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Do I qualify for financial assistance with Medicare?

Color portrait of Mark Pabst By Mark Pabst

When it comes to Medicare, you’ve earned each and every benefit. But it’s important to recognize early on your Medicare journey that the program is not without costs. Some of these are up front, like the monthly premium payments you make to maintain your Medicare coverage. Others are associated with your share of medical services, like the payments you make at the doctor’s office to cover your portion of the care you received, or the percentage of the cost of a hospital stay you are expected to pay.

These payments can add up, and not everyone is able to afford them. But there’s good news: you may be able to qualify for help paying for your Medicare costs.  Here are some available options. 

Help paying for Medicare premiums

Medicare Savings Programs (MSPs) are programs run by state governments that can pay for premiums, deductibles, copayments and coinsurance associated with Medicare for people with limited income and assets.

To learn more about the costs of Medicare, read the most frequently misunderstood Medicare terms.

Income is the amount of money you earn during the year.

Assets are any money you have in the bank, and the value of any investments (i.e., stocks, bonds and real estate). However, the house you live in and up to one car you own are not counted as assets when it comes to qualifying for a Medicare Savings Program.

There are three types of Medicare Savings Programs designed to help with paying costs for Original Medicare or Medicare Part B. They are distinguished by their income limits and what costs they help pay for. The programs include:

  • Qualified Medicare Beneficiary Program (QMB)
    • This program helps to pay Part B premiums and copayments. It also helps to pay deductibles and coinsurance for both Part A and Part B.
    • A single person can qualify for the program in 2018 with an income up to $1,032 per month.
    • A couple can qualify with a combined income of $1,392 per month.
    • The asset limits are $7,560 for an individual and $11,340 for a couple.
  • Specified Low-Income Medicare Beneficiary Program (SLMB)
    • This program helps to pay premiums for Part B.
    • A single person can qualify in 2018 with an income up to $1,234 per month.
    • A couple can qualify with a combined income of $1,666 per month.
    • The asset limits are $7,560 for an individual and $11,340 for a couple.
  • Qualified Individual Program (QI)
    • This program helps to pay premiums for Part B, but does not cover as large a percentage of the premium as the Specified Low-Income Medicare Beneficiary Program. 
    • In 2018 a single person can qualify with an income up to $1,386 per month.
    • A couple can qualify with a combined income of $1,872 per month.
    • The asset limits are $7,560 for an individual and $11,340 for a couple.

It is important to note that income limits to qualify for these programs are slightly different in Alaska and Hawaii. To learn more about the income limits in those states, see details on the Social Security Administration website.

It’s important to recognize early on your Medicare journey that the program is not without costs. But if you need help paying for Medicare, there are options available.

Help from Medicaid 

Medicaid is a health insurance program operated by each state that is designed to provide coverage for low-income and low-asset individuals. Each state sets its own limits on income, assets and the type of benefits they include in their Medicaid program.  It’s possible to be eligible for both Medicare and Medicaid. In fact, about 20 percent of people who receive Medicare benefits also receive help paying for Original Medicare – and most of these people also receive Medicaid benefits.  If you receive Medicare benefits and meet your state’s Medicaid eligibility requirements – income and asset requirements, plus citizenship and residency requirements for full Medicaid benefits – you can be full benefit dual eligible.

If you are a full benefit dual eligible, you can receive benefits included in both Medicaid and Medicare coverage. Here are some examples of what’s covered under Medicaid:

  • Some types of care you get at your home, like nursing that focuses on helping a person get in and out of bed or get dressed
  • Care delivered in a nursing home
  • Some prescription drugs not covered by Medicare Part D plans 

If you only meet the income and asset requirements of the Medicare Savings Program, you are a partial dual eligible and will receive assistance with Medicare costs, but will not receive additional Medicaid benefits.

Paying for a prescription drug plan

If you qualify for any of the Medicare Savings Programs described above, then you also automatically qualify for a program called Extra Help designed to assist with paying for your prescription drugs. Prescription drug coverage is provided through Medicare Part D, which is why Extra Help is also known as the Part D Low-Income Subsidy. Part D coverage generally comes with a premium, a deductible and a copayment. Learn more about Medicare Part D here.

But you don’t have to be in a Medicare Savings Program to receive help paying for your prescriptions under Extra Help. If your monthly income as an individual is up to $1,386 per month or $1,872 as a couple in 2018, you may be eligible. Asset limits in 2018 are up to $9,060 for an individual or $14,340 for a couple.  

Depending on which Medicare Part D plan you choose, the program can reduce or eliminate your plan’s premium and deductible, and also lower the cost you pay for the prescription drugs covered under your plan.

Finding out if you qualify

With so many different programs providing assistance for so many different types of costs, it’s easy to get confused. Fortunately, there is help available to find out if you qualify for financial assistance for Medicare. 

A good place to start is with BenefitsCheckup.org, a free online tool from the National Council on Aging that connects older adults with benefits they may qualify for. Insurance brokers and state-area offices on aging are also excellent resources.

Don’t be afraid to reach out for help in finding out if you qualify for assistance paying for your Medicare coverage. After all, you’ve earned it.  

About the author

Mark Pabst has worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.

Disclaimers

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.