If you’re struggling to pay your Medicare premiums, you’re not alone. Many Americans require assistance with their Medicare premiums. You may be wondering where to seek help and how to qualify. Continue reading to discover programs offering Medicare premium assistance and specific eligibility requirements.
Understanding Medicare Premiums and Their Parts
Your Medicare premium refers to the monthly payment you make for your Medicare insurance plan. Medicare consists of four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Each part has a separate premium. Parts A and B, collectively known as Original Medicare, are directly provided by the Medicare program.
Medicare determines and bills premiums for Parts A and B. Part A premiums can go up to $471 per month as of 2021. However, most individuals don’t pay Part A premiums because they have already contributed through Social Security taxes after working for at least 10 years in the U.S. The estimated Part B premium for 2022 is $158.50.
Part C plans combine various Medicare parts, including Original Medicare and often Part D, offering a broader range of benefits. Private insurance companies approved by Medicare sell these plans, and premium rates vary based on plan type and location. The average premium for 2022 Part C plans is $19.
Medicare Part D plans are also provided by private insurance companies. The national average Part D premium for 2022 is $33. However, costs may differ depending on your location and plan type.
Help paying for Medicare premiums
There are four different types of Medicare Savings Programs available to assist with the costs of Original Medicare or Medicare Part B. These programs vary based on their income limits and the specific costs they cover. The programs are as follows:
Qualified Medicare Beneficiary Program (QMB):
- Helps pay for Part A and Part B premiums, copayments, deductibles, and coinsurance.
- For 2023, an individual can qualify with a monthly income of up to $1,235.
- A couple can qualify with a combined monthly income of $1,663.
- The asset limits are $9,090 for an individual and $13,630 for a couple.
Specified Low-Income Medicare Beneficiary Program (SLMB):
- Assists with paying premiums for Part B.
- In 2023, a single person can qualify with a monthly income up to $1,478.
- A couple can qualify with a combined monthly income of $1,992.
- The asset limits are $9,090 for an individual and $13,630 for a couple.
Qualified Individual Program (QI):
- Helps pay premiums for Part B, but covers a smaller percentage compared to the Specified Low-Income Medicare Beneficiary Program.
- In 2023, an individual can qualify with a monthly income up to $1,660.
- A couple can qualify with a combined monthly income of $2,239.
- The asset limits are $9,090 for an individual and $13,630 for a couple.
Qualified Disabled and Working Individuals Program (QDWI):
- Assists with paying premiums for Part A.
- Eligibility is based on having a disability, being employed, and losing Social Security disability benefits and premium-free Part A due to returning to work.
- For 2023, an individual can qualify with a monthly income up to $4,945.
- A couple can qualify with a combined monthly income of $6,659.
- The asset limits are $4,000 for an individual and $6,000 for a couple
How Medicare Savings Programs Work
To be eligible for premium assistance through Medicare Savings Programs (MSPs), you must have limited income and resources. Each state manages program funds and determines eligibility criteria. MSPs can cover some or all of your Medicare out-of-pocket expenses, including premiums. These programs primarily cater to Original Medicare (Parts A and B) plan enrollees, meaning all states must assist eligible individuals with premium payments. However, states have the discretion to decide whether to contribute to Medicare Advantage premiums. As for Medicare Part D, those who qualify for certain MSPs can receive premium assistance through a separate program called Extra Help, which we’ll discuss later.
Income and Resource Limits for Medicare Savings Programs
Medicaid considers your income and resources (assets) when determining eligibility for Medicare premium assistance. MSPs have varying monthly income limits, with most states (including the District of Columbia) sharing the same limits. Alaska and Hawaii are the only states with different income limits. Three of the four MSPs have identical resource limits, which apply to all states, including Alaska and Hawaii. If your income falls within or below these limits, you may qualify for assistance.
Do I Meet the Requirements for Medicare Premium Assistance?
You might be eligible for assistance with your Medicare premiums through Medicare Savings Programs if you:
- Qualify for or have Medicare Part A.
- Meet the income limits set by the program.
- Have limited resources below the maximum allowed amount, which may include stocks, bonds, and funds in checking or savings accounts.
If you believe you could qualify for help with paying your Medicare insurance, you or your representative must contact your state’s Medicaid office. Even if your income slightly exceeds the limits, you may still be eligible for full or partial premium assistance.
Assistance with Medicare Advantage (Part C) Premiums
If you qualify for the Qualified Medicare Beneficiary (QMB) program, you may receive assistance with your Part C premiums. However, coverage for Medicare Advantage plan premiums is determined by each state, and it is not guaranteed that all states will provide premium payment assistance.
If you have both Medicare and Medicaid and are enrolled in a Medicare Advantage Special Needs Plan, most of your insurance costs will be covered by Medicaid. However, states are not required to pay for plan premiums. While premium assistance may not be available, states are responsible for covering Medicare Advantage copayments and coinsurance for services provided under Medicare Parts A and B.
Extra Help for Medicare Part D
If you meet the requirements for the QMB, SLMB, or QI Medicare Savings Programs, you automatically qualify for a program called Extra Help, which aims to assist with the cost of prescription drugs. Extra Help, also known as the Part D Low-Income Subsidy, is specifically designed for Medicare Part D, which provides prescription drug coverage. Medicare Part D typically involves a premium, deductible, and copayments or coinsurance. To learn more about Medicare Part D, click here.
However, you don’t have to be enrolled in a Medicare Savings Program to receive assistance with prescription drug costs through Extra Help. If your annual income is up to $1,822.50 per month as an individual or $2,465 per month as a couple in 2023, you may be eligible. In 2023, the asset limits are set at up to $16,600 for individuals or $33,240 for couples.
Depending on the specific Medicare Part D plan you choose, Extra Help can reduce or eliminate your plan’s premium and deductible, as well as lower the cost of prescription drugs covered by your plan.
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