You may be unaware that Medicare has programs that help lower some of its costs. Medicare Pathways is here to help navigate you through each program and find out if you qualify for it. One of the more commonly known programs is Medicaid.

Medicaid:

In case you don’t already know, Medicaid is a joint federal and state program that helps people with limited income and resources. The program helps cover medical costs for some people, and it offers benefits not normally covered by Medicare. These benefits include nursing home care, personal care services, and others. The program varies from state to state regarding rules, eligibility and applying.

Medicaid spend-down

Even though you may have too much income to qualify, some states have a “spend down” that allows you to become eligible for Medicaid. The process will enable you to subtract your medical expenses from your income, thus making you eligible for Medicaid. In this case, you’re considered “medically needy,” which makes you eligible for Medicaid. To be eligible as “medically needy,” your measurable resources must also be under the resource amount allowed in your state.

Medicare Savings Programs:

Medicare Savings Programs allow you to get help from your state when paying your Medicare premiums. Sometimes, the programs may also help pay for Medicare Part A and Medicare Part B deductibles, copayments, and coinsurance if you meet certain conditions. You can answer three questions at the end to find out if you are most likely eligible.

Medicare has four different kinds of programs designed to help people save money. You may still qualify for these four programs if you have income from working. This applies even if your income is higher than the income limits listed for each program.

Qualified Medicare Beneficiary (QMB) Program:

*You could still qualify for benefits even if your income is higher or if you have income from working. The income limit is based on monthly payments.

The program helps pay for:

  • Part A premiums and Part B premiums coinsurance, copayments, and deductibles.

If you’re eligible, it helps pay for Part A and/or Part B premiums. Medicare providers are not allowed to bill you for items that Medicare covers, including copayments, coinsurance, and deductibles, except outpatient prescription drugs and services. If you do end up getting billed for these charges, tell your provider that you’re in the QMB Program. If you’ve already made payments on a bill for items and/or services Medicare covers, you are entitled to a refund.

Specified Low-Income Medicare Beneficiary (SLMB) Program:

This state program helps pay Part B premiums for people with limited income and resources and Part A.

* The program helps pay for Part B premiums only. You could still qualify for benefits even if your income is higher than the limits listed or if you have income from working.

Qualifying Individual (QI) Program:

This state program helps pay Part B premiums for people who have limited income and resources, and Part A. QI applications are granted on a first-come, first-served basis; people who got QI benefits in the previous year are prioritized. You must apply for the QI program every year. (People who qualify for Medicaid are not qualified for the QI program).

* The program helps pay for Part B premiums only. You could still qualify for benefits even if your income is higher than the limits listed or if you have income from working

Qualified Disabled and Working Individuals (QDWI) Program:

You may qualify for this program that helps cover Part A premiums if any of these apply to you:

  • You meet the resource and income limits required by your state
  • You lost your Social Security premium-free Part A and disability benefits because you started working again
  • You’re a working disabled person under 65
  • You are not getting medical assistance from your state

* The program helps pay for Part A premiums only. You could still qualify for benefits even if your income is higher than the limits listed or if you have income from working.

You will need to make sure this applies to your state as policies vary from state to state. You will need to call your State Medicaid Program if you answer yes to these three questions.

  1. Are you eligible for, or do you have a Medicare Part A?
  2. Is your income for 2021 below or at the income limits listed above?
  3. Do you have limited resources below the limits below?

It’s essential to fill out an application or call if you think you could qualify for any of these programs —even if your income or resources are higher than the amounts listed here.

If you have any questions about these programs feel free to reach out to Medicare Pathways. Our team is always ready and happy to help answer any questions you may have.