Medicare Assistance Programs

Summary: If you need help with your Medicare costs, you may qualify for a Medicare Assistance Program. These programs are federal and state programs that can help with Original Medicare and/or prescription drug costs. Below, we’ll take a look at the various types of programs available and how you can apply. Estimated Read Time: 6 min

What are Medicare Assistance Programs?

Medicare Assistance Programs are state and federal programs that help with the costs of Medicare. Each program has eligibility requirements that you must meet to receive aid. You must often meet income and resource requirements to obtain Medicare assistance for your healthcare costs.

In addition to programs that help with your Original Medicare costs, some programs help pay for your prescription drug out-of-pocket costs through a Medicare Part D Prescription Drug plan. Below, we’ll explain the various types of Medicare Assistance Programs available to you. Understanding how each program works is essential for ensuring you get the Medicare aid you need.

Medicare Savings Programs

Medicare Savings Programs assist with paying your Original Medicare (Part A and B) costs. These programs are federally funded but are offered through your state’s Medicaid department. Medicare Savings Programs can help with your Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments and ultimately help reduce your total out-of-pocket spending.

Generally, to be eligible for a Medicare Savings Program, your income and resources must be below a certain amount. Income and resource limits for these programs increase each year. Even if your income or resources exceed the limits listed below, Medicare recommends applying for a savings program anyway.

Which program(s) you qualify for will be determined by your state. Some states don’t consider certain types of income or resources when determining who qualifies. This is why applying is essential, even if your income exceeds the limits below.

2024 Medicare Savings Programs Comparison Chart

Types of Medicare Savings Programs

The Qualified Medicare Beneficiary (QMB) Program helps pay for your Medicare Part A premium and your Part B premium, deductibles, coinsurance, and copayments. You cannot be billed for Medicare-covered services and items if you qualify for this program. You will also get Extra Help for your prescription drugs. With the QMB program and Extra Help, you’ll pay no more than $11.20 in 2024 for each drug covered under your Medicare drug plan.

The Specified Low-Income Medicare Beneficiary (SLMB) Program helps pay your Medicare Part B premium. You must have both Medicare Part A and Part B to qualify. If you are eligible for the SLMB, you will get Extra Help with your prescription drugs. Upon qualifying for the Specified Low-Income Medicare Beneficiary Program and Extra Help, you will pay no more than $11.20 in 2024 for each drug your Medicare drug plan covers.

The Qualifying Individual (QI) Program helps pay your Medicare Part B premium. To qualify, you must be enrolled in Medicare Part A and Medicare Part B. Eligible individuals must apply annually to stay in the QI program. Unlike other savings programs, Qualifying Individual Program applications are approved on a first-come, first-served basis. Priority is given to individuals who received QI benefits the previous year. This program is not for individuals who qualify for Medicaid.

The Qualified Disabled & Working Individual (QDWI) Program helps pay your Medicare Part A premium. In addition to the income and resource limits, you may also qualify for this program if you:

• Have a disability
• Are working
• Lost your Social Security disability benefits and Medicare premium-free Part A because you returned to work

Programs to Help with Medicare Drug Costs

Even when enrolled in a Medicare Part D drug plan, you may struggle with the costs of prescription drugs. There are programs available that can help lower your Medicare Part D out-of-pocket costs.

Medicare and Social Security offer Extra Help for individuals with limited income and resources. This program can help pay for your Medicare Part D premium, deductible, copayments, and other costs. In most cases, your income and resources must be below a specific limit. In 2024, the individual income limit to qualify for Extra Help is $22,590. If you also need assistance paying your Medicare medical costs, you can apply for Extra Help and Medicare Savings Programs at the same time.

State Pharmaceutical Assistance Programs can also help with Medicare drug costs. These programs differ from state to state and provide assistance based on financial need, age, or medical condition. You can contact your State Health Insurance Assistance Program (SHIP) to learn more about your state’s specific programs.

Another option for reducing your Medicare Part D drug costs is through Pharmaceutical Assistance Programs. Pharmaceutical manufacturers sponsor these programs to provide low-income individuals with financial assistance or free drug products. These programs can help Medicare Part D enrollees and work alongside Part D plans. You can find Pharmaceutical Assistance Programs at Medicare.gov.

Getting Help With Medicare Costs Through Medicaid

There are Medicare assistance options available for individuals who qualify for Medicaid. Medicare-approved health plans can help lower costs for Medicaid recipients.

Medicare-Medicaid Plans

States offer Medicare-Medicaid plans (MMPs) and help coordinate Medicare and Medicaid benefits. To qualify for an MMP, you must have Medicare, get full Medicaid benefits, and meet any other criteria your state sets. These plans include Medicare drug coverage. Medicare-Medicaid plans are only available in some states; you can contact your local Medicaid office for more information.

Programs of All-Inclusive Care for the Elderly (PACE)

Programs of All-Inclusive Care for the Elderly (PACE) is a program that helps individuals who need nursing home-level care get the healthcare they need at home instead of going to a facility. PACE is a Medicare and Medicaid program only available in some states. To qualify for PACE, you must:

• Have Medicare, Medicaid, or both
• Are age 55 or older
• Live in a state that has PACE and within the service area of a PACE organization
• Need nursing home-level care (certified by your state)
• Can live safely in the community (with help from PACE)

You can join PACE even if you do not qualify for Medicaid but have Medicare. However, you must pay a monthly premium for long-term care under PACE and a premium for your prescription drugs. If you qualify for Medicare and Medicaid, you will not have to pay a premium or any other out-of-pocket cost.

PACE covers all Medicare- and Medicaid-covered services, including prescription drugs and medically necessary care. PACE may cover dentistry, emergency services, meals, occupational therapy, social work counseling, and more. When you join PACE, you will work with a team of healthcare professionals who will help coordinate care to meet your healthcare needs.

Medicare Dual Eligible Special Needs Plans

Dual Eligible Special Needs Plans can also reduce out-of-pocket costs for dual-eligible individuals. These plans are a type of Medicare Advantage plan, so private providers offer them and may not be available everywhere. Dual Eligible Special Needs Plans tailor their benefits and coverage to best meet the needs of those with Medicare and Medicaid. These plans can help coordinate your benefits and reduce costs.

How to Get Help with Medicare

If you’re struggling with Medicare costs, a Medicare Assistance Program may be able to provide the help you need. If you have questions regarding programs available for low-income Medicare beneficiaries, give us a call. Our team of licensed insurance agents can help answer your questions and explore your options

Suppose you don’t qualify for a Medicare Assistance Program. In that case, you may reduce your Medicare costs by changing drug plans or enrolling in a Medicare Supplement plan or a Medicare Advantage plan.

Sources

Medicare Savings Programs, Medicare.gov. Accessed February 2024

https://www.medicare.gov/basics/costs/help/medicare-savings-programs

Supplemental Security Income, Social Security Administration. Accessed August 2023

https://www.ssa.gov/ssi/

PACE, Medicare.gov. Accessed August 2023

https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/other-medicare-health-plans/PACE

Pharmaceutical Manufacturer Patient Assistance Program Information, CMS.gov. Accessed August 2023

https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PAPData