What if I need help paying for Medicare?

Access to Medicare is an essential benefit for older individuals. While it is provided by the government, it does cost money. Most people are entitled to premium-free Part A due to their work history, but Medicare Part B and Part D both carry monthly premiums.  Fortunately, there are several programs designed to help qualifying individuals pay for their Medicare coverage. Some of these programs also offer added benefits that may not be covered by Original Medicare, such as dental, vision, or hearing coverage.

Continue reading to learn more about these programs and how they can assist you with your Medicare coverage.

Medicaid

Medicaid is a joint state and federal program. It is designed to help provide health coverage for low-income individuals.  This program can help supplement Medicare in two ways:

  1. By covering some of the costs associated with Medicare and/or
  2. By providing additional health benefits.  

People with certain income and asset levels may qualify for Medicaid coverage in addition to Medicare. Additionally, these “dual-eligible” individuals may have their Medicare-related costs covered and receive other benefits, including eyeglasses, hearing aids, and expanded skilled nursing facility coverage.

Medicare Savings Programs

For individuals who may not qualify for their state’s Medicaid coverage, but still need financial assistance, there are four Medicare Savings Programs provided by Medicaid. All of the savings programs are designed to pay for- or help offset – Medicare premiums, deductibles, coinsurance, and copayments. If you’d like to know whether you qualify, you should contact your state’s Medicaid program.

The Qualified Medicare Beneficiary (QMB) Program provides the most extensive coverage. It covers your Part A and Part B premiums, deductibles, copays, and coinsurance in full. Qualification is based on your monthly income and your savings (see chart below).

The Specified Low-income Medicare Beneficiary (SLMB) and the Qualifying Individual (QI) Programs will help pay for your Medicare Part B premium. Qualification is based on your monthly income and your countable financial resources (assets). You can visit this directory, which provides a link to each state’s Medicaid website, to learn which income and resources will be counted toward your own eligibility.

Like the SLMB, the Qualifying Individual (QI) Program is designed to offset the cost of your monthly Medicare Part B premium.

Program

Benefits

Monthly Income Level

Asset Limits

Qualified Medicare Beneficiary (QMB) – Premiums for Parts A & B

– Deductibles for Parts A & B

– Coinsurance for Parts A & B

Single: $1012 / Couple: $1372

Alaska: $1265 / $1715

Hawaii: $1163 / $1578

Single: $7390

Couple: $11090

Specified Low-Income Medicare Beneficiary (SLMB) – Part B Premium Single: $1214 / Couple: $1646

Alaska: $1518 / $2058

Hawaii: $1396 / $1894

Single: $7390

Couple: $11090

Qualifying Individual (QI) – Part B Premium Single: $1366 / Couple: $1852

Alaska: $1708 / $2315

Hawaii: $1570 / $2130

Single: $7390

Couple: $11090

 

Prescription Drug (Part D) Help

Low Income Subsidy (LIS), or Extra Help, is a program designed to help offset the costs of Part D coverage and prescription drugs. Extra Help may cover Part D premiums, deductibles, and copayments. People who qualify for the LIS program are also permitted to change Part D plans once a month at anytime during the year.

Coverage levels, deductibles, copays, and premiums vary by income level; for full income requirements and coverage details click here.

To Qualify for Extra Help, you must:

Have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); and

  • Live in one of the 50 States or the District of Columbia; and
  • Meet the qualifying asset and income levels for your state

Need a little help?

If you’re not sure whether or not you qualify for assistance from one of these programs, visit the Medicare.gov website, which provides information and resources for identifying your eligibility for (and level of) extra help.

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