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Tennessee Medicare Savings Programs: How to Apply Through TennCare for Help With Medicare Costs

The Greek Revival Tennessee State Capitol in Nashville, with its tall stone columns and a cupola tower against a blue sky with white clouds, seen from below in afternoon light, above hook text: Medicare costs in TN? Savings programs.

If Medicare premiums, deductibles, and copays are hard to keep up with, a Tennessee Medicare Savings Program may help, and you apply through TennCare. TennCare says these programs help people with limited income by paying some of Medicare’s out of pocket costs, such as premiums, deductibles, coinsurance, and copayments. The rules are the same in Memphis, Nashville, Knoxville, Chattanooga, Clarksville, Jackson, Johnson City, Cookeville, or anywhere else in Tennessee.

This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in Tennessee. We are not Medicare, CMS, Social Security, TennCare, or an insurance company, and we do not decide who qualifies. We do not quote prices or name plans here. See TennCare’s own answers in the TennCare FAQ.

The short answer

  1. There are four programs, and each pays a different share of Medicare costs.
  2. You must be enrolled in Medicare Part A, and your income and resources must be under TennCare’s limits. TennCare decides who qualifies, and the limits can change every year.
  3. You can apply online, by phone, or on paper through TennCare Connect.

The four programs

TennCare describes them this way:

  1. Qualified Medicare Beneficiary (QMB) helps with Part A and Part B premiums, deductibles, coinsurance, and copayments.
  2. Specified Low-Income Medicare Beneficiary (SLMB) helps with Part B premiums only.
  3. Qualifying Individual (QI) helps with Part B premiums, but TennCare says it is offered first come, first served until funds run out. Medicare.gov adds that you must apply every year to stay in QI, and priority goes to people who had it the year before.
  4. Qualified Disabled and Working Individuals (QDWI) helps with Part A premiums for certain people with disabilities who are working.

Who may qualify

TennCare’s Eligibility Reference Guide sets each program’s income limit as a share of the federal poverty level:

  1. QMB: up to 100%.
  2. SLMB: above 100% and up to 120%.
  3. QI: above 120% and up to 135%, and you can’t be getting another kind of Medicaid.
  4. QDWI: up to 200%.

There are also resource limits, which count things like money in the bank. We don’t list dollar figures here because they change, so check with TennCare Connect or see the TennCare Eligibility Reference Guide. Medicare.gov also says you may still qualify in your state even if your income or resources are higher than the federal limits, because some states don’t count certain income or resources. When in doubt, apply.

What QMB means at the doctor’s office

Medicare.gov says that if you qualify for QMB, Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments. You may still get a bill for a small Medicaid copayment, if one applies. Show your Medicare card and your Medicaid or QMB card each time you get care. See Medicare.gov’s Medicare Savings Programs page.

The link to Extra Help with drug costs

Medicare.gov says that if you qualify for QMB, SLMB, or QI, you also get Extra Help paying for your prescription drugs. It works the other way too: you can apply for Extra Help and Medicare Savings Programs at the same time, and when you apply for Extra Help through Social Security, Social Security sends your information to the state to start a Medicare Savings Program application, unless you tell them not to. See Medicare.gov’s Extra Help page.

Medicare.gov also says that if you have Medicaid or get Extra Help, you can change your drug coverage once per calendar month, and the change starts the first day of the next month. That is in addition to annual enrollment, which runs October 15 to December 7. Our Tennessee Medicare annual enrollment guide covers what to review this fall.

How to apply in Tennessee

TennCare lists three ways to apply for Medicaid and Medicare Savings Programs:

  1. Online through TennCare Connect. Your local Department of Human Services (DHS) office also has kiosks you can use to apply online.
  2. By phone: call TennCare Connect at 1-855-259-0701. If you have a hearing or speech problem, call the Tennessee Relay Service at 1-800-848-0298 and ask to be connected to TennCare Connect.
  3. On paper: fill out the application and return it to a local DHS office, or mail or fax it to TennCare.

Have your Medicare card, proof of income (such as your Social Security benefit letter or pension statements), and recent bank statements ready. If you get a letter asking for more information, answer by the date on the letter.

Unbiased help in Tennessee

The Tennessee State Health Insurance Assistance Program (TN SHIP) offers unbiased Medicare counseling and says it does not promote any insurance agency. Counselors can help with Medicare questions and with applying for programs like these. Call 1-877-801-0044 or see the TN SHIP page.

If you live across the line in Kentucky, Virginia, North Carolina, Georgia, Alabama, Mississippi, Arkansas, or Missouri, apply in your own state. Our agent is not licensed in those states, so use Medicare.gov or that state’s SHIP counselors through SHIP’s national locator.

Watch for scams

Medicare.gov says Medicare will never call you to sell you anything or visit you at your home. If someone pressures you, hang up. See Medicare.gov’s fraud page.

Someone in your house under 65?

If a spouse or adult child needs coverage, read our TennCare vs Marketplace guide and our Tennessee open enrollment guide.

How we help

We are licensed in Tennessee and help people with Medicare by phone and online, in English or Spanish. Learn more on our Tennessee health insurance help page. We can explain how a Medicare Savings Program fits with your Medicare coverage, point you to TennCare Connect to apply, and once you know the outcome, compare Medicare Advantage plans, Medigap policies, and drug plans with you and help you enroll if you decide to. We are not Medicare, TennCare, or the government, and the decision is always yours.

Want to talk it through?

Have your Medicare card, your most recent Social Security or pension letter, and your list of doctors and prescriptions ready, and we can go over your options together.

Call (321) 315-0054 | agent@inshh.com

We do not offer every plan available in your area. Currently we represent 10 organizations which offer 489 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, is available 24 hours a day, 7 days a week, except some federal holidays. Instant Health Help is not connected with or endorsed by the U.S. government or the federal Medicare program.

Featured photo: Tennessee State Capitol, Nashville by w_lemay, CC BY-SA 2.0, cropped with text added.