2021: Programs that lower your health care 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 Medicaid, 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. Contact your local State Health Insurance Assistance Program (SHIP) to find out if you are eligible and what you will need to apply for one of these programs.

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 2021, 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. If you have QMB, you should not have out-of-pocket costs for Medicare-approved services in traditional Medicare or for in-network services in a Medicare Advantage plan.
     • Income limit monthly depends upon where you live but is around
       • $1,094 for individuals
       • $1,472 for couples
     • Asset limit
       • Individuals: $7,970
       • Couples: $11,960
   • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20
     • Income limit monthly depends upon where you live but is around
       • $1,308 for individuals
       • $1,762 for couples
     • Asset limit
       • Individuals: $7,970
       • Couples: $11,960
   • Qualifying Individual (QI)—135 percent of FPL +$20, covers your Medicare Part B premiums
     • Income limit monthly depends upon where you live but is around
       • $1,469 for individuals
       • $1,980 for couples
     • Asset limit
       • Individuals: $7,970
       • Couples: $11,960

   What counts as income and assets? 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 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.

1. 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 Part D drug coverage. The amount of help with cost-sharing depends on the level of your income and assets. In 2021, you may qualify if you have up to $1,630 in monthly income ($2,198 for a married couple) and up to $14,790 in assets  ($29,520 for a married couple). If your income and assets are lower– income up to $1,469 and assets up to $9,470 for an individual) you may qualify for full Extra Help. With Extra Help your drug costs are no more than $3.70 for each generic/$9.20 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.)
2. 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.
3. 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.
4. 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.

Here’s more from Just Care:

• Four things to know about Medicaid if your income is low and you have Medicare.
• Free local resources to help older adults,
• Medicare covers a wide array of preventive care services
• Avoid supplements with these 15 ingredients
• Why you need to complete a durable power of attorney