Do I qualify for financial assistance with Medicare?

When it comes to Medicare, you’ve earned each and every benefit. But it’s important to recognize early on your Medicare journey that the program is not without costs. Some of these are up front, like the monthly premium payments you make to maintain your Medicare coverage. Others are associated with your share of medical services, like the payments you make at the doctor’s office to cover your portion of the care you received, or the percentage of the cost of a hospital stay you are expected to pay.

These payments can add up, and not everyone is able to afford them. But there’s good news: you may be able to qualify for help paying for your Medicare costs. Here are some available options.

Help paying for Medicare premiums

Medicare Savings Programs (MSPs) are programs run by state governments that can pay  for premiums, deductibles, copayments and coinsurance associated with Medicare for people with limited income and assets.

Income is the amount of money you earn during the year.

Assets are any money you have in the bank, and the value of any investments (i.e., stocks, bonds and real estate). However, the house you live in and up to one car you own are not counted as assets when it comes to qualifying for a Medicare Savings Program.

There are three types of Medicare Savings Programs designed to help with paying costs for Original Medicare or Medicare Part B. They are distinguished by their income limits and what costs they help pay for. The programs include:

Help from Medicaid

Medicaid is a health insurance program operated by each state that is designed to provide coverage for low-income and low-asset individuals. Each state sets its own limits on income, assets and the type of benefits they include in their Medicaid program. It’s possible to be eligible for both Medicare and Medicaid. In fact, about 20 percent of people who receive Medicare benefits also receive help paying for Original Medicare — and most of these people also receive Medicaid benefits. If you receive Medicare benefits and meet your state’s Medicaid eligibility requirements — income and asset requirements, plus citizenship and residency requirements for full Medicaid benefits — you can be full benefit dual eligible.

If you are a full benefit dual eligible, you can receive benefits included in both Medicaid and Medicare coverage. Here are some examples of what’s covered under Medicaid:

• Some types of care you get at your home, like nursing that focuses on helping a person get in and out of bed or get dressed
• Care delivered in a nursing home
• Some prescription drugs not covered by Medicare Part D plans

If you only meet the income and asset requirements of the Medicare Savings Program, you are a partial dual eligible and will receive assistance with Medicare costs, but will not receive additional Medicaid benefits.

Paying for a prescription drug plan

But you don’t have to be in a Medicare Savings Program to receive help paying for your prescriptions under Extra Help. If your annual income in 2021 as an individual is up to $19,320, or as a married couple is up to $26,130, you may be eligible. Asset limits in 2021 are up to $14,790 for an individual or $29,520 for a couple.

Depending on which Medicare Part D plan you choose, the program can reduce or eliminate your plan’s premium and deductible, and also lower the cost you pay for the prescription drugs covered under your plan.

Finding out if you qualify

With so many different programs providing assistance for so many different types of costs, it’s easy to get confused. Fortunately, there is help available to find out if you qualify for financial assistance for Medicare.

Don’t be afraid to reach out for help in finding out if you qualify for assistance paying for your Medicare coverage. After all, you’ve earned it.

About the author

Mark Pabst has worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.