Programs that lower your costs if you have Medicare

Medicare only covers about half of a typical person’s health care costs. So, even with Medicare, many people struggle to afford premiums, deductibles and other out-of-pockets health care costs. Some people qualify for Medicare, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs.

1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2018, but vary somewhat by state. You should apply through your local Medicaid office.
   • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20
     • Income limit monthly depends upon where you live but is around
       • $1,010 for individuals
       • $1,355 for couples
     • Asset limit
       • Individuals: $7,560
       • Couples: $11,340
   • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20
     • Income limit monthly depends upon where you live but is around
       • $1,208 for individuals
       • $1,622 for couples
     • Asset limit
       • Individuals: $7,560
       • Couples: $11,340
   • Qualifying Individual (QI)—135 percent of FPL +$20
     • Income limit monthly depends upon where you live but is around
       • $1,357 for individuals
       • $1,823 for couples
     • Asset limit
       • Individuals: $7,560
       • Couples: $11,340

   No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

   Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, less than a half the people over 65 who qualify for the Qualified Medicare Beneficiary program (48%) are not enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (28%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

2. Extra Help with Medicare Part D prescription drug coverage: You may qualify for Extra Help, a program administered by Medicaid, which pays for some or all of the cost of your drug coverage. The amount of help with cost-sharing depends on the level of your income and assets. In 2018, you may qualify if you have up to $18,210 in yearly income ($24,690 for a married couple) and up to $14,100 in assets  ($28,150 for a married couple). With Extra Help your drug costs are no more than $3.35 for each generic/$8.35 for each brand-name covered drug. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program or receive Supplemental Security Income benefits. You can apply for Extra Help online here. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)
3. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.
4. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.
5. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

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