Public Benefits for Medicare Beneficiaries
This article was updated on: 09/15/2018
Seniors on a fixed income may sometimes have trouble paying for health-care coverage and related medical costs. If you have a chronic health condition that requires ongoing treatment or frequent doctor visits, you know that copayment and coinsurance costs can quickly add up.
Fortunately, there are many public benefits available for eligible Medicare beneficiaries with limited income. Many of these funds are available through state-run Medicaid programs. Depending on your level of eligibility, you may be able to get help with costs like premiums, deductibles, copayments, and more. Here is an overview of some of the public benefits that may be available to you.
Medicaid and dual eligibility
Jointly funded at the federal and state level, Medicaid is a public benefit that provides health coverage for low-income individuals, including Medicare beneficiaries. If you qualify for both Medicare and Medicaid, you’re known as a “dual eligible.”
Although state Medicaid programs must meet certain federal guidelines, each state has the flexibility to expand its public benefits beyond that. Many programs cover health-care costs that the Medicare program doesn’t typically cover, including long-term care, chiropractic services, and personal care services.
You can look up the contact information for your state’s Medicaid program to learn more about eligibility and how to apply.
Public benefits that help with Medicare costs: Medicare Savings Programs
If you have Medicare and meet income and asset requirements, you may be eligible for public benefits through a Medicare Savings Program. These programs help with Medicare costs like premiums and cost sharing and are administered by state Medicaid programs. There are four types available, and each type corresponds with a different level of aid and has different income requirements:
- The Qualified Medicare Beneficiary (QMB) Program helps pay for Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments.
- The Specified Low-Income Medicare Beneficiary (SLMB) Program helps pay for your Part B premium only.
- The Qualifying Individual (QI) Program helps pay your Part B premium only.
- The Qualified Disabled and Working Individuals (QDWI) Program helps pay for the Part A premium only. If you’re one of the many beneficiaries who qualifies for premium-free Part A, this program wouldn’t help you. To be eligible, you must:
- Meet your state’s income and resource eligibility limits.
- Not currently be getting state public benefits for medical costs.
- Be a currently working disabled individual under 65 years old.
- Have lost your premium-free Part A because you started working again.
- Income and asset levels may change annually. For the most up-to-date information on eligibility, check the Medicare.gov website.
- If you have income from employment, you might qualify for these programs even if your income is more than the limits listed, so it’s a good idea to apply just in case.
- If you live in Alaska or Hawaii, the income limits are slightly higher.
- If you qualify for the QMB, QI, or SLMB programs, you’ll automatically be eligible for the Extra Help program, which helps with Medicare Part D prescription drug costs (see below for more information).
Call your state Medicaid program to see if you qualify and request an application. You can apply even if your income and assets are higher than the listed eligibility requirements; if you don’t qualify for public benefits this year, you can always reapply. To get the contact information for your Medicaid program, you can call 1-800-MEDICARE (1-800-633‑4227; TTY users call 1-877-486-2048), 24 hours a day, seven days a week.
Public benefits for Medicare prescription drug costs: Extra Help (Low-Income Subsidy)
If you need help with prescription drug costs, the Extra Help program is another public benefit for those with Medicare. Also known as the Low-Income Subsidy program, Extra Help assists with costs like monthly premiums, annual deductibles, copayments, and/or coinsurance costs.
To qualify for the Extra Help program, you must be a resident in one of the 50 states or the District of Columbia. In addition, your annual income and resources must meet eligibility limits, which change from year to year. Like Medicare Savings Programs and Medicaid, it’s worth applying even if you’re not sure whether you may qualify.
In some cases, you’re automatically eligible for Extra Help if you’re enrolled in Medicare and one of the following situations apply:
- You receive full Medicaid coverage.
- You’re in a Medicare Savings Program that pays for your Part B premiums.
- You receive Supplemental Security Income (SSI) benefits.
You can see if you qualify and fill out an application online at www.socialsecurity.gov/extrahelp, or call Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday from 7AM to 7PM (all U.S. time zones). If you end up being eligible, you can enroll in a Medicare Prescription Drug Plan at that point, or Medicare will choose a plan for you.
Other ways to save on Medicare costs
If you’re having trouble paying for your Medicare costs, one of the best ways to lower your expenses is to research more cost-effective options. For example, Medicare Prescription Drug Plans often vary significantly when it comes to costs like copayments and coinsurance, even when covering the same medications. Taking the time to research plan options in your area may save you money on medical and prescription costs. If you’re in Original Medicare, a Medicare Supplement (Medigap) plan can help with out-of-pocket expenses that Part A and Part B don’t cover, like deductibles, cost sharing, and overseas emergency health coverage.
If you’d like help figuring out plan options that may work for you, that’s where I can help. I can walk you through different Medicare plan options that may fit your health and budget needs. You have a few options: you can set up a phone appointment or receive an email containing personalized plan options using the links below. If you want to browse plan options yourself, click the Compare Plans button on this page.