Which Programs Can Help with My Medicare Expenses?

The federal government rewards hard-working individuals with benefits such as Social Security income and Medicare later in life when their income becomes fixed or limited. Those are nice benefits to have, yet all parts of Medicare are not free. Beneficiaries will incur some amount of out-of-pocket expenses. 

It may become difficult for some beneficiaries to pay their Medicare premiums as their retirement income may be limited, and they may have higher medical expenses due to aging. 

Fortunately, programs are available to help pay for Medicare premiums and assist with other healthcare expenses such as deductibles, copays, and prescription drug costs. 

We’ll cover four programs to help with Medicare expenses:

• Medicaid
• Medicare Savings Programs
• Supplemental Security Income Benefits (SSI)
• Extra Help

You can also purchase a Medigap plan to help with out-of-pocket costs. To learn more about Medigap plans visit https://boomerbenefits.com/faq/what-is-medigap/.

Individuals who are eligible for Medicaid may get help to pay for their Medicare premiums. 

Federal and state governments jointly administer Medicaid. Each state sets its own requirements for income and resources to qualify for Medicaid. State governments also determine the services they cover under Medicaid and what those services cost. 

Medicaid can help with healthcare expenses for beneficiaries in the following ways:

• Serves as a secondary payer
• Qualifies a beneficiary for other programs such as Medicare Savings Program and Extra Help
• Offers care coordination which can help reduce costs

Be aware that Medicaid is always the payer of last resort which means other applicable programs pay before Medicaid does. 

Find your state Medicaid office at Medicaid.gov or call (877) 486-2048.

Individuals with limited incomes and resources may be able to get assistance from their states under a Medicare Savings Program (MSP). Individuals who are dually enrolled in Medicare and Medicaid will automatically be enrolled in an MSP in many states. The benefit of an MSP is that it will pay your Medicare Part B premium, and it may offer additional assistance as well.  

Note that Medicare Savings Programs are not available in the U.S. Virgin Islands or Puerto Rico. 

There are four types of MSPs including: 

Qualified Medicare Beneficiary Program (QMB)

Those who qualify for this program won’t have to pay premiums for Medicare Parts A or B. Also, Medicare providers will not bill for Medicare deductibles, coinsurance, or copayments for Medicare expenses. Beneficiaries will have to pay for outpatient prescription drugs. 

Specified Low-Income Medicare Beneficiary Program (SLMB)

This program only pays for Medicare Part B premiums. Beneficiaries must meet certain income requirements to qualify for this program. 

Qualifying Individual Program (QI)

This program also only pays for Medicare Part B premiums. Beneficiaries must apply annually for QI benefits. Governments grant applications on a first-come/first-served basis.

Qualified Disabled and Working Individuals Program (QDWI)

Individuals who have a disability and are working but have lost their Social Security benefits because they returned to work may qualify for QDWI. This program helps pay for Medicare Part A premiums only. State agencies administer QDWI, so the qualifications vary by state. 

Your state Medicaid office can provide the specifics on whether you meet the eligibility requirements for any of these programs. You can also learn more about programs and Medicare premium assistance at the Benefit Eligibility Screening Tool site. 

Individuals who are age 65 or older, blind, or have a disability may qualify for SSI. SSI is a different program than Social Security retirement benefits. Individuals may qualify for SSI and Social Security payments. 

Note that SSI is not available for individuals who reside in the U.S. Virgin Islands, Puerto Rico, Guam, or American Samoa. 

Individuals who have limited income and resources may qualify for a Medicare program called Extra Help. As its name indicates, Extra Help gives individuals a bit of extra help with paying for Medicare prescription drug costs. The degree of extra help someone gets depends on the level of their income and other resources. 

Those who qualify for Extra Help should consider that the income and resource requirements may change annually, so they may not get the same level of help each year. 

The Centers for Medicare & Medicaid Services (CMS) puts out Your Guide to Medicare Drug Coverage which describes how to qualify for Extra Help, how to apply for it, and more.   

Because of the Inflation Reduction Act, more assistance will be available for Medicare beneficiaries in 2024. Individuals who meet the current income caps for partial Extra Help will be eligible for full benefits in the coming year.