Understanding Medicare Assistance Programs

Understanding Medicare Assistance Programs

There are several assistance programs available to help those on a limited fixed income with their medical and/or prescription drug costs through Social Security or your State welfare office. Please take the time and read about the programs below to see if you may qualify for any assistance program or the extra benefits and services often combined with various Medicare Advantage plans.

Medicare Assistance Programs
  • Medicaid
  • Medicare Savings Programs
  • Qualified Medicare Beneficiary (QMB)
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Qualified Individual (QI)
  • Extra Help/Low Income Subsidy (LIS)
  • Extra Benefits & Services

What is Medicaid?

Medicaid is a state and federal program that provides health coverage if you have a limited fixed income.

Medicaid provides health coverage to people with low-income and asset levels who meet certain eligibility requirements. Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.

What does Medicaid cover?

Medicaid pays for “medically necessary” health care such as:

• Physician visits

• X-ray and laboratory tests

• Hospital and nursing-home care

• Home healthcare

• Prosthetic and orthopedic devices

• Hearing aids

• Medical equipment

• Ambulance services

• Certain prescription drugs excluded as a Medicare Part D benefit

Medicaid will only cover these costs and services if you use providers that accept Medicaid. If you have both Medicare and Medicaid, Medicare is the primary payer (meaning Medicare will pay first for Medicare-covered benefits) and Medicaid is the secondary payer. If you qualify for Medicaid, it will also cover your Medicare Part A and B deductibles and co-payments, and pay your monthly Medicare Part B premium.

Medicare Savings Program

Medicare Savings Programs are federally funded program administered by each state. These programs are for people with limited income and resources and help pay some or all of the Medicare premiums, deductibles, co-payments and coinsurance.

There are three major Medicare Savings Programs:

• Qualified Medicare Beneficiary (QMB)

• Specified Low-Income Medicare Beneficiary (SLMB)

• Qualifying Individual (QI)

Below are general requirements for the MSP:

• Reside in a state or the District of Columbia,

• Are age 65 or older,

• Receive Social Security Disability benefits,or

•People with certain disabilities or permanent kidney failure (even if under age 65)

• Meet standard income and resource requirements.

Medicare Savings

Medicare Savings Program

Medicare offers several Medicare Savings Programs (MSPs) that assist people with low income and assets:

Qualified Medicare Beneficiary (QMB)

  • Pays Part A Premium, Part B Premium, Part A & B Deductibles, Part A & B Coinsurance
  • Income: Up to $1,025/mo Single, $1,374/mo Couple
  • Assets: Up to $7,390 Single, $11,090 Couple

Specified Low-Income Medicare Beneficiary (SLMB)

  • Pays Part B Premium
  • Income: Up to $1,226/mo Single, $1,644/mo Couple • Assets: Up to $7,390 Single, $11,090 Couple

Qualified Individual (QI)

  • Pays Part B Premium
  • Income: Up to $1,377/mo Single, $1,847/mo Couple
  • Assets: Up to $7,390 Single, $11,090 Couple
What Is Extra Help

Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage for eligible individuals who have a limited income.

Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for:​

  • Part D monthly premium
  • Annual deductible
  • Coinsurance and Co-payments.
  • Coverage in the gap (donut hole)
  • Part D Late Enrollment Penalty (waived)

Extra Help Eligibility?

You may qualify for the Extra Help available under Medicare Part D if:​

  • Your assets are less than $14,100 (single individual) or $28,150 (married couple living together)
  • Your annual income is less than $18,210 (single individual) or $24,690 (married couple living together).
  • Your annual income is higher than the eligibility limit, but you support other family members who also live in the same household; or you live in Hawaii or Alaska.

Assets that count toward eligibility include:

  • Cash and bank accounts, including checking, savings, and certificates of deposit
  • Real estate outside of your primary residence
  • Stocks and bonds, including U.S. savings bonds
  • Mutual funds and IRAs
Extra Help Income Asset Levels

Additional Benefits Available

There are programs available to help those on Medicare get extra benefits and services, like:​

  • Over the Counter Health Product
  • Basic & Comprehensive Dental Coverage
  • Routine Foot Care
  • Fitness Membership
  • Hearing Exam and Hearing Aid Coverage
  • Transportation for Medical Appointments
  • Chiropractic & Acupuncture
  • Vision Exams and Eyewear
Next Step

Next Steps

  • Find out what assistance programs you qualify for.
  • Get a drug plan comparison to see if you can save money on your prescriptions.
  • Determine what extra benefits you need.
  • Let our Simple Senior Benefits” advisors help you through the process to make sure you get all the benefits and services you deserve.

Let one of our Advisors assist you today!


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