Get Help Paying Your Medicare Costs
Extra Help to pay for Medicare prescription drug costs
Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help if your yearly income and resources are below these limits in 2021:
- Single person - yearly income less than $19,320 ($1,610 monthly) and less than $13,290 in other resources per year
- Married person living with a spouse and no other dependents - yearly income less than $26,136 ($2,178 monthly) and less than $26,520 in other resources per year
You may qualify even if you have a higher income (like if you still work, live in Alaska or Hawaii, or have dependents living with you). Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement
Accounts (IRAs). Resources don’t include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person), or life insurance policies.
If you qualify for Extra Help and join a Medicare drug plan, you'll:
- Get help paying your Medicare drug plan's costs.
- Have no late enrollment penalty.
You automatically qualify and will receive Extra Help if you have Medicare and meet any of these conditions:
- You have full Medicaid coverage.
- You get help from your state Medicaid program paying your Part B premiums (in a Medicare Savings Program).
- You get Supplemental Security Income (SSI) benefits.
Drug costs in 2020 for people who qualify for Extra Help will be no more than $3.60 for each generic drug and $8.95 for each brand-name drug.
To apply for Extra Help:
- Call SHIIP toll-free at 1-855-408-1212 Monday through Friday from 8am to 5pm and one of our Medicare counselors can assist you.
- Visit socialsecurity.gov/i1020 to apply online.
- Call the Social Security Administration at 1-800-772-1213. TTY users can call 1-800-325-0778.
Medicare Savings Programs to help pay for Medicare health care costs
You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions. There are four kinds of Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB) Program - helps pay for Part A and/or Part B premiums, and in addition Medicare providers aren't allowed to bill you for services and items Medicare covers like deductibles, coinsurance, and copayments.
- Specified Low-Income Medicare Beneficiary (SLMB) Program - helps pay for Part B premiums.
- Qualified Individual (QI) Program - helps pay for Part B premiums and funding for this program is limited.
- Qualified Disabled and Working Individuals (QDWI) Program - helps pay for Part A premiums only.
If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.
Medicaid
Medicaid is a joint federal and state program that helps pay health care costs if you have limited income and resources and meet other requirements. Some people qualify for both Medicare and Medicaid. All states also have Medicaid programs for people with limited incomes and assets who need nursing home care, long-term care services, and home health care services. Some states also have programs for individual adults who don’t fit any of these categories. Each state uses financial eligibility guidelines to determine whether you are eligible for Medicaid coverage. Generally, your income and assets must be below a certain amount to qualify, but this amount varies from state to state and from program to program. You are eligible for Medicaid if you fall into an eligible group and meet that group’s financial eligibility requirements. If you are eligible for Medicare and Medicaid (dually eligible), you can enroll in both. Medicaid can cover services that Medicare does not, like long-term care. It can also pick up Medicare’s out-of-pocket costs (deductibles, coinsurances, copayments). Some states offer a Medicaid spend-down program or medically needy program for individuals with incomes over their state’s eligibility requirements. A spend-down program allows you to deduct your medical expenses from your income so that you can qualify for Medicaid.
State Pharmacy Assistance Programs (SPAPs)
Many states have SPAPs that help certain people pay for prescription drugs based on financial need, age, or medical condition.
Pharmaceutical Assistance Programs (also called Patient Assistance Programs)
Many drug manufacturers offer assistance programs for people with Medicare drug coverage who meet certain requirements. Visit Medicare.gov/pharmaceutical-assistance-program to learn if there are any programs available for the drugs you are taking.
Programs of All-Inclusive Care for the Elderly (PACE)
PACE is a Medicare and Medicaid program offered in many states that allows people who need a nursing home level of care to remain in the community.
Supplemental Security Income (SSI) Benefits
SSI is a cash benefit paid by Social Security to people with limited income and resources who are blind, 65 or older, or have a disability. SSI benefits aren’t the same as Social Security retirement benefits. You may be able to get both SSI benefits and Social Security benefits at the same time if your Social Security benefit is less than the SSI benefit amount, due to a limited work history, a history of low-wage work, or both. If you’re eligible for SSI, you automatically qualify for Extra Help, and are usually eligible for Medicaid.
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