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

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

2020 Medicare premiums, deductibles, costsA: Yes. 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 2019, the asset limits for most of the MSPs are $7,730 for an individual, and $11,600 for a couple (these limits are likely to increase in 2020). 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 2019 with an income up to $1,061 per month ($1,430/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 2019 with an income up to $1,269 per month ($1,711/month for a couple). If you qualify as a 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 2019 with an income up to $1,426 per month ($1,923/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 ($4,249/month for an individual, and $5,722 for a couple in 2019), but the asset limit is lower, at $4,000 for an individual and $6,000 for a couple.

Here’s more information about MSPs, and the income/asset limits that apply to each type of MSP in 2019, including numbers for Alaska and Hawaii. 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.

I think I might be eligible for an MSP. How do I apply?

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).

Extra Help with prescription drug coverage

Medicare offers “Extra Help” for Medicare enrollees who can’t afford their Part D prescription drug coverage. In 2019, if you’re a single person earning less than $1,581 per month, with financial resources that don’t exceed $14,390 ($28,720 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 doctors 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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Related terms

deductible

dual eligible

Extra Help

Medicare Part A

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prescription drug coverage

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Delores Pace

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

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

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

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

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

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

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.

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

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)?

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

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… Read more »

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… Read more »

Ann

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?

terry

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

Maurie Backman

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