Looking for some help with paying your Medicare costs? Don’t worry – you have options. There are many federal and state financial assistance and benefits programs available to people from low-income households who may need a little extra support. Depending on your needs and which program you qualify for, this can mean assistance covering premiums, deductibles and coinsurance amounts across different parts of Medicare. Here’s how you can find and enroll in a program that works for you.
Getting help paying your Part B premium
One of the most asked questions about Medicare financial assistance is “How can I get help paying for my Part B premium?” And it makes sense – Part B premiums change each year, and as a regular monthly payment, it can be hard to manage for those with an income limit. However, there are plenty of federal and state-run programs that can help, such as a Medicare Savings Program. You can even look into a dual-eligible special needs plan which combines your Medicare and Medicaid coverage in one place.
Getting help paying for Part D prescription drug plans
Unfortunately, Original Medicare doesn’t cover outpatient prescription drugs. To get prescription drug coverage, you must enroll in a separate Medicare Part D prescription drug plan.
But some of these plans can get costly – are there resources you can tap into for help? Absolutely. One option you can explore is a pharmaceutical assistance program. Some drug companies offer programs and benefits that will help you pay for medicines if you’re enrolled in Part D, and Medicare makes it easy to find participating companies online. Also, select states run their own Part D assistance programs for prescriptions, drug plan premiums and other costs you may need help covering. In addition, you can look at programs run at the federal level, such as Extra Help.
Programs for people who need help with Medicare costs
We’ve briefly touched on a few Medicare financial assistance options, but how do you know which one you should choose? How do you know if you qualify? Here are some of the most used programs to consider, how they help, eligibility criteria and how to apply.
The Extra Help program
Extra Help is a Medicare program run by the United States Social Security Administration (SSA) and the Centers for Medicare & Medicaid Services (CMS). It helps people from low-income households pay for their Medicare drug coverage. This can include financial assistance covering premiums, deductibles, coinsurance and other costs.
Extra Help can be an impactful support option for people with limited resources or an income limit – but not many know about it. It’s estimated that around three million seniors and people with disabilities could benefit from enrolling in the Extra Help program.
To qualify for Extra Help, you must meet a certain income and resource requirement. According to the SSA, your resources (including income, savings, investments, real estate and more) must be below $17,010 as an individual or $33,950 for a married couple currently living together.
Some people qualify for Extra Help automatically, and other people must apply. You'll get Extra Help automatically if you already receive full Medicaid coverage, state-supported financial assistance for your Part B premiums or Supplemental Security Income (SSI) benefits.
If you’re not automatically enrolled, and you’re interested in seeing if you qualify, you can apply on the SSA’s official website.
The Medicare Savings Programs
If you’re looking for help covering your Medicare Part A (hospital insurance) and Part B (medical insurance) premiums, you may be able to enroll in a Medicare Savings Program. There are four different Medicare Savings Programs that help pay for Original Medicare costs. You may qualify based on your income, assets and whether you’re disabled. However, these guidelines can vary by state.
If you qualify, your state may help pay for all your Medicare Part A and/or B premiums. And not only that, but if you meet certain conditions, your state may also assist with costs for your Medicare deductibles, coinsurance and copayments.
You can apply for Medicare Savings Programs through your state, and when you do, your state determines which program(s) you qualify for. Even if you don’t think you qualify, it’s still a good idea to apply – it never hurts to make sure.
The Elderly Waiver program
The Elderly Waiver (EW) program offers financial support and services to people living at home who need nursing home-level care. To be eligible, you must qualify for Medical Assistance (Medicaid). The EW program is specific to Minnesota, but there are many other states that have similar waiver programs covering home and community services like home health aides, home delivered meals and homemaker services.
Minnesota Senior Health Options (MSHO)
Some states have health plans that cover both Medicare and Medicaid and are at no or low cost. Medicare Dual Special Needs Plans (D-SNPs) are an option in some states, including Iowa, Minnesota, and Wisconsin. These plans are different than the Medicare Savings Programs we talked about above. In these Dual Special Needs Plans, private health insurance companies provide Medicare and Medicaid benefits for medical, dental and prescription drug coverage in one health care plan plus extra benefits – often at no cost.
In Minnesota, the Minnesota Senior Health Options (MSHO) program is a Special Needs Plan for people aged 65 or older who are eligible for Medicaid and enrolled in Medicare Parts A and B. MSHO plan choices vary by county.