What You Need to Know About Lowering Your Medicare Costs
Key Takeaways:
- A wide variety of programs can help you pay for your Medicare costs, including a Medicare Savings Program, PACE, and SSI, to name just a few.
- Most programs come with individual and married couple income and resource limits. If you fall adobe these limits, you may not qualify.
According to the Kaiser Family Foundation (KFF), as of 2018, “Medicare spending (net of income from premiums and other offsetting receipts) totaled $605 billion, accounting for 15 percent of the federal budget.”
But what happens if you’re unable to pay your Medicare premiums and contribute your fair share to these numbers? In this article, we’ll explore eight different assistance programs that can help you better afford your Medicare premiums, so you can gain access to the healthcare you need.
Medicaid
If you have limited income and resources, Medicaid is a federal program that can help with your medical costs. Medicaid also covers things like nursing home care and personal care services, which are not covered under Original Medicare.
Related: Medicare vs. Medicaid
To qualify for Medicaid, you’ll need to show that you’re “medically needy.” This means your measurable resources must be under the amount allowed in your state, which can vary depending on where you live.
Furthermore, each state has different rules regarding Medicaid eligibility and the application process, so you’ll need to contact your state’s agency for qualification and application details.
It’s important to emphasize that Medicare and Medicaid aren’t necessarily mutually exclusive. In other words, you can qualify for both programs. Also, you can still be eligible for Medicaid whether you choose to go with Original Medicare or an Advantage (Part C) plan.
Medicare Savings Programs
Medicare Savings Programs are state-run programs that can help you pay your Medicare premiums. Overall, there are four different kinds:
Qualified Medicare Beneficiary (QMB) Program
This program can help pay for Part A premiums, Part B premiums, deductibles, coinsurance, and copayments. You might have to pay up to $4 (as of 2021) for prescription drugs covered by Medicare Part D.
Income limits are as follows:
| Individual monthly income limit | $1,094 |
| Married couple monthly income limit | $1,472 |
| Individual resource limit | $7,970 |
| Married couple resource limit | $11,960 |
Specified Low-Income Medicare Beneficiary (SLMB) Program
If you already have Part A and have limited income and resources, the SLMB program can help pay for your Part B premiums only. Income limits are as follows:
| Individual monthly income limit | $1,308 |
| Married couple monthly income limit | $1,762 |
| Individual resource limit | $7,970 |
| Married couple resource limit | $11,960 |
Qualifying Individual (QI) Program
This state-run program also helps pay Part B premiums, and applications are granted on a first-come, first-served basis. Keep in mind that if you qualify for Medicaid, you won’t be eligible for QI.
| Individual monthly income limit | $1,469 |
| Married couple monthly income limit | $1,980 |
| Individual resource limit | $7,970 |
| Married couple resource limit | $11,960 |
Qualified Disabled and Working Individuals (QDWI) Program
Comparatively, the QDWI program helps pay for Part A premiums only if you’re a working disabled person under 65, you returned to work and lost your Social Security disability benefits, you aren’t receiving medical assistance from your state, or you meet the income and resource limits required by your state. These are as follows:
| Individual monthly income limit | $4,379 |
| Married couple monthly income limit | $5,892 |
| Individual resource limit | $4,000 |
| Married couple resource limit | $6,000 |
Program of All-inclusive Care for the Elderly (PACE)
The PACE program covers all Medicare- and Medicaid-covered care and services. It is designed to help you avoid going to a nursing home or other care facility by providing access to health care in the community. To qualify for PACE, you’ll need to meet the following criteria:
- Age 55 or older
- Live in the service area of a PACE organization
- Need a nursing home-level of care (as certified by your state)
- Be able to live safely in the community with help from PACE
According to the Medicare.gov website, PACE covers services like:
- Adult day primary care (including doctor and recreational therapy nursing services)
- Dentistry
- Emergency services
- Home care
- Hospital care
- Laboratory/x-ray services
- Meals
- Medical specialty services
- Nursing home care
- Nutritional counseling
- Occupational Therapy
- Physical therapy
- Prescription drugs
- Preventive care
- Social services, including caregiver training, support groups, and respite care
- Social work counseling
- Transportation to the PACE center for activities or medically necessary medical appointments.
Lower Prescription Costs
This program helps pay for Medicare drug coverage, such as premiums, deductibles, and copays or coinsurance when you fill your prescriptions. For 2021, you’ll pay no more than $3.70 for each generic drug and $9.20 for each brand-name, covered drug.
Income and resource limits are as follows:
| Individual yearly income limit | $19,320 |
| Married couple yearly income limit | $26,130 |
| Individual resource limit | $14,790 |
| Married couple resource limit | $29,520 |
Extra Help
Extra Help also assists beneficiaries with paying for Part D premiums, deductibles, and coinsurance.
You might qualify for the Extra Help program if you also qualify for Medicaid and receive benefits through Medicare, you’re in a Medicare Savings Program, or you get Supplemental Security Income (SSI) benefits (more soon).
If you qualify, you’ll pay no more than $3.70 for each generic medication and $9.20 for each brand-name, covered drug.
Insure Kids Now
As the name implies, this program (the Children’s Health Insurance Program (CHIP)) is designed to provide free or low-cost health and dental coverage for children up to age 19. Services include (not an exhaustive list):
- Regular check-ups
- Immunizations
- Doctor and dentist visits
- Hospital care
- Mental health services
- Prescriptions
Keep in mind that a family of four cannot earn more than $50,000 per year to qualify.
Supplemental Security Income (SSI)
If you have a limited income and resources and are disabled, blind, or age 65 or older, the federal SSI program, which is different from Social Security retirement or disability benefits, may assist adults and children. Limits include:
| Individual resource limit | $2,000 |
| Married couple resource limit | $3,000 |
Where does all of this leave you?
Want to Know More About Help Paying Your Medicare Premiums?
Medicare premiums—including assistance programs that provide help if you cannot afford them—can be complicated. That’s why the team at IHS Insurance Group is standing by to answer your questions!
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