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More than half a million Medicare beneficiaries rely on the Qualified Individual (QI) program to pay their Part B premium – a critical benefit afforded to older adults and people with disabilities with very low incomes and few assets. Reauthorization for the QI program is attached to the Medicare physician payment formula, known as the "Sustainable Growth Rate" (SGR), and has been extended annually in tandem with SGR. As bi-partisan, bi-cameral consensus emerges in Congress on a permanent fix to the flawed SGR Medicare physician payment formula, it is essential that a permanent extension of the QI program be a part of any agreement.

QI pays the $104.90 Medicare Part B premium for more than 520,000 Medicare beneficiaries with incomes between 120% and 135% of the Federal Poverty Level (FPL) (about $1,167 to $1,312 per month) and very limited resources (less than $7,160 for an individual).[1] Receipt of the QI benefit also automatically entitles individuals to, and enrolls them in, the full Medicare Part D Low-Income Subsidy (LIS), or Extra Help, to help them pay for prescription drugs. According to the Social Security Administration, the Low-Income Subsidy can save participating beneficiaries as much as $4,000 per year toward the cost of prescription drugs.[2]

A recent analysis by AARP found that Medicare beneficiaries living between 101% and 150% FPL spend more than one quarter (26.1%) of their income on out-of-pocket health care costs, more than any other income group.[3] Full Extra Help combined with the QI benefit can save beneficiaries in the group between 120% and 135% of poverty an estimated $5,200 in annual out-of-pocket health care costs.[4]

Without QI, many beneficiaries simply will not be able to afford their Part B premium and may consider dropping Part B, seriously limiting their access to doctors, therapy services, and durable medical equipment. If they later decide to re-enroll in Part B, they will face strict enrollment period restrictions and premium penalties. The loss of QI also puts them in jeopardy of losing their Part D low-income subsidy and access to affordable medications. Without QI, low-income seniors and people with disabilities may be forced to choose between necessities like warm clothes and nutritious food, and Medicare premiums.

We applaud Congress for its attempts to fix, once and for all, the flawed SGR formula. Medicare physicians deserve a sound payment system that is predictable. However, Medicare beneficiaries living near the poverty line also deserve predictability. If Congress intends to permanently fix the way the Medicare program pays doctors, it must also permanently ensure financial protection for poor Medicare beneficiaries.

In December SGR legislation, the Senate Finance Committee voted to extend QI for only five years. This represents a grave error. It is essential that the QI program be a part any final fix, and not be de-coupled from SGR through a five year extension. If QI is extended for only five years, there is tremendous risk that the political will to permanently reauthorize the program will be absent when those five years are up.

Contact your Congressperson today and let them know how important it is that permanent QI be a part of any permanent SGR fix.

[1] According to the Medicare-Medicaid Coordination office, in 2011 523,000 people were enrolled in QI. Medicare-Medicaid Coordination Office, “Data Analysis Brief: Medicare-Medicaid Dual Enrollment from 2006 through 2011,” (Centers for Medicare & Medicaid Services: February 2013), available at:
[2] Social Security Administration, “What Help Can I Receive?” (2013), available at:
[3] C. Noel Miller,” Medicare Beneficiaries’ Out-of-Pocket Spending for Health Care” (AARP; Dec. 2013) available at
[4] The Leadership Council on Aging Organizations Issue Brief, “Medicare Part B Premium Low-Income Protections Under the Qualified Individual (QI) Program Should be Made Permanent,” (July, 2013) available at:

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