Medicare Assistance Programs: Explaining the Basics
Key Takeaways
Do low-income seniors have to pay for Medicare? There are several different federal and state programs to assist beneficiaries with paying premiums and cost-sharing.
Read your mail! Medicare sends notifications by mail if you automatically qualify for these programs.
You can have both Medicare and Medicaid at the same time. Dual-eligibility is very helpful for covering the costs of Medicare and additional services not covered by Medicare.
What is Medicaid?
Medicaid is a federal and state program that helps individuals with medical costs. The assistance program is intended for people with limited income and resources. Medicaid is separate from Medicare, but the two programs can work alongside one another.
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Can You Have Medicare and Medicaid Together?
Yes. Beneficiaries that qualify for both Medicare and Medicaid are called dual eligible. Medicare is the primary payer for most services, but Medicaid covers benefits not offered by Medicare. Medicare coverage for dual-eligibles includes:
- Hospitalizations
- Physician services
- Prescription drugs
- Skilled nursing facility care
- Home health visits
- Hospice care
Medicaid requires states to cover specific items and services for dual-eligible beneficiaries:
- Long-term nursing facility services
- Home health services
States are required to cover certain services and have the option to expand coverage beyond the standard services. Because expansion is a state-by-state determination, some states may offer more expansive coverage than others.
Prescription Drugs and Part D
Medicare Part D plans cover prescription drugs, and some beneficiaries can qualify for extra help to pay the costs of their prescriptions. To qualify, an individual must meet specific requirements for income and resource limits.
Are you eligible for cost-saving Medicare subsidies?
Does Extra Help Work With Medicare Part D?
Extra Help is a federal program that helps pay for some, and in certain cases, most, out-of-pocket costs for Part D. To qualify for Extra Help, your income and assets may not exceed the determined threshold. Extra Help is also known as the Part D Low-Income Subsidy (LIS).
Automatic Enrollment
If you enroll in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you will automatically qualify for Extra Help. In this instance, you should receive notification from the Centers for Medicare & Medicaid Services (CMS) to let you know you don’t need to apply.
Extra Help Benefits
After you qualify for the Extra Help program, your income and assets will determine if you’re eligible for full or partial Extra Help. The program offers the following:
- Pays Part D premiums and Rx deductibles up to state-determined amounts allowed
- Lowers the cost you pay for prescription drugs
- You receive a Special Enrollment Period (SEP) once per quarter for the first nine months of every calendar year. During the SEP you can switch between Part D plans.
- Eliminates Part D late enrollment penalty
What Is A Medicare Savings Program?
A Medicare Saving Program allows beneficiaries to receive help from their state to pay Medicare premiums. Depending on your circumstances, you may also receive help to pay Part A and Part B deductibles, coinsurance and copayments.
What extra benefits and savings do you qualify for?
Does Supplemental Security Income (SSI) Affect Medicare Premiums?
People with limited income, disabled, blind, 65 or older can qualify to receive this monthly benefit from the Social Security Administration (SSA). For dual-eligible Medicare beneficiaries who receive SSI benefits, your state of residence will pay your Medicare premiums.
FAQs
If you don’t enroll in a Medicare drug plan when you’re first eligible, you may pay a late enrollment penalty if you join later. You’ll have to pay this penalty for as long as you have Medicare prescription drug coverage. However, you won’t pay the penalty if you get Extra Help Keep in mind that this applies to Part D late penalties and not Part B late penalties.
Applying for Extra Help is easy. Just complete Social Security’s Application for Extra Help with Medicare Prescription Drug Plan Costs. You have options to:
- Apply online
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone.
- Request an application and apply at your local Social Security office
After you apply, Social Security will review your application and send a letter to you to let you know if you qualify for Extra Help. After you are eligible, you can choose a Medicare prescription drug plan. If you do not select a plan, the Centers for Medicare & Medicaid Services will do it for you.
Yes, you can have both because MSP and Medicaid are two separate programs. You can have both at the same time. The medical coverage is different for both programs. The Qualified Medicare Beneficiary (QMB) program only covers medical benefits that Medicare covers.
