Are Medicare Advantage Plans Subsidized?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 09/15/2018

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If you are looking for a Medicare subsidy, you might be happy to find out that there may be ways to get financial help paying for Medicare and Medicare Advantage. Healthcare.gov defines subsidized coverage as health coverage available at reduced or no cost for people with incomes below certain levels. If you have a Medicare Advantage plan you could be responsible for up to three premiums (a Part A premium, a Part B premium, and the premium charged by your Medicare Advantage plan) as well as a deductible, copayment and coinsurance for each visit or service. The government paying a portion or all of your Medicare Advantage premiums, coinsurance, copayments, and deductibles is generally considered by most people to be a Medicare subsidy, even if the payment is for a Medicare Advantage plan instead of for Original Medicare.

What is Medicare Advantage?

Medicare Advantage (also called Part C) is another way to get your Original Medicare (Part A and Part B) benefits. Private insurance companies offer Medicare Advantage plans and some may charge $0 premiums. However, you must still continue to pay your Medicare Part B premium and your Part A premium if it applies. Medicare Advantage plans must offer everything Original Medicare covers except hospice care, which is still covered by Medicare Part A. Some Medicare Advantages plans offer extra benefits, such as prescription drug coverage, routine dental, routine vision, and wellness programs.

Can Medicaid provide a Medicare subsidy?  

Medicaid is an example of subsidized coverage that may be available to Medicare beneficiaries enrolled in either Original Medicare or Medicare Advantage. If you are eligible for both Medicare and Medicaid, you are called “dual eligible” and most of your health care costs are generally subsidized. Usually you will become eligible for Medicaid based on your income and resources.  In states that have expanded Medicaid coverage, your household income generally must be below 138% the federal poverty level to qualify. (In 2018, the federal poverty guideline was $12,140 for a household of one and $16,460 for a household of two in the contiguous US.) Some states may allow you to qualify for Medicaid if you are “medically needy” even if you have too much income to qualify.

Medicaid may:

  • Cover services not usually covered by Medicare, such as nursing home care and personal care services.
  • Cover your Part B premium (If you have a Medicare Advantage plan you are responsible for a Part B premium, just like you would be with Original Medicare.)

Because Medicaid is partially administered by states, each state has different rules about eligibility and applying for Medicaid. Call you State Medicaid program to see how to apply.

Can Medicare Savings Programs provide a Medicare subsidy?

A Medicare Savings Program from the state may help subsidize your Medicare and Medicare Advantage premiums. If you meet certain conditions, a Medicare Savings Program may also pay hospital and medical insurance deductibles, copayments and coinsurance.

There are four types of Medicare Savings Programs. Each has an income and resource limit but these amounts may increase each year. You can still apply if your income and resources are slightly higher than the stated limits. Resources include checking and savings account balances, stocks and bonds.

The four types of Medicare Savings Programs are:

Qualified Medicare Beneficiary Program (QMB)

The QMB is the most comprehensive of the four Medicare Savings Programs. The QMB program may pay for Part A and Part B premiums as well as deductibles, coinsurance, and copayments. The individual monthly income limit in 2017 is generally $1,025 and the individual resource limit in 2017 is $7,390. To be sure your provider knows you have QMB, show them both your Medicare and QMB (or Medicaid) card each time you visit.

Specified Low-Income Medicare Beneficiary Program (SLMB)

The SLMB program may help subsidize your Part B premiums only. The individual monthly income limit in 2017 is generally $1,226 and individual resources limit is $7,390 (the same as the QMB program).

Qualifying Individual Program (QI)

Like SLMB program, the QI program is for Part B premiums only. Your individual monthly income limit generally must be $1,377 in 2017 and your individual resource limit must be $7,390. You must apply every year for QI benefits and priority is given to people who got QI benefits the previous year.

Qualified Disabled and Working Individuals Program (QDWI)

The QDWI program helps subsidize the Medicare Part A premium only. You may have to pay a Part A premium with a Medicare Advantage plan if you don’t qualify for premium-free Part A. To qualify for QDWI you generally must be a working disabled person under 65 who lost your premium-free Part A when you went back to work. You also cannot be getting medical assistance from your state and you must meet income and resources limits set by your state. The individual monthly income limit in 2017 is $4,105 and the individual resource limit is $4,000.

To apply for a Medicare Savings Program, contact your state Medicaid program.

Would you like to know more about Medicare Advantage Medicare subsidies? I’d be happy to help you. I can walk you through your options or email you information; you can request that using the links below. Or take a look at plans by clicking the Compare Plans buttons on this page.

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