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Is there help for me if I can’t afford Medicare’s premiums?

Medicare Savings Programs (MSP) can pay Medicare Part A and Medicare Part B premiums, deductibles, copays, and coinsurance for enrollees with limited income and limited assets.

Q: Is there help for me if I can’t afford Medicare’s premiums?

A: Yes. Medicare Savings Programs (MSP) can help with premiums and out-of-pocket costs.

What are Medicare Savings Programs?

Medicare Savings Programs (MSP) can pay Medicare Part A and Medicare Part B premiums, deductibles, copays, and coinsurance for enrollees with limited income and limited assets. There are four different types of MSPs, and they provide varying benefits. Two of the MSPs only help to pay Medicare Part B premiums (but not Part A premiums or Medicare cost sharing), and one MSP helps disabled working individuals pay their Part A premiums.

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The four types of Medicare Savings Programs each have different requirements in terms of the financial situation that will make a person eligible, including income limits and asset (resource) limits. These are federal standards; states can have more generous guidelines for MSPs, and several don’t use asset limits (in other words, they base eligibility on income alone).

As of 2020, the federal asset limits for most MSPs are $7,860 for an individual, and $11,800 for a couple. But the federal income limits are different for each type of MSP (these income limits are for the continental U.S.; income limits are higher in Alaska and Hawaii):

  • Qualified Medicare Beneficiary Program (QMB). Helps to pay premiums for Part A and Part B, as well as copays, deductibles, and coinsurance. This is the most robust MSP, and has the lowest income limits for eligibility. A single person can qualify in 2020 with an income up to $1,084 per month ($1,457/month for a couple).
  • Specified Low Income Medicare Beneficiary Program (SLMB). Helps to pay premiums for Part B. A single person can qualify in 2020 with an income up to $1,296 per month ($1,744/month for a couple).
  • Qualified Individual Program (QI). Helps to pay premiums for Part B. A single person can qualify in 2020 with an income up to $1,456 per month ($1,960/month for a couple).
  • Qualified Disabled and Working Individuals Program (QDWI). Helps to pay Part A premiums. This MSP is for people who are disabled but have returned to work, and lost their premium-free Medicare Part A. The income limits are higher (up to $4,339/month for an individual, and $5,833 for a couple in 2020), but the asset limit is lower, at $4,000 for an individual and $6,000 for a couple.

If you qualify for QMB, SLMB, or QI, you’ll also receive Extra Help, a federal program that lowers prescription drug and premium costs under Medicare Part D.

Here’s more information about MSPs, including the federal income and asset limits that apply to each type of MSP in 2020. Note that assets include money in the bank, and investments in stocks and bonds. But your primary residence and one car are not counted as assets, nor are your household and personal items. Here is more information about MSP benefits in each state.

How do I apply for Medicare Savings Programs?

Eligibility for MSPs is determined by your state Medicaid office, as the funding for MSPs comes from the Medicaid program. Medicaid is jointly run by the federal and state governments. If you think you might be eligible, you can apply for an MSP at your Medicaid or social services office (contact information for each state is available here).

Time to sign up for Medicare?Medicare urges beneficiaries to apply for MSP benefits if there’s any chance they might be eligible, even if they initially think that their income or resources are too high to qualify. This is particularly important given that states can have more lenient eligibility rules than the federal guidelines. So depending on the state, a person might end up being eligible for an MSP even if they assumed they wouldn’t after looking at the federal eligibility rules.

This page explains what documentation is needed for the MSP application process, and what to expect when you’re applying for benefits.

It’s important to understand that you have to reapply and re-qualify for your MSP benefits each year. You may get a renewal notice in the mail from your state Medicaid office explaining what you need to do. If not, you’ll need to reach out to your state Medicaid office to see what needs to be done to qualify for ongoing MSP benefits in the coming year.

You can also contact your State Health Insurance Assistance Program (SHIP) with questions related to MSPs.

Medicare-Medicaid dual eligibility

People who are eligible for MSPs are covered by Medicare, but receive assistance with premiums (and in some cases, cost-sharing) from the Medicaid program. But some low-income Medicare enrollees are eligible for full Medicaid benefits, in addition to Medicare.

About 20 percent of Medicare beneficiaries are dually eligible for both Medicare and Medicaid. This is true of older seniors who need nursing home care and have exhausted their own funding to cover the cost. Medicare does not cover custodial long-term care, but Medicaid does, if the person has a low income and few assets. Almost two-thirds of the people living in American nursing homes are covered by Medicaid (almost all of them are also covered by Medicare).

Is there financial help for Medicare Part D coverage?

Medicare offers “Extra Help” for Medicare enrollees who can’t afford their Part D prescription drug coverage. In 2020, if you’re a single person earning less than $1,615 per month ($2,175 for a couple), with financial resources that don’t exceed $14,610 ($29,160 for a couple), you may be eligible for “Extra Help.” The program will reduce or eliminate your Part D plan’s premium and deductible, and also lower the cost of prescription drugs to a very small amount.

MSP enrollees automatically receive Extra Help, as do Medicare enrollees who receive Medicaid or Supplemental Security Income (SSI).

Many states offer State Pharmacy Assistance Programs (SPAPs), which help low-income individuals pay for prescription drugs based on their financial situation. You can use this Medicare tool to search for your state’s SPAP.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Delores Pace
1 year ago

I got a notice that I have to pay for my Medicare. I am disabled and am 88 years old. I was getting $1295.00 a month Social Security. and now in February it will go down to $870.00 a month. I have a part time job only making $620.00 a month. to help pay my rent and utilities and food. Why has this happened? D. Pace

Josh Schultz
1 year ago
Reply to  Delores Pace

You should call Social Security to get additional details on why your monthly benefit is decreasing so much. Medicare usually doesn’t cost that much, so something else must be happening. Your Social Security benefit statement may also help clarify the situation.

midori k thalansy
5 months ago
Reply to  Josh Schultz

because they took out part b for 2-3 months then your check will go back to 1295.00 minus the part b 148.50 as of 2021

Karrie Ann Robichaux
1 year ago

No one even helps with step down programs in Louisiana. I’ve called Governor’s office several times. No one returns call. My gross Soc Sec disabled and I turn 60 in March. I have been disabled since 2008. I’m $17 over and I know there is a stepdown for MSP. I believe I’m also eligible for medicade possibly if only someone would look into to it. Who steps in to help when State is not. It’s just frustrating when you know they receive federal grants to help those on the threshold. Please help. Thank you, Karrie Ann Robichaux

Josh Schultz
1 year ago

Some states allow you to subtract health insurance premiums or certain other costs from your countable income and allow yourself to qualify for Medicare Savings Program (MSP) benefits. You should contact your state’s Medicaid office for more information about the benefits you qualify for.

Shelia lay
1 year ago

Can not afford Medicare part b I am married but I live on my little check an he gets disability we owe bills an it takes all of his check I need help I have heart problems an lung problems I need help

Josh Schultz
1 year ago
Reply to  Shelia lay

We’re sorry you’re having trouble. As the article mentions, you can apply for help with your Medicare premiums by contacting your local Medicaid office (https://www.medicare.gov/contacts/#resources/msps) and asking about the Medicare Savings Program. While you’re applying, be sure to ask if you qualify for any other government health or assistance programs.

Sean Sollars
1 year ago

I only get 1,234 a month disability, not enough for rent and food here in the US. They want to take 144.60 out of my check every month which will ruin me completely. So sad and distraught.

Admin
Josh Schultz
1 year ago
Reply to  Sean Sollars

You should consider applying for the Medicare Savings Program; it could help you save that monthly payment to use for other day-to-day things.

midori k thalansy
5 months ago
Reply to  Josh Schultz

1234.00 is to high for a single person to get the medicare savings program why are you giving people false hope?

camille
4 months ago
Reply to  Sean Sollars

You are fortunate you get that much. I am still getting 697.00 but about to be cut because my children decided to pay my bills, through their funds. I am psychotic and allowed this to happen. I will be cut soon because I was stupid enough to not say there were no changes in my living situation. Now I will be paying for it for a large part of my life. I need medicine and I won’t have funding for it. Nor will I have funding for housing since my Special Needs Trust moneies will run out. I pay for a Fiduciary and a lawyer who do nothing. My son and daughter who were helping me are moving out in less than a month and I have Akathisia which is a very crippling condition. I need the medicine to treat that. I am at the point where I may have to just hang myself because it is too expensive to live without help or funding.

James Asher
3 months ago
Reply to  camille

Camille, I recently went through the same thing. Are you sure you don’t qualify for the Medicare Savings Program?

eileen
1 year ago

I am already on SSDI, but need now to see non medicare Doctors. Can I stop paying for medicare then? It cost me $144 a month and I never use it now. Would it impact my SSDI if I quit the program?
Second question. If I see a non medicare Doctor, can I mail in their report as proof I am still under a Doctor’s care (which is required to keep SSDI)?

Admin
Josh Schultz
1 year ago
Reply to  eileen

You can’t refuse Medicare Part A (hospital care) without cancelling and paying back all received Medicare benefits under that program. It is in your best interest to keep your Medicare coverage, even if it doesn’t pay for certain doctors. If you disenroll from parts of Medicare, you could face gaps in health coverage and late enrollment penalties for as long as you have Medicare, when you re-enroll. As far as your SSDI question, we recommend you contact a disability attorney or Legal Aid organization with specialty in disability issues.

midori k thalansy
5 months ago
Reply to  eileen

YOU DON’T HAVE TO SEE A MEDICARE DOCTOR ! PERIOD YOU NEED A DOCTOR WHO ACCEPTS MEDICARE !!!!!!!!!!!!!!!!! You can stop part B but you need to see a doctor and be uner his care and social security does reviews so if the doctors says your still disabled your will contiune to get SSDI benifit and if your trying to save money and don’t want the part B you will have to pay out of pocket to see a doctor or you will lose you’re disabiltiy benifits when review time comes around. not wise.

Sidney L Tallant
1 year ago

I receive an early retirement check 0f $457. a month.this is all the income and only income I receive, well until Sept of last year it went d0wn to $257,and I couldn’t figure out what was going on, I dreimvid the medicaid renewal decertification 5 days before the deadline.so I was unaware that I had been dropped(how convenient right before turning 65) and it has been hell getting them to let me be eligible after so many different requests and not even getting turned in to processing dept for 2 0f the months then waiting over 45days .finally after 6 months I became eligible again but for those month I owe a lot of people .so the premium for medicare if you dont get medicaid is quite a lot is there any chance to get a reimbursement

Admin
Josh Schultz
1 year ago

It sounds like you started having premium deductions for Medicare Part B and perhaps also a Medicare Advantage plan (did you sign up for a private plan?) just as you were turning 65. You are correct that Medicaid will pay your Part B premiums (this is called the Medicare Savings Program) if you’re eligible for this Medicaid benefit. Once approved, you should eventually be reimbursed for months going back to your effective date — which can be up to three months prior to applying, depending on your income. Any reimbursement should be deposited into the account where you receive your Social Security. If you have questions you should contact your Medicaid office.

Richard Edwards
4 months ago
Reply to  Josh Schultz

Who do i contact to stop the $148 per month for medicare part b

Cynthia Saffo
2 months ago

Contact the social security office. They will send you a form to send back

Ann
1 year ago

I am a US citizen, having lived abroad, for 30 years. I am intending to return back to USA. At 65 years, I only have 11 Social Security credits, therefore I am not eligible for Medicare. It is understood, immigrants, are entitled to Medicare Plan A – after 5 years. A major issue which there has been no report, research from any USA organization – what happens to Would US citizens living abroad (we all will not have the 40 credits) and returning – can we qualify for the Immigrant category. What rights do we have?

Mary McGuyer
1 year ago
Reply to  Steve Anderson

This is laughable, isn’t it. In the example, the Senior in question is already 80 years old, and has to wait 5 years, with every possibility of dying before then! I too looked on the Marketplace, but living in Texas, which is unsupportive of the ACA, there is no help at all at an affordable price!

Mary McGuyer
1 year ago
Reply to  Ann

Ann, I’m an immigrant, and have been here for 15 years. I pay a total of $677.37 monthly for Parts A and B. I do not have enough credits in this country to qualify, so I don’t know where your info regarding 5-year immigration status came from. It has nothing to do with the time, and everything to do with how many credits you have. I don’t get a social security pension in this country either.

1 year ago
Reply to  Mary McGuyer

Mary,
New immigrants cannot purchase Medicare until they’ve been in the US for at least five years. After that, they can pay for Medicare, with the cost based on how many credits they have for time they worked in the US.

terry
1 year ago

i have never been charged a premium,noe they are taking $144 out of my alreadt smaill sociol secuity

Maurie Backman
1 year ago
Reply to  terry

That’s the standard premium for Medicare Part B. Part B is not free so you should expect to pay that premium monthly.

Admin
Josh Schultz
1 year ago
Reply to  Maurie Backman

If you did not pay a premium for your Medicare before now, you may have been enrolled in a Medicare Savings Program. Contact your local Medicaid office to re-apply for this benefit.

midori k thalansy
5 months ago
Reply to  Josh Schultz

There are income limits ! make $1.00 too much and you don’t qualify QMB $1,437.00 FOR A COUPLE SLMB $1,724.00 AND QI-1 $1,940.00 FOR A COUPLE IF YOU MAKE MORE YOU’RE OUT OF LUCK 1/01/2021 ONLY PEOPLE WHO DO NOT KNOW SAY Contact your local Medicaid office to re-apply for this benefit.

John Z
1 year ago

I just had all of my work cancelled because of Corona19 , I cannot afford my premium because I don’t get SS till I’m 66, I’m 65 now and I have two grandchildren to raise because of my sons death in 2013 (Opioid overdose) What they give to care for them is minimal $600, is there assistance for my situation or do I go without healthcare during this Pandemic , the children have to eat, my wife receives disability and has COPD, if we die the children are screwed, I’ll praise trump if that’s what it will take

Admin
1 year ago
Reply to  John Z

John, did you review the various options in this article?

Judy
9 months ago
Reply to  John Z

John you can get early retirement at age 65. In the long run you aren’t losing much.
Call Social Security and apply.. I raised two of my grandchildren. Go to the Medicaid office and apply for insurance for the two children. They do not count grandparents income. My grandchildren were on medical assistance until they graduated. You only fill out the medical part of the application.

Antoinette Khoury
1 year ago

I received a letter by social security that my Medicare part Premiums will no longer be paid for by the State of Georgia. No reason given. The numbers I called at the State level can’t figure out why. How do I find out why? My SS income dropped from 1188 to 899.
Can you help?

Admin
Josh Schultz
1 year ago

It sounds like you were enrolled in a Medicare Savings Program (MSP) where the state pays your Medicare premiums, and your enrollment in that program has now ended. I’m not sure which office you called, but you should contact Medicaid. This web page (under the first heading) has an online link you can also use to apply: https://medicaid.georgia.gov/medicare-savings-plans-programs-faqs

If you had your MSP wrongly terminated, you can appeal by requesting what’s known as a Fair Hearing. Otherwise, your best bet now is to reapply.

Andrei Ustinov
1 year ago

I just start get my retirement, it’s only $499 per month . I’m not sure if my work will be even start sometime soon. And now I must pay $144 ?! What to do ?

Admin
Josh Schultz
1 year ago
Reply to  Andrei Ustinov

If you don’t have significant income from sources other than Social Security, it sounds like you could qualify for a Medicare Savings Program (MSP), as described in the article. If you start working, a little less than half of that income would be counted toward the eligibility limit (asset tests may also apply depending on the state you live in). You can apply by contacting your Medicaid office.

Lisa Harris
1 year ago

I really don’t use my Medicare insurance so how could I get that back into my SSD check

Admin
Josh Schultz
1 year ago
Reply to  Lisa Harris

You should really remain enrolled in Medicare Part B, even if you feel you’re not using your coverage. The exception is if you are covered through an employer-sponsored plan: https://www.medicareresources.org/faqs/do-i-need-to-sign-up-for-medicare-at-65-if-im-still-working/

If you opt out of Medicare Part B, you’ll have to pay a late enrollment penalty when you sign up later. Everyone needs Medicare at some point in their life.

Here is a list of things covered under Medicare Part B at no cost: https://www.medicareresources.org/faqs/what-free-preventive-services-does-medicare-offer/

Bettie McDonald
1 year ago

I have been expecting back pay from my medicare plan since I qualified for medicare savings, I’m supposed to get 144,and I have been waiting since April 14, which is the date I was told, could you tell me what might be the problem?

Admin
Josh Schultz
1 year ago

It can take 2-3 months or sometimes even longer before premiums are no longer withheld from your Social Security benefits. I’d hang in there a little bit longer — especially if you were only told you were approved beginning this month. Rest assured you will get all the money owed to you deposited back into the bank account where you receive your Social Security benefits.

camille
4 months ago
Reply to  Josh Schultz

Sound like like you’re in good standing. I don’t know when I will ever be reinstated agailn.

david stamey
1 year ago

my SS check went from $845 down to $700 , now i can not cover the rest of my bills due to the deduction

Merie Noel Ayala
1 year ago

Hello my parents are 89 and 86 between both of them they receive 1500 in social security they have lived abroad for 20 years so Medicare is charging them over $400 each due to penalty mind you my dad had part B before he left but they made him re apply. They can’t afford this premium with their income. Can they apply for help to pay the premium?

Lois Jean Meador
1 year ago

Who do My husband contact to get help paying my medicare premiums?

Victoria
1 year ago

I am qualified for tms under medicare but the co pay maybe 500dollars a week for 6 weeks i need the treatment bad but can’t afford it and dont qualify for low income help what can i do

Admin
1 year ago
Reply to  Victoria

Victoria, have you read this article about how you could be enrolled in both Medicare and Medicaid? https://www.medicareresources.org/medicare-benefits/how-medicaid-supports-1-in-5-medicare-enrollees/

Vanessa
1 year ago

Do Medicare Saving Programs in Florida or Qualified Medicare Beneficiary in particular, have a look back period? What is their asset cutoff for eligibility?

Admin
Josh Schultz
1 year ago
Reply to  Vanessa

The Medicare Savings Programs (MSPs) are unlike Medicaid Long Term Services and Supports (LTSS) coverage in that they don’t have a lookback period in any state. This website has more information about income/asset limits in Florida: https://www.floridalawhelp.org/content/medicare-savings-plans

PATRICIA A MILLER
1 year ago

Please advise, if I were to Qualify for these programs, will that mean that I will lose my United Healthcare Advantage Plan? And have only Medicare???

Admin
Josh Schultz
1 year ago

Receiving the Medicare Savings Program (MSP) won’t impact your eligibility or enrollment in other programs. However, beneficiaries sometimes use the Qualified Medicare Beneficiary Program (QMP) to pay their Medicare co-pays and deductibles — eliminating the need for a Medicare Advantage plan (although this is usually not recommended).

Patty
1 year ago
Reply to  Josh Schultz

Thanks…who administers the MSP ( ssa) or a 3 party united health care representatives?

Josh Schultz
10 months ago
Reply to  Patty

Hi Patty,

Medicaid administers the Medicare Savings Program benefit.

Deborah J Pullen
1 year ago

I am 69 Y/OFemale I am having new symptoms which have no t be diagnosed yet. I have Have DM ll , chronic Back & Neck pain, uneven gate, hypothyroidism, Rehumatoid Arthritis, osteoarthritis, hypoparathyroidism, My new symptoms. are SOB & Falling.At this time I have to take many breaks while doing my household chores. Lifting etc.
Question: Is there any program that will pay someone to help me ?Thank you for your assistance is greatly appreciated.
Name: Deborah J Pullen
I have Medicare A &B &D , Omaha Supplement &Silver Script meds.

Josh Schultz
1 year ago

It sounds like you may need some help around the house. Unfortunately, I don’t have an agency to refer you to. Here is a directory of Medicare home health providers: https://www.medicare.gov/homehealthcompare/search.html But note that Medicare only covers limited amounts of help at home — and only under specific circumstances: https://www.medicareresources.org/faqs/how-much-in-home-care-will-medicare-cover/

This means you may have to apply for Medicaid if you want more comprehensive help with daily activities.

Dana C.
11 months ago

My parents just moved here to Colorado with me. Can you send me a link for them to apply for the savings program here? My mom wants to drop medicare completely because they are going to take 260 of their 1642 a month.

Terrence Suthby
10 months ago

I am turning 65 next month. My wife and I have a total monthly income of $1560.00 so it appears we qualify for SLMB. We live in Ohio. The Ohio Department of Insurance website says we are allowed $11,800.00 in total resources. How do we calculate what are total resources are?

midori k thalansy
5 months ago

all the money in bank cd’s etc…. you can google it( what is considered total resources for SLMB ) you are allowed one car and one home and a $1,500.00 burial plot etc…..

shirley
10 months ago

I get 30. a month too much to qualify for medicare premium part b, so ever since my auto accident, i have had no health insurance. There are many like me who are on ssdi, ssi and have no health ins. They need to raise the amt one can get to qualify. We give all that money to israel, and they have uni health ins. . Every civilized nation has uni health ins

John Zambrano
10 months ago

I’m currently covered by my union with Aetna until I turn 65 next May. The problem is, I’m receiving $1270.00 a month from SSDI, and $625.00 a month from my pension. ($588.00 after federal tax). My rent is $1250.00 a month, which does not leave me much to pay for food and utilities. I can’t move, I’m on disability, and have no help from anyone else. Is there a plan I can look into for some assistance?

Lidia
10 months ago

I’m a SHIP counselor, helping a senior who became eligible for MSP in 2/2020. She is still waiting for SSA to stop deducting $144.60 from her monthly benefit. What can she do?

Josh Schultz
10 months ago
Reply to  Lidia

Hi Lidia,

I recommend having her contact Medicaid to ask about the delay. The MSP shouldn’t take this long to go into effect.

Rodney Richmond
9 months ago

Does Medicade Q I 1 cover Transportation benifits?

ESwar
7 months ago

I am 43 and receive SS disability. Now Medicare is being taken out of my SS check so I only get 1,036 /mo. I also have a state run insurance that pays for everything (Blue Choice option) also known as medicaid. Why do I need the medicare as long as I am receiving free care from NYS. Can I opt out of this medicare without losing my SS benefit check? please respond ASAP

Editor
5 months ago
Reply to  ESwar

It would be a very bad idea to opt-out of Medicare benefits. Instead, consider applying for a Medicare Savings Program through your Local Department of Social Services. This website has more information about that benefit in NYS: https://www.medicareresources.org/states/new-york-guide-content/

camille
4 months ago
Reply to  ESwar

You are only 43 and already the Medicare payments are being deducted from your checks? Wow. Well at least you get your checks. I don’t know how much long I will receive mine. I am freaking out.

Trina glisson
6 months ago

I called gomedicare i beieve in September and they signed me up with united and she said i quaified for exta help but they are still taking$148 premium everymonth! And she told me that i would get reimbursement on my $148 each month they took it out after that day i qualified for and signed up for united and extre?

jeff
5 months ago

Medicare is more costly than some ACA insurance. Why do we have to sign up for something that costs more?

camille
4 months ago

I am 62 years old and have been cut of my benefits. How will I be able to get my medicines without medicaid, and medicare?

nancy koplinski
2 months ago

i turned 65 a few weeks ago and recently got Medicare A &B. I cant really afford the premium but i need healthcare. Are the requirements for financial assistance based on my 2020 income because I am not working full time any longer therefore my salary has decreased..just wondering what i need to do to get some help.

Blueice
1 month ago

Thanks for the helpful article. New to this.

Per the link below, looks like California has two types of measure for Medi-CAL, Non-MAGI for those are >=65, and MAGI for 19-64. That doesn’t make much sense in terms of annual income is still the same as last year. Now they use the assets limit of $2,000 for single and $3,000 for couple to determine if the person qualifies for Medi-CAL. Does it mean that person won’t qualify if he has more than $2,000 in assets?

https://www.dhcs.ca.gov/formsandpubs/forms/Forms/MCED/myMediCal_Digital_Version.pdf

Silvia
54 minutes ago

Right now I have Medicare and Medicaid and still been taking out $148 a month. I have been told it take 2-3 month before I get the money paid back and to get it stopped from taking it from my social security. I am 65 and living in NJ. I need my money. Can’t live off $669 a month….can I do anything about it or I have to wait….

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