Medicare can be expensive, but many people don’t realize that assistance programs are available to help cover the costs. Whether you have a limited income, high medical bills, or other financial challenges, these programs can make Medicare more affordable.
This chapter will explore the different types of assistance programs, who qualifies, and how to apply.
Medicare Savings Programs (MSPs)
Medicare Savings Programs are state-run programs that help cover Medicare premiums and other costs. There are four main types of MSPs, each with its eligibility requirements and benefits:
- Qualified Medicare Beneficiary (QMB) Program
- What it covers: The QMB program helps pay for Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments.
- Eligibility: To qualify, your monthly income must be below $1,094 if you’re single or $1,472 if you’re married. Your assets must also be below $7,970 (single) or $11,960 (married).
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- What it covers: The SLMB program helps pay for Medicare Part B premiums.
- Eligibility: To qualify, your monthly income must be below $1,308 if you’re single or $1,762 if you’re married. Your assets must also be below $7,970 (single) or $11,960 (married).
- Qualified Individual (QI) Program
- What it covers: The QI program also helps pay for Medicare Part B premiums. Unlike the QMB and SLMB programs, it is funded on a first-come, first-served basis.
- Eligibility: Your monthly income must be below $1,469 if you’re single or $1,980 if you’re married. Your assets must also be below $7,970 (single) or $11,960 (married).
- Qualified Disabled and Working Individuals (QDWI) Program
- What it covers: The QDWI program helps pay for Medicare Part A premiums if you’re under 65, disabled, and returning to work.
- Eligibility: To qualify, your monthly income must be below $1,308 if you’re single or $1,762 if you’re married. Your assets must also be below $7,970 (single) or $11,960 (married).
Extra Help with Prescription Drug Costs
The Extra Help program, known as the Low-Income Subsidy (LIS), helps pay for Part D prescription drug costs. Extra Help can significantly reduce your premiums, deductibles, and copayments for prescription drugs depending on your income and assets.
- Eligibility: To qualify, your annual income must be below $21,870 if you’re single or $29,580 if you’re married. Your assets must also be below $16,660 (single) or $33,240 (married).
- How to apply: You can apply for Extra Help through the Social Security Administration (SSA) or your state Medicaid office.
State Pharmaceutical Assistance Programs (SPAPs)
Some states offer State Pharmaceutical Assistance Programs (SPAPs) that help pay for prescription drugs. These programs vary by state and may be available to people who don’t qualify for Extra Help but still need assistance with their medication costs.
- Check your state: Visit your health department website or contact your state’s Medicaid office to determine if you qualify for an SPAP.
Medicaid
If your income and assets are very limited, you may qualify for Medicaid. Medicaid can help pay for Medicare premiums, copayments, and services that Medicare doesn’t cover, such as long-term care.
- Dual eligibility: If you qualify for both Medicare and Medicaid, you’re considered “dual eligible,” Medicaid will help cover your Medicare costs. Dual eligibles often qualify for Special Needs Plans (SNPs) through Medicare Advantage, which provides tailored coverage for those with Medicare and Medicaid.
Key Mistake: Not Applying for Assistance Programs
Many assume they don’t qualify for assistance programs or aren’t aware that these programs exist. One of Medicare’s biggest mistakes is not applying for programs that could significantly reduce healthcare costs. Even if you think you won’t qualify, it’s worth checking to see what’s available in your state.
Conclusion
Medicare assistance programs can make a big difference in managing your healthcare costs, especially if you’re on a fixed income. From Medicare Savings Programs to Extra Help and Medicaid, these options are worth exploring to help reduce your financial burden.
In the next chapter, we’ll discuss the importance of choosing the right Medigap plan and ensuring you get the necessary coverage.
Chapter 7: Choosing the Right Medigap Plan