Saving on Medicare Expenses
Medicare is designed to provide coverage for healthcare costs, but it is important to understand that you are still responsible for a portion of those costs. When it comes to adding up premiums, deductibles and co-pays, these costs can be significant, particularly if you are living on a fixed income. The good news is, there are programs available to help limit these costs.
Medicare Savings Programs
Medicare Savings Programs (MSPs) are state-based programs, with each having unique eligibility requirements. They are as follows:
Qualified Medicare Beneficiary (QMB) Program
Through the Qualified Medicare Beneficiary (QMB) Program, the government makes monthly premium payments toward Medicare Part A (when applicable) and Medicare Part B plans, and covers deductibles, co-insurance payments, and some prescription drug costs.
Specified Low Income Medicare Beneficiary (SLMB) Program
The Specified Low Income Medicare Beneficiary (SLMB) Program helps cover the cost of Medicare Part B premiums for qualifying individuals.
Qualifying Individual (QI) Program
The Qualifying Individual (QI) Program helps pay for Medicare Part B premiums. You have to reapply every year for QI, as benefits are granted on a first-come, first-serve basis.
Qualifying Disabled and Working Individuals (QDWI) Program
The Qualifying Disabled and Working Individuals (QDWI) Program is for those people younger than age 65 who are disabled but working, and helps pay for Medicare Part A premiums.
To apply for one of the four savings programs or to learn more about eligibility, please contact your state’s Medicaid office.
Medicare Extra Help
The Medicare Extra Help program helps those with fixed incomes pay for some, if not all, of the out-of-pocket expenses that come with Medicare Prescription Drug Plans. Extra Help is not a replacement for Part D nor is it a plan on its own.
The amount of financial support you can receive from this program is dependent upon your income and resources, but most who qualify for Extra Help can expect:
- No premiums (up to state benchmark; varies by state)
- No drug deductibles
- No more than $4.15 for generic & $10.35 for brand-name for each drug the plan covers1
Extra Help beneficiaries can also expect the following benefits:
- Quarterly Special Enrollment Period – Extra Help beneficiaries can join or switch Medicare Part D drug plans once every three months from January-September. This special enrollment period ensures qualifying individuals don’t have to wait for the Medicare Advantage & Prescription Drug Plan Annual Enrollment Period (October 15-December 7) to change plans. Any plans made outside of the Medicare Annual Enrollment Period become valid the following month.
- No Part D Late Enrollment Penalty – Even if you enroll after you were first eligible to join a Part D plan and did not have other drug coverage.
To apply for Extra Help, you can complete an ‘Application for Extra Help with Medicare Prescription Drug Plan Costs’ by:
- Visiting www.socialsecurity.gov/prescriptionhelp
- Calling Social Security at 1-800-772-1213
- Applying in person at your local Social Security office
Dual Eligibility Program (Medicare Medicaid Eligibility)
Dual Eligibility happens when an individual is eligible for both Medicare and Medicaid. Medicare is a federal health insurance program for seniors and disabled persons, while Medicaid is a state and federal medical assistance program for people with limited incomes and resources. Those enrolled in both could receive greater healthcare coverage and have lower out-of-pocket costs.
To be eligible for Medicare, you must be a U.S. citizen or legal resident residing in the U.S. for a minimum of five years. Additionally, you must meet one of the following criteria:
- Be at least 65 years old
- Have a disability (and have been declared “legally disabled” for at least 24 months)
- Have been diagnosed with end-stage renal disease or Lou Gehrig’s disease
Although federally set, eligibility for Medicaid varies from state-to-state.