Overview

Health care is expensive, and so is the insurance coverage that helps you pay for it. But that shouldn't stop you from getting the medical services you need. There are a variety of government programs designed to help you get adequate coverage if you qualify. Fair warning: There are a lot of similar, confusing acronyms involved, but we'll help you through it.

    Benefit Period

    is the way the Original Medicare program measures your use of inpatient hospital and skilled nursing facility (SNF) services. It begins the day that you enter a hospital or SNF and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row.
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  • How can I get help paying for my healthcare costs?

    Short Answer:

    There are a number of government programs that can help pay your healthcare and prescription drug costs, including some initiatives specifically for Medicare beneficiaries, if you have a modest income and limited savings. Here’s an overview of some of them:

    More Info

    For help with prescription drug costs:

    Extra Help
    Medicare’s Extra Help program can assist people who have trouble paying their prescription drug costs. The program helps cover the costs of your Medicare drug plan, plus ensures you have no coverage gap, no late enrollment penalty, and can switch plans at any time.

    You may qualify for Extra Help in 2018 if you are single, your annual income is less than $18,210, and you have less than $14,100 in savings. (Your savings, or "countable resources" as they're sometimes called, include assets like the money in your checking or savings account, stocks and bonds, mutual funds, and IRAs.) For married people living together (with no dependents), the 2018 limit for annual income is $24,690, and for savings, $28,150.

    Note that these limits may be different if you have dependents living with you, or you live and work in Alaska or Hawaii.

    You’ll automatically qualify for Extra Help if you have full Medicaid coverage, if Medicaid helps pay your Medicare Part B premium, or you get Supplemental Security Income (SSI) benefits. If you don’t automatically qualify but meet the other requirements, you can apply for Extra Help online at socialsecurity.gov/i1020 or by calling Social Security at 1-800-772-1213.

    State Pharmacy Assistance Programs (SPAPs)
    Some states offer SPAPs that can help you with prescription drug costs. Eligibility is often based on financial need, age, or medical condition. Contact your State Health Insurance Assistance Program (SHIP) for more information. Find your SHIP contact here.

    Pharmaceutical Assistance Programs or Patient Assistance Programs
    Many drug manufacturers offer Pharmaceutical Assistance Programs to people with the costs of Medicare drug coverage. If you meet certain requirements, you may be able to receive your prescriptions at no cost or at a reduced rate. For more information, visit Medicare.gov/pharmaceutical-assistance-program.

    For assistance with healthcare costs:

    MEDICARE SAVINGS PROGRAMS

    There are four types of programs designed to help people with modest incomes and savings, each with different financial limits and covering different costs. They are:

    Qualified Medicare Beneficiary (QMB) Program
    The QMB Program helps pay your Part A and/or Part B premiums. It also prohibits health care providers from billing you directly for Medicare deductibles, coinsurance, and copayments. You won’t be charged over a certain amount for Part D-covered prescription drugs, and you’ll automatically get Extra Help.

    Specified Low-income Medicare Beneficiary (SLMB) Program
    This program only helps cover the Part B premium.

    Qualifying Individual (QI) Program
    This also only helps cover Part B premiums, and you must apply each year for benefits. QI benefits are awarded on a first-come, first-served basis.

    Qualified Disabled and Working Individuals (QDWI) Program
    The QDWI Program helps pay Part A premiums, and you may qualify if you have a disability and are currently working.

    To see if you qualify for a Medicare Savings Program, check with your state to find out income and resource limits. You can find your state’s contact information here.

    MEDICAID

    Medicaid is a joint federal and state health insurance program for low-income people or for those with high medical expenses relative to their income and savings (termed "medically needy"). This assistance program covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.

    Each state has different Medicaid requirements. Call your state’s Medicaid office, or 1-800-MEDICARE to see if you qualify.

    Programs of All-Inclusive Care for the Elderly (PACE)
    A Medicare and Medicaid program, PACE is available in many states for people who need nursing home-level care. PACE’s assistance allows them to remain in their community by covering home care, transportation to doctor visits, hospital stays, prescription drugs, and more. Contact your Medicaid office to see if there’s a PACE program near you.

    Supplemental Security Income (SSI) Benefits
    SSI is available to people with limited income who are also disabled, blind, or 65 and older. The Benefit Eligibility Screening Tool at benefits.gov/ssa can help you determine if you’re eligible for SSI benefits, or you can call Social Security at 1-800-772-1213.

  • What are the Medicare Savings Programs?

    Short Answer:

    Medicare Savings Programs help people with limited income and financial resources pay for medical expenses and prescription drug costs.

    More Info

    Here are some of the federal and state government programs that can help people of modest means with medical expenses and prescription drug costs:

    Medical Expenses

    Medicare Savings Programs Programs that help cover medical expenses include:

    • Qualified Medicare Beneficiary (QMB) Program
    • Specified Low-income Medicare Beneficiary (SLMB) Program
    • Qualifying Individual (QI) Program
    • Qualified Disabled and Working Individuals (QDWI) Program

    Prescription Drugs

    Medicare Savings Programs that help cover prescription drug costs include:

    • Extra Help
    • State Pharmacy Assistance Programs (SPAPs)
    • Pharmaceutical Assistance Programs or Patient Assistance Programs

     

  • How do I apply for Medicare Savings Programs?

    Short Answer:

    If you qualify for a Medicare Savings Program, you need to call your state Medicaid program to apply. Even if your income or resources are higher than the maximums your state requires, it's important to call or fill out an application because the limits may increase for 2019 or there may be other special circumstances that might allow you to qualify for savings.

    More Info

    You can find your state’s contact information here.

    In order to qualify for a Medicare Savings Program in your state, you must meet these conditions:

    • You already have or are eligible for Medicare Part A (hospital insurance).
    • Your income is below the applicable limit in your state.*
    • Your assets, also called countable resources, are below the maximum amounts that your state requires.*

    Countable resources includes checking, savings, and investment accounts, and excludes your home, one car, furniture, other household goods, personal items, and a burial plot, along with $1,500 set aside for burial expenses.

    To learn more about the program in your state, see here.

    If your income or assets are slightly above the limits imposed by your state, you should still apply. The maximums are often raised each year and/or extenuating circumstances may apply.

  • Am I eligible for a QDWI program?

    Short Answer:

    If you're younger than 65 and get Medicare benefits because of a disability, you may get help paying your Part A (hospital insurance) premiums through the Qualified Disabled and Working Individuals (QDWI) program. To be eligible, you must meet certain income and asset requirements.

    More Info

    To get help paying your Medicare Part A (hospital insurance) premiums through the Qualified Disabled and Working Individuals program (QDWI), you must meet these conditions:

    • You're a disabled person under 65 who is currently working
    • You lost premium-free Part A when you went back to work
    • You aren't getting medical assistance (Medicaid) from your state
    • You meet the income and asset limits for your state

    The federal income and asset limits to qualify for QDWI in 2018 are*:

    If you are single:

    • Less than $4,132 a month in income
    • No more than $4,000 in assets, such as checking, savings, and investment accounts. Resources such as your home, one car, household goods an furniture, and personal items aren't counted.

    If you are married:

    • Less than $5,572 a month in income
    • No more than $6,000 in assets, such as checking, savings, and investment accounts. Resources such as your home, one car, household goods and furniture, and personal items aren't counted.

    *These limits apply to the 48 mainland states; the limits are slightly higher in Alaska and Hawaii.

    These limits may increase in 2019, so if your income and assets are slightly higher, you should still apply.

    In addition, while most states use the federal limits, some have their own, more generous income and asset guidelines. Be sure to check with your state to find out if you qualify. You can find your state’s contact information here.

    The QDWI Program helps pay for Part A premiums only.

  • Am I eligible for a QMB program?

    Short Answer:

    If you have limited income and assets, you may be eligible for the Qualified Medicare Beneficiary (QMB) program, which helps pay your Medicare Part A (hospital insurance) and Part B (medical insurance) costs.

    More Info

    The QMB Program helps you pay your Original Medicare (Parts A & B) premiums, deductibles, coinsurance and copayments. It also prohibits healthcare providers from billing you directly for Medicare deductibles, coinsurance, and copayments.

    You won’t be charged more than $3.70 in 2018 for any prescription drugs covered by Part D, and you’ll automatically get Extra Help, a federal program that helps pay for some to most of Medicare prescription drug coverage.

    Here are the federal income and asset limits to qualify for QMB in 2018:

    If you are single:

    • Less than $1,032 a month in income
    • No more than $7,560 in assets, such as checking, savings, and investment accounts. Your home, one car, household goods and furniture, and personal items are excluded.

    If you are married:

    • Less than $1,392 a month in income
    • No more than $11,340 in assets, such as checking, savings, and investment accounts. Your home, one car, household goods and furniture, and personal items are excluded.

    These limits may increase in 2019, so you should still apply even if your income and assets are slightly higher than these maximums.

    In addition, while most states use the federal limits, some have their own, more generous income and asset guidelines. Be sure to check with your state to find out if you qualify. You can find your state’s contact information here.

  • Am I eligible for a QI program?

    Short Answer:

    If your income is low and you have limited financial resources, you may be eligible for a Qualifying Individual (QI) program to help pay your Medicare Part B (medical insurance) premiums.

    More Info

    The federal income and assets limits to qualify for the QI program in 2018 are:

    If you single:

    • Less than $1,386 a month in income
    • No more than $7,560 in assets, such as checking, savings, and investments accounts. Your home, one car, household goods and furniture, and personal items are excluded.

    If you are married:

    • Less than $1,872 a month in income
    • No more than $11,340 in assets, such as checking, savings, and investment accounts. Your home, one car, household goods and furniture, and personal items are excluded.

    These limits may increase in 2019, so you should apply even if your income and assets are slightly above the limits.  You must apply each year for benefits.

    In addition, while most states use the federal limits, some have their own, more generous income and asset guidelines. So be sure to check with your state to find out if you qualify. You can find your state’s contact information here.

    QI benefits are awarded on a first-come, first-served basis.  Priority is given to those who received QI benefits last year.

  • Am I eligible for an SLMB program?

    Short Answer:

    You may be eligible for the Specified Low-Income Medicare Beneficiary (SLMB) program to help pay for your Medicare Part B (medical insurance) premiums if your income is low and you have limited savings.

    More Info

    This program helps cover the Medicare Part B premium only.  If you didn't sign up for Part B on time and are subject to a penalty, the SLMB program will also cover the penalty.

    The federal income and asset limits to qualify for SLMB in 2018 are:

    If you are single:

    • Less than $1,234 a month in income
    • No more than $7,560 resource limit in assets, such as checking, savings, and investment accounts. Your home, one car, household goods and furniture, and personal items are excluded.

    If you are married:

    • Less than $1,666 a month in income
    • No more than $11,340 in assets, such as checking, savings, and investment accounts. Your home, one car, household goods and furniture, and personal items are excluded.

    These limits may increase in 2019, so if you're slightly above these limits, it still pays to apply.

    In addition, while most states use the federal limits, some have their own, more generous income and asset guidelines. Be sure to check with your state to find out if you qualify. You can find your state’s contact information here.