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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).

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
Delores Pace
8 months 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
Josh Schultz
8 months 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.

Karrie Ann Robichaux
Karrie Ann Robichaux
8 months 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
Josh Schultz
8 months 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
Shelia lay
8 months 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
Josh Schultz
8 months 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
Sean Sollars
8 months 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.

Josh Schultz
Admin
Josh Schultz
8 months 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.

eileen
eileen
7 months 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)?

Josh Schultz
Admin
Josh Schultz
7 months 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.

Sidney L Tallant
Sidney L Tallant
7 months 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

Josh Schultz
Admin
Josh Schultz
7 months 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.

Ann
Ann
7 months 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
Mary McGuyer
6 months 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
Mary McGuyer
6 months 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.

Louise Norris
4 months 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
terry
7 months ago

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

Maurie Backman
Maurie Backman
7 months 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.

Josh Schultz
Admin
Josh Schultz
6 months 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.

John Z
John Z
6 months 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

Steve Anderson
Admin
6 months ago
Reply to  John Z

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

Antoinette Khoury
Antoinette Khoury
6 months 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?

Josh Schultz
Admin
Josh Schultz
6 months 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
Andrei Ustinov
6 months 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 ?

Josh Schultz
Admin
Josh Schultz
6 months 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
Lisa Harris
5 months ago

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

Josh Schultz
Admin
Josh Schultz
4 months 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
Bettie McDonald
5 months 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?

Josh Schultz
Admin
Josh Schultz
5 months 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.

david stamey
david stamey
5 months 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
Merie Noel Ayala
5 months 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
Lois Jean Meador
5 months ago

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

Victoria
Victoria
4 months 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

Steve Anderson
Admin
4 months 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
Vanessa
4 months 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?

Josh Schultz
Admin
Josh Schultz
4 months 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
PATRICIA A MILLER
4 months 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???

Josh Schultz
Admin
Josh Schultz
4 months 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
Patty
4 months ago
Reply to  Josh Schultz

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

Josh Schultz
Josh Schultz
1 month ago
Reply to  Patty

Hi Patty,

Medicaid administers the Medicare Savings Program benefit.

Deborah J Pullen
Deborah J Pullen
3 months 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
Josh Schultz
3 months 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.
Dana C.
1 month 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
Terrence Suthby
1 month 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?

shirley
shirley
1 month 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
John Zambrano
1 month 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
Lidia
1 month 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
Josh Schultz
1 month 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
Rodney Richmond
14 days ago

Does Medicade Q I 1 cover Transportation benifits?

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