Q: Is there help for me if I can’t afford Medicare’s premiums?
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 also MSPs that help just help to pay Medicare Part B premiums (for most seniors, Medicare Part A is premium-free), and one MSP that helps disabled working individuals pay their Part A premiums.
There are four types of Medicare Savings Programs, each with their own income limits (income limits detailed below are for the continental US; income limits are higher in Alaska and Hawaii) and asset limits.
As of 2020, the asset limits for most of the MSPs are $7,860 for an individual, and $11,800 for a couple. These are federal standards; states can have more generous guidelines (several have no asset limits), but cannot impose stricter limits.
- 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). If you qualify as a QMB, you’re automatically eligible for Extra Help paying for Part D prescription coverage.
- 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). If you qualify as an SLMB, you’re automatically eligible for Extra Help paying for Part D prescription coverage.
- 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). Enrollments are granted on a first-come, first-serve basis. If you qualify as a QI, you’re automatically eligible for Extra Help paying for Part D prescription coverage.
- 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 when they returned to work. The income limits are higher ($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.
Here’s more information about MSPs, including the income/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.
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, so each state has its own Medicaid office). If you think you might be eligible, you’ll need to contact the Medicaid office in your state (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 requalify 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 alone, but receive assistance with premiums (and in some cases, cost-sharing as well) from the Medicaid program. But some low-income Medicare enrollees are also fully eligible for Medicaid, in addition to Medicare.
About 20 percent of Medicare beneficiaries are “dual eligible” for both Medicare and Medicaid. This is especially true of older seniors who need nursing home care and have exhausted their own funding to cover the cost. Medicare does not cover 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.
Many states offer State Pharmacy Assistance Programs (SPAPs), which help low-income individuals pay for prescription drugs based on their financial situations, on their age and on their medical condition. You can use this Medicare tool to search for SPAPs in your area.
Assistance with prescription drug coverage is also available for elderly and disabled people through PACE (Programs of All-Inclusive Care for the Elderly). This Medicare / Medicaid program provides resources that are equivalent to nursing home services but which allow the enrollee to remain at home. PACE covers doctor visits, home care, hospital visits, transportation, and home care as well. The fact sheet, “Quick Facts About Programs of All-inclusive Care for the Elderly” will answer your questions about the program.
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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