Do You Qualify for Assistance with Medicare Costs?
Key Takeaways
Medicare and Medicaid have several income-based programs to assist in paying for your health care costs. These can include premiums , deductibles , copayments and coinsurance .
If you’re dual eligible, Medicare is the primary payer for your care. Medicaid typically pays the rest. Income-based Medicare Savings Programs can help cover additional costs associated with Original Medicare .
Extra Help, or Low Income Subsidy (LIS), helps pay for your Medicare Part D and keeps at-the-counter costs low.
Medicare is funded by the Federal Government through your tax dollars. Still, some people may need help paying for coverage. Out-of-pocket medical costs often eat up a considerable chunk of seniors’ budgets on things like monthly premiums and prescription drugs. Some rely on younger loved ones for assistance, while others simply don’t know where to turn.
Fortunately, there are several programs available for people that need help paying for insurance. Here’s an overview of potential options:
65 or Older With Low Income? You May Be Dual Eligible
If you’re 65 or older and have a limited income, you may qualify for both Medicare and full Medicaid coverage. When you are eligible for both programs, it’s called dual eligibility. Medicare will be the primary payer for your health care costs before Medicaid picks up some, or all, of the rest. Services covered can include:
- Prescription drugs
- Hospitalizations
- Physician services
- Skilled nursing facility care
- Home health visits
- Hospice care
Who’s Considered Dual Eligible?
Just like real estate, this is all about location, location, location. Medicaid is overseen by your state, and each has different eligibility rules. If your state has expanded Medicaid, your income and resource levels may be enough to qualify. For up-to-date dual-eligibility standards, contact your state’s Medicaid office.
Medicare Savings Programs Help With Part A and B Costs
Medicare Savings Programs (MSP) may help pay for Medicare Part A and B premiums, deductibles, coinsurance and copayments if you have limited income and resources. Being enrolled in an MSP may automatically qualify you for a low income subsidy. This will help you pay for Medicare Prescription Drug Plan (Part D) premiums and copays.
Who’s eligible for an MSP?
Generally, there are four different Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individuals (QDWI) Program
Each MSP can help enrollees based on their level of income and resources. Medicare Savings Programs (MSP) are federally funded and administered by the states. While the Federal Government has its eligibility standards, each state can establish its income levels and requirements.
Need Help With Prescription Costs? Look for Extra Help.
Extra Help is a Medicare program that helps enrollees pay for their Part D costs. Also called the Low Income Subsidy (LIS), Extra Help may pay some or all of your Part D premium and deductible. Recipients also enjoy significantly reduced copays and coinsurance at the counter.
Who’s Eligible for the Part D LIS?
Your income and resources determine your Part D LIS eligibility. You may qualify if:
- You’re single, make up to $21,870 per year, and have no more than $16,600 in resources.
- You’re married, make up to $29,580 per year, and have no more than $33,240 in resources together.
If you’re fully dual eligible or have an MSP to help pay for your Part B costs, you may be automatically qualified for Extra Help.
How Do Medicare and Medicaid Define Personal Resources?
To determine your resources, Medicare looks at your:
- Bank accounts
- Stocks
- Bonds
These are used, along with your income, to figure out if you qualify for cost assistance programs like MSPs or Extra Help. While the states may apply different eligibility standards when Medicaid is involved, certain assets won’t be counted against you when determining your eligibility, including wedding rings, your primary house, one car, and more.
Can I Get Help From A State Pharmaceutical Assistance Program for Prescription Drugs?
The answer here is — maybe. Some states offer a robust State Pharmaceutical Assistance Program (SPAP) to help pay your Part D costs. Many states, however, only allow certain drugs or don’t fund an SPAP at all. Medicare keeps a listing of the SPAPS offered in each state.
Need Help With Costs AND Care? PACE Yourself
Short for Programs of All-Inclusive Care for the Elderly, PACE is a program that pairs you with a team of healthcare providers when you need nursing home-level care but aren’t ready to move into one. PACE enrollees typically don’t pay copayments or deductibles for care and services approved by their PACE care team.
Who’s Eligible for PACE?
To be eligible for PACE, you need to:
- Be 55 or older
- Be certified by your state as needing nursing home-level care
- Live within a PACE service area
- Be able to live safely in your community with the help of a PACE team
If you’re on Medicare and qualify for PACE, you’ll pay separate monthly premiums for your long-term care and Part D drugs.
