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From Part B premiums to prescription drug copays, there are various costs to consider for those with Medicare coverage. In this blog post we discuss programs that help people with their Medicare costs.

First, let’s learn about the Medicare Savings Program.

Medicare Savings Programs, or MSPs, help pay your Medicare costs if you have limited income and savings. There are three main programs, each with different benefits and eligibility requirements. If you qualify for any one of the three MSPs, your Part B monthly premium will no longer be deducted from your Social Security check. Two of the three main MSPs additionally give you up to three months of retroactively reimbursed Part B premiums. The third main MSP eliminates all cost-sharing for Medicare-covered services and pays for your Part A premium, if you do not have the work history for premium-free Part A. If you are already in enrolled in Part A, all three main MSPs additionally allow you to enroll in Part B outside of usual enrollment periods and eliminate your Part B late enrollment penalty, if you have one. You cannot choose to apply for a certain MSP; you will be enrolled in the MSP that corresponds to your income, assets, and application details.

Below are the baseline federal income and asset limits for each MSP. Most states use these limits, but some states have different guidelines: 

MSP 

Benefits 

Monthly income limit 

Asset limit 

Qualified Medicare Beneficiary (QMB

- Pays Part A and B premiums 

- Eliminates cost-sharing for Medicare-covered services 

Individual: $1,094 

Couple: $1,472 

Individual: $7,970 

Couple: $11,960 

Specified Low-income Medicare Beneficiary (SLMB

- Pays Part B premium 

Individual: $1,308 

Couple: $1,762 

Individual: $7,970 

Couple: $11,960 

Qualifying Individual (QI

- Pays Part B premium 

Individual: $1,469 

Couple: $1,980 

Individual: $7,970 

Couple: $11,960 

 

You can contact your State Health Insurance Assistance Program (SHIP) to learn about the specific MSP eligibility guidelines in your state. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).

Another cost assistance program to know is called Extra Help.

Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. The Extra Help program can:

  • Pay for your Part D drug plan premium up to a state-specific benchmark amount

  • Lower the cost of your prescription drugs

  • Eliminate any Part D late enrollment penalty you may have

  • Give you Special Enrollment Periods throughout the year to enroll in a Part D plan or switch between plans

It is important to know that Extra Help is not a replacement for Part D on its own. You must still have a Part D plan to receive Medicare prescription drug coverage and get Extra Help assistance. You should be automatically enrolled in Extra Help if you have Medicaid, Supplemental Security Income, or a Medicare Savings Program. Otherwise, you may be eligible for Extra Help if you meet national eligibility requirements:

Income limit 

Asset limit 

Program 

Copayments 

Below $1,630 ($2,198 for couples) per month 

Up to $14,790 ($29,520 for couples) 

Partial Extra Help 

- Premium depends on your income 

- $92 deductible or the plan’s standard deductible, whichever is cheaper 

- 15% coinsurance or the plan copay, whichever is less 

- After $6,550 in out-of-pocket drug costs, you pay $3.70/generic and $9.20/brand-name or 5% of the drug cost, whichever is greater 

Up to $1,469 ($1,980 for couples) per month 

Up to $9,470 ($14,960 for couples) 

Full Extra Help 

$0 premium and deductible 

- $3.70 generic copay 

- $9.20 brand-name copay 

- No copay after $6,550 in out-of-pocket drug costs 

 

If you are not automatically enrolled, you can apply for Extra Help through the Social Security Administration. To learn more about the eligibility guidelines and benefits of Extra Help, you can contact your SHIP. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).

Finally, let’s learn about other ways to receive Medicare cost assistance.

Many states offer State Pharmaceutical Assistance Programs, or SPAPs, to help residents pay for prescription drugs. Each program works differently. SPAPs may continue providing coverage during your plan’s coverage gap or pay for your Part D plan’s premium, deductible, or copayments. You can contact your State Health Insurance Assistance Program, or SHIP, to learn about SPAPs in your state. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).

Additionally, if you require health services at a reduced cost, there are hundreds of government-funded health centers around the country that provide medical care regardless of your ability to pay. These clinics may be called HRSA Health Centers, Federally Qualified Health Centers, or FQHCs.  

People with Medicare may also be eligible for Medicaid, which can cover services that Medicare does not, like long-term care, and also cover Medicare’s out-of-pocket costs. Generally, your income and assets must be below a certain amount to qualify. These limits vary from state to state and from program to program. To learn more about Medicaid in your state, contact your local Medicaid office or your SHIP. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).

Still have questions? 

Your SHIP is here for you! You can contact your SHIP for questions regarding your move and how your coverage may be affected. SHIP counselors are government-funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) 

Use our online SHIP Locator by clicking the orange "Find Your local SHIP" button or call 877-839-2675 (and say “Medicare” when prompted).