Medicare is a federal health insurance program for people over the age of 65, as well as some younger people with certain disabilities. About 62.6 million Americans are enrolled in Medicare, and while many health expenses are covered by the program, beneficiaries do have to pay some costs out-of-pocket.
That can really add up, especially for those with lower incomes. Fortunately, there are both federal and state programs to help relieve healthcare and prescription costs. Below is a look at a few programs that can help you avoid spending too much on Medicare, especially if you can’t afford to do so.
Medicaid is an assistance program run by state and local governments under federal guidance. It helps certain people of all ages with limited income and resources afford medical care. Other than a small copay, patients usually don’t pay anything out-of-pocket for covered medical expenses. Every state has its own eligibility rules, costs and other requirements.
Medicare Savings Programs (MSP)
If you have limited income and resources, you may qualify for one of four Medicaid-administered savings programs. Here are the program details and requirements as of 2022:
- Qualified Medicare Beneficiary (QMB) Program: This program covers premiums for Medicare Part A, which is for hospital care, and/or Medicare Part B, which is for doctor’s visits and certain outpatient care. Providers aren’t allowed to bill for deductibles, copayments or coinsurance on services covered by Medicare, except for outpatient prescription drugs. You may qualify if your income is under the Federal Poverty Level (FPL) and you have resources less than $8,400 (single) or $12,600 (married).
- Specified Low-Income Medicare Beneficiary (SLMB) Program: This program pays for Medicare Part B premiums only. You may qualify if your income is between 100-120% FPL and you have resources under $8,400 (single) or $12,600 (married).
- Qualifying Individual (QI) Program: This is another program that pays Medicare Part B premiums on a first-come, first-served basis. To receive these benefits, you have to apply each year. You may qualify if your income is between 120-135% FPL and you have resources of less than $8,400 (single) or $12,600 (married).
- Qualified Disabled and Working Individuals (QDWI) Program: This program pays premiums for Medicare Part A only. It’s reserved for people under age 65 with disabilities who recently started working again. To qualify, your income must be at or below 200% FPL (or 400% FPL in certain situations) with resources under $4,000 (single) or $6,000 (married).
Keep in mind that these program names and rules may vary by state.
Supplemental Security Income (SSI)
Not to be confused with Social Security benefits, SSI is a program administered by Social Security that’s designed to help people who are over the age of 65, blind or have disabilities and have limited income and resources. It provides a cash benefit to ensure that people are able to afford basic living expenses, such as food and shelter.
States pay the Medicare premiums for people who receive SSI benefits and qualify for Medicaid. Additionally, if you have Medicare and receive SSI benefits, you can qualify for Extra Help with Medicare Prescription Drug Coverage without needing to fill out a separate application (more on that next).
Extra Help is a program made for people with limited income and resources who need help specifically with Medicare Part D, or prescription drug costs. The amount of help you can receive through the Extra Help program depends on your specific income and resources, and the requirements may change each year.
You automatically qualify for Extra Help if you qualify for Medicaid, a Medicare Savings Program or SSI. You can also apply directly with your state Medicaid office.
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