Here’s How To Get Help Paying Your Medicare Premiums

By: Edward Neeman
Published: Monday, December 10 2018
Last Updated: 9 months ago

It’s safe to say that most people look forward to the leisurely life that is retirement. Spending days with your friends and family, enjoying and exploring new hobbies, and rediscovering old passions. While retirement is supposed to reduce your stress, a fixed income and growing healthcare expenses often result in the opposite.

Medicare is one of the most comprehensive health plans, and all things considered, is relatively inexpensive compared to private options. However, even with federal subsidies, millions of American seniors are finding it difficult to afford the monthly premiums on top of the out-of-pocket expenses that add up quickly. Thankfully, there are programs that will help you, or any other qualifying Medicare beneficiary pays for premiums.

What Is Your Medicare Premium?

Premiums are a fee, typically paid monthly by Medicare beneficiaries in exchange for health coverage and benefits. You may be familiar with premiums if you’ve ever had health insurance before you became eligible for Medicare, but the main difference here is Medicare premiums are based on income, not medical history or age. Most people won’t have to pay a monthly premium for Medicare Part A but will need to for Medicare Part B, Medicare Advantage plans, or Prescription Drug plans.

How They Work

Medicare premiums work in the following way. The beneficiary pays a predetermined amount to their insurer, in this case, Medicare, or private insurers who are approved by Medicare. The money you pay each month is put in a risk pool with premiums from all other participants.

When a beneficiary seeks out medical attention, the money from the risk pool is used by insurers to pay the medical provider. As you can imagine, premiums won’t always be enough to cover all of your medical costs, which is why there are out-of-pocket expenses and negotiated rates to help subsidize the costs.

Programs That Help You Pay For Medicare Premiums

Now that you have a good understanding of what your Medicare premium is and how it works, there’s probably a follow-up question you have. What happens when you can’t afford your Medicare premium? Are you effectively priced out of Medicare? Were all those tax deductions on your paychecks over the years for nothing?

You probably have a million questions running through your head, but know that there are savings programs in place to help people in your exact situation. So, before you begin stressing out, let’s cover some of the Medicare savings programs available to you.

The Centers for Medicare and Medicaid Services (CMS) offer assistance for your medical costs, including premiums, through Medicaid and Medicare Savings Programs (MSPs). Although these programs are designated for both Original Medicare Part A and Part B, some states may opt to extend help to those enrolled in Medicare Advantage or Medicare Part D.

Medicaid

You may familiar with Medicaid as a free, or low-cost health insurance plan for people of all ages. Medicaid is administered by both the federal and state governments and is also used to help Medicare-eligible individuals with limited income and resources. Medicaid may also offer additional benefits that Medicare may not offer, for example, nursing home care and personal care services.

Since Medicaid is a joint federal and state healthcare program, eligibility, benefits, and requirements will vary between states. So, your best bet is to contact your local Medicaid office to learn if you are eligible.

Medicare Savings Programs

The CMS also operates additional savings programs on top of Medicaid that can help you pay your Medicare premiums. Eligibility for these programs is based on both your monthly income and resources. Resources that count towards your limit include things like money in your checkings or savings accounts, stocks, and bonds. Your home, burial plot, furniture, and similar items are not included in your resource limit.

Qualified Medicare Beneficiary (QMB) Program

  • The program helps pay for Original Medicare premiums, your deductible, coinsurance, and copayments.
  • Individual monthly income limit (2018) - $1,032
  • Married couple monthly income limit (2018) - $1,392
  • Individual resource limit (2018) - $7,560
  • Married couple resource limit (2018) - $11,340

Specified Low-Income Medicare Beneficiary (SLMB) Program

  • The program helps pay for Medicare Part B premiums only.
  • Individual monthly income limit (2018) - $1,234
  • Married couple monthly income limit (2018) - $1,666
  • Individual resource limit (2018) - $7,560
  • Married couple resource limit (2018) - $11,340

Qualified Individual (QI) Program

  • The program helps pay for Medicare Part B premiums only.
  • Individual monthly income limit (2018) - $1,386
  • Married couple monthly income limit (2018) - $1,872
  • Individual resource limit (2018) - $7,560
  • Married couple resource limit (2018) - $11,340

Qualified Disabled and Working Individuals (QDWI) Program

  • The program helps pay for Medicare Part A premiums only.
  • Individual monthly income limit (2018) - $4,132
  • Married couple monthly income limit (2018) - $5,572
  • Individual resource limit (2018) - $4,000
  • Married couple resource limit (2018) - $6,000

Extra Help - Medicare Part D

Extra Help is a Medicare Savings Program specifically designed for low-income individuals who need help paying their prescription drug costs, in other words, it’s a savings program for Medicare Part D. In order to qualify, you will need to meet certain eligibility requirements, which include:

  • Individual yearly income limit - $18,210
  • Married couple yearly income limit - $24,690
  • Individual yearly resource limit - $14,100
  • Married couple yearly resource limit - $28,150

In 2018, with extra help, generic drugs will cost no more than $3.35, and $8.35 for each brand-name drug. Those prices will each increase for 2019, and generic drugs will cost $3.40, and brand-name drugs will cost $8.50. Depending on your income level, you may also get help paying for your Medicare Part D premium and deductible.

If you don’t qualify for Extra Help, there are still programs that can help you pay for your Medicare Part D premiums. In fact, there are State Pharmaceutical Programs (SPAPs) that are designed specifically for this reason. They help those on disability and low-income individuals pay for prescription drugs.

Save Money With Additional Coverage

If you’re worried about your premiums, Medicare Savings Programs are the way to go. However, if you can handle the premiums, but are worried about out-of-pocket costs, then you may want to consider supplementing your Medicare with a Medigap plan.

Medigap plans will cover, or help cover your out-of-pocket expenses, for example, your deductibles. Finding a Medigap plan is simple, especially with powerful search tools like FirstQuote Medicare. Plans and pricing may vary by county, so by entering your zip code, you will make sure to get the most accurate Medicare quotes in your area. FirstQuote Medicare is free to use and comes with absolutely no obligation.