What are the basic Medicare eligibility requirements?

To be eligible for Medicare, you must be at least 65 years old and a U.S. citizen or a permanent legal resident who has lived in the United States for at least five continuous years.

How does my work history affect my Medicare eligibility?

If you have paid Medicare taxes for about 10 years, you typically qualify for premium-free Part A hospital insurance. Those with shorter work histories may still qualify by paying monthly premiums.

Can individuals under 65 qualify for Medicare?

Yes. Individuals under 65 can qualify if they have received Social Security Disability Insurance (SSDI) benefits for 24 months or have specific medical conditions such as End-Stage Renal Disease (ESRD) or ALS.

What is the Initial Enrollment Period for Medicare?

The Initial Enrollment Period begins three months before your 65th birthday and ends three months after it—a seven-month window that allows you to enroll without late-enrollment penalties.

What is the main difference between Original Medicare and Medicare Advantage?

Original Medicare is administered by the federal government and includes Part A and Part B. Medicare Advantage (Part C) is offered by private insurers and combines hospital, medical, and often drug coverage with different cost structures and networks.

How does hospitalization coverage differ under each program?

Original Medicare uses benefit periods with deductibles and coinsurance after 60 days, while Medicare Advantage typically charges daily copays for a limited number of days and caps annual out-of-pocket costs.

What is the 90-day hospitalization rule under Original Medicare?

After 90 days in one benefit period, you begin using 60 lifetime reserve days at a higher daily cost. Once those are used, you pay all remaining hospital costs yourself.

Does Medicare Advantage have an annual spending limit?

Yes. Every Medicare Advantage plan includes a maximum out-of-pocket (MOOP) limit. In 2025 it can be up to $8,850 for in-network care, after which the plan pays 100% of covered services.

What is the main difference between Original Medicare and Medicare Advantage?

Original Medicare is administered by the federal government and includes Part A and Part B. Medicare Advantage (Part C) is offered by private insurers and combines hospital, medical, and often drug coverage with different cost structures and networks.

How does hospitalization coverage differ under each program?

Original Medicare uses benefit periods with deductibles and coinsurance after 60 days, while Medicare Advantage typically charges daily copays for a limited number of days and caps annual out-of-pocket costs.

What is the 90-day hospitalization rule under Original Medicare?

After 90 days in one benefit period, you begin using 60 lifetime reserve days at a higher daily cost. Once those are used, you pay all remaining hospital costs yourself.

Does Medicare Advantage have an annual spending limit?

Yes. Every Medicare Advantage plan includes a maximum out-of-pocket limit. In 2025 it can be up to 8850 dollars for in-network care, after which the plan pays 100 percent of covered services.

What are the key parts of family health insurance?

Premiums, deductibles, copays, and out-of-pocket maximums determine how much a family spends on health insurance each year.

How do I find affordable ACA coverage?

Visit GenerationHealth.me/aca-marketplace-quotes to compare ACA plans and see if you qualify for subsidies that lower your monthly premium.

Do family health plans include dental and vision?

Most standard health plans do not include dental and vision. Families should add standalone coverage to complete their protection.

What is the main difference between Medicare Plan G and Medicare Advantage?

Medicare Plan G works with Original Medicare to cover most out-of-pocket costs after the Part B deductible. Medicare Advantage replaces Original Medicare with a private plan that includes copays, networks, and often drug and extra benefits.

Is Medicare Plan G better than Medicare Advantage?

Plan G is better if you want predictable costs and doctor freedom. Medicare Advantage can be better if you want lower premiums and built-in extras like dental and vision.

What are the four main parts of Medicare?

Medicare consists of four primary parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage). Each part covers different aspects of healthcare needs.

How do I enroll in Medicare, and what are the important enrollment periods?

You can enroll in Medicare during your Initial Enrollment Period, which begins three months before your 65th birthday and lasts for seven months. There are also General Enrollment Periods from January 1 to March 31 each year and Special Enrollment Periods for unique circumstances like continued employment or qualifying life events.

What are the costs associated with each Medicare part?

Part A is often premium-free for most beneficiaries but includes a $1,676 deductible per benefit period. Part B has a standard $185 monthly premium and a $257 annual deductible in 2025. Costs for Part C (Medicare Advantage) and Part D (drug coverage) vary by plan and include potential copays and premiums.

What are the penalties for missing Medicare enrollment deadlines?

Missing Medicare enrollment deadlines can result in permanent financial penalties. For Part D, the penalty adds 1% of the national base beneficiary premium for each month without coverage, applied permanently. Late enrollment in Part B also triggers ongoing higher monthly premiums.

What Is the SLMB Program and How It Helps You Save on Medicare Costs in 2025 -

💰 What Is the SLMB Program for 2025?

The Specified Low-Income Medicare Beneficiary (SLMB) program is one of four Medicare Savings Programs designed to help people with limited income and assets. SLMB specifically pays for your Medicare Part B premium, which covers doctor visits, outpatient care, and preventive services.

In 2025, the standard Part B premium is about $185.00 per month — and SLMB covers this amount for qualified individuals.

🩺 How SLMB Works With Medicare

When you qualify for SLMB:

You keep your regular Medicare Parts A and B coverage.
The state pays your Part B premium directly to Medicare through Medicaid funds.
You’ll see a higher Social Security check because your premium is no longer deducted.

💳 How SLMB Works With Medicaid

SLMB is a partial Medicaid benefit, meaning it doesn’t pay your deductibles or copays.
However, you’re considered dually eligible for both Medicare and Medicaid.
That status can make you eligible for:

$0 premium Medicare Advantage D-SNP plans
Extra Help (Low-Income Subsidy) to reduce prescription drug costs

📊 SLMB Eligibility Limits (2025)

Category	Individual	Married Couple
Monthly Income Limit	≤ $1,661	≤ $2,239
Asset Limit	≤ $9,090	≤ $13,630

(Actual limits may vary slightly by state.)

📝 How to Apply

You apply through your state Medicaid office.
Have these ready:

Proof of income (pay stubs, Social Security award letter)
Bank statements
Your Medicare card

Once approved, your state notifies Medicare and Social Security. Your Part B premium will stop being deducted within 1-2 months.

🕊️ Need Help Enrolling?

If you want to know whether you qualify for SLMB or how to combine your benefits with a Dual-Eligible Medicare Advantage plan, contact:8287613324
Robert Simm | GenerationHealth.me
Licensed Medicare Broker – Serving North Carolina, Virginia, Georgia & Texas.

🧩 Summary of Medicare Savings Programs

Program	Pays For	Full Medicaid?	Extra Help for Drugs?
SLMB	Part B Premium	❌ No	✅ Yes
QMB	Parts A & B Premiums + Deductibles	✅ Yes	✅ Yes
QI	Part B Premium (similar to SLMB)	❌ No	✅ Yes

🧠 Frequently Asked Questions About the SLMB Program (2025)

❓ What does the SLMB program pay for?

The Specified Low-Income Medicare Beneficiary (SLMB) program pays your Medicare Part B premium, which is $185.00 per month in 2025. This premium covers doctor visits, outpatient care, lab tests, and preventive services.

❓ Does SLMB provide full Medicaid coverage?

No. SLMB is a partial Medicaid benefit. It only pays your Part B premium and doesn’t cover deductibles, coinsurance, or other out-of-pocket costs.
However, qualifying for SLMB makes you dually eligible, meaning you have both Medicare and partial Medicaid status.

❓ Who qualifies for SLMB in 2025?

To qualify, you must:

Be enrolled in Medicare Part A.
Have limited income and assets within your state’s SLMB limits.
- Individual: Income ≤ $1,661 /month, assets ≤ $9,090.
- Couple: Income ≤ $2,239 /month, assets ≤ $13,630.
  (These numbers vary slightly by state.)

❓ How do I apply for the SLMB program?

You apply through your state Medicaid office.
Bring:

Proof of income (pay stubs or Social Security award letter)
Recent bank statements
Your red, white, and blue Medicare card

Once approved, your state pays your Part B premium directly to Medicare. You’ll see an increase in your Social Security check once the deduction stops.

❓ Can I have SLMB and a Medicare Advantage plan?

Yes! Many people with SLMB enroll in a Dual-Eligible Special Needs Plan (D-SNP). These plans often include extra benefits such as dental, vision, hearing, and prescription coverage — usually at $0 monthly premium.

❓ Does SLMB help with prescription drug costs?

Yes. SLMB automatically qualifies you for Extra Help (the federal Low-Income Subsidy). This program lowers your Part D premiums, copays, and deductibles, often reducing prescriptions to $0–$4 per medication.

❓ How soon does SLMB start after applying?

Most states process SLMB applications within 30–60 days. Once approved, your Part B premium deduction stops, and you’ll receive a slightly higher Social Security payment each month.

💡 Need Assistance?

If you’re unsure whether you qualify or want to explore Dual-Eligible Medicare Advantage (D-SNP) plans in your area, contact: 8287623324
Robert Simm | GenerationHealth.me | Licensed Medicare Broker
Serving North Carolina, Virginia, Georgia & Texas

👨‍⚕️ About the Author

Robert Simm is a licensed Medicare broker and founder of GenerationHealth.me — a trusted resource helping seniors and families navigate Medicare, Marketplace, and supplemental health coverage with confidence.

With years of hands-on experience assisting clients across North Carolina, Virginia, Georgia, and Texas, Robert specializes in Medicare Advantage, Medicare Savings Programs, Dual-Eligible (D-SNP) plans, and ACA Marketplace options. His approach blends real-world expertise with education-first guidance, helping clients make informed, stress-free coverage decisions.

When he’s not meeting with clients or hosting local Medicare workshops, Robert enjoys volunteering in his community and working on health education outreach initiatives that empower individuals to understand their benefits and live healthier lives.

📞 Need help with your Medicare options?
Visit GenerationHealth.me or call (8287613324) for a personalized coverage review today.

Tagged Dual Eligible, Medicaid, Medicare Savings Programs, SLMB Program

What Is the SLMB Program and How It Helps You Save on Medicare Costs in 2025