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MassHealth EOM 24-03 March 2024 Page 2 of 5 Benefits QMB SLMB/QI Pays the person’s Medicare Part A premium

Pays the person’s Medicare Part B premium

Comes with Health Safety Net (HSN) coverage at acute care hospitals and community health centers (CHCs)

Helps with prescription drug costs by automatically enrolling the person in Medicare Part D Extra Help

Pays all costs of Medicare Part A and Part B covered services, like Medicare deductibles, coinsurance, and copays

Person receives a MassHealth card

Qualifying for MSPs A person may qualify for an MSP if their countable monthly income is within the following limits. Applicant Monthly Income Available Benefit Level Single Less than or equal to 190% federal poverty level (FPL) QMB

Above 190% FPL and less than or equal to 225% FPL SLMB or QI A married couple Less than or equal to 190% FPL QMB

Above 190% FPL and less than or equal to 225% FPL SLMB or QI * Income limits change each year on March 1.