Income Medicare Beneficiary program may pay Medicare: Part B premiums. Eligibility depends on income and assets. The basic difference between the two programs in terms of eligibility is that the Qualified Medicare Beneficiary program is available to individuals whose income is below the poverty level and whose assets are limited, while the Selected Low-Income Medicare Beneficiary program is available to individuals whose income is slightly above the poverty level. (See Appendix B for a list of booklets that describe these programs in detail.)

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