Financial Aid for Medicare

You may need help paying for Medicare. The program has monthly premiums for Part B (doctor's visits) and Part D (prescription drugs), deductibles, and copays each time you get care. A small number of people also have to pay premiums for Part A. If you can't afford these costs, you may qualify for financial aid to pay all or part of these costs. In most states, you qualify for help based on how much money you make each year and your financial assets -- how much money you've saved or have invested.

Aid programs include:

  • Medicare Savings Programs. This can help pay for doctor visits, tests, hospital costs, and more.
  • Part D Extra Help. This covers your prescription drug costs.
  • Medicaid . This covers many medical costs and services. It's run by the state where you live.

The three main programs to help pay for Medicare cover some of the same things. But they cover different types of care and services, too. To qualify, you have to meet different rules for each one. Look at each one carefully to decide what is best for you.

Medicare Savings Programs

These state programs may help pay for your monthly Medicare premiums, copayments, and more. They're open to certain people with low incomes.

You should be able to save on your out-of-pocket costs. How much you save will vary depending on the state you live in.

The programs are:

  • The Qualified Medicare Beneficiary Program, which helps with Part A and B premiums and Part A and Part B deductibles, coinsurance, and copays.
  • The Specified Low-Income Medicare Beneficiary Program, which helps with Part B premiums.
  • The Qualifying Individual Program, which also helps with Part B premiums.
  • The Qualified Disabled and Working Individuals Program, which helps with Part A premiums. Although most people do not have to pay a premium for Part A, some people who are under age 65 may lose their premium-free Part A benefits when they return to work. This program can help pay that premium.

Whether you qualify depends on your income and assets. To find out if you qualify, go to Medicare.gov to see the income limits for each of the programs.

To apply, call your state's medical assistance or Medicaid office. To get your local number, call 800-MEDICARE (800-633-4227) or visit Medicare.gov.

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Part D Extra Help

This can help pay for the Part D monthly fee and the cost of prescriptions. In 2016, you may be able to pay as little as $2.95 for generic drugs and $7.40 for brand-name drugs that are covered by the program. These prices change each year.

To qualify, your yearly income for 2016 must be less than $17,820 for one adult or $24,030 for a couple.

Your assets, which include savings, stocks, or bonds, must be less than $13,640 if you're only getting coverage for yourself, and less than $27,250 for a couple.

If you qualify for any of the Medicare savings programs, receive Supplemental Security Income (SSI) benefits, or qualify for Medicaid you automatically qualify for the Part D Extra Help program. You may get a colored notice from Medicare if you qualify for Extra Help. A purple notice means you automatically qualify for Extra Help. A yellow or green notice means you are automatically enrolled in Extra Help, and an orange notice means that your copayment amounts will change next year. If you get a notice on grey paper, it means you no longer automatically qualify for Extra Help and you need to apply to find out if you can still enroll.

You can apply online at the Social Security web site. Or you can call Social Security at 800-772-1213 or go to your local Social Security office. You also can apply by contacting your local department of human services or state Medical Assistance or Medicaid Office. You can find contact information for your State Medical Assistance Office at Medicare.gov.

You may have to wait up to 4 months to find out if you qualify. If you do, you'll get a letter saying so. Then, you may get money back for any premiums you paid while you waited.

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Medicaid

This is low or no-cost health care for people with very low incomes or assets. It covers lots of benefits that Medicare doesn't. It is set up by the federal government, but it's run by the states. The program varies from state to state.

To qualify for Medicaid, your income must not be above a certain amount. This amount is different for each state.

For more details on Medicaid and how to apply, use the insurance and coverage finder at healthcare.gov. Even if you missed the annual open enrollment period (from November 1 to January 31st each year), if you qualify for Medicaid you can enroll at any time.

More Help for Lowering Medicare Costs

If you do not qualify for one of the programs described above, you may be able to lower your Medicare costs by joining a Medicare Advantage Plan. If you join a Medicare Advantage plan you must follow the plan’s rules which usually require you to see a provider in their network. You cannot go to any provider that accepts Medicare as you can with traditional Medicare. You can only join a Medicare Advantage plan during the annual open enrollment (October 15-December 7).

If you remain in the traditional Medicare program, you may be able to lower your costs by buying a Medicare supplemental plan, which is also called a Medigap plan.

If you still have questions or need individual help, contact your local State Health Insurance Assistance Program (SHIP). SHIPs are funded by the federal government to provide personalized counseling and assistance to people with Medicare. You can find your local SHIP at https://www.shiptacenter.org/

WebMD Medical Reference Reviewed by Sarah Goodell on July 31, 2016

Sources

SOURCES:

Centers for Medicare & Medicaid Services: "Get help with your Medicare Costs," "Medicare Savings Programs," "4 Programs That Can Help You Pay Your Medical Expenses," "Medicare and You," "Save on Drug Costs."

Department of Health and Human Services: "Eligibility."

Kaiser Family Foundation: "Filling the Financial Gaps in Medicare Coverage."

Medicare Rights Center: "Find Out If You Qualify," "Program Financial Eligibility Guidelines."

Michigan Department of Community Health: "Medicare Savings Program."

Minnesota Department of Human Services: "People who need help with Medicare costs."

Social Security Administration: "Apply online for Extra Help with Medicare prescription drug costs," "Apply for Medicaid."

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