Help With Medicare Costs

When you must take an unexpected trip, the choices can feel overwhelming. Should you fly or drive? Do you stay with relatives or in a hotel? Who will take care of your pet and plants? Where should you eat?

And—just how much will this trip cost?

For those living on a fixed income, Medicare can feel the same way. Health care benefits and plan choices can be overwhelming. And then there’s the question of cost.

Here’s the good news if you’re on a limited income. There are programs that help pay premiums and costs like health care deductibles, coinsurance, and copays.

Medicare Savings Programs

You can get help from your state through Medicare Savings Programs. There are four different kinds of programs: QDWI, SLMB, QI, and QMB. They help pay Medicare costs, if you meet certain income and resource requirements. Medicare counts these as resources when qualifying:

• Money in your checking or savings account
• Stocks
• Bonds

Medicare suggests you call your State Medicaid Program and check if you qualify. Be sure to call even if your income or resources are slightly above the limits. Limits may increase each year and may be higher in some states. Visit www.medicare.gov/talk-to-someone , select your state, then choose “Other insurance programs” to find your state Medicare office.

NOTE: Limits listed below are for 2023.

For help paying your Part A premium only
Qualified Disabled and Working Individuals (QDWI) Program

To qualify, you:

• Have a disability
• Are working
• Lost your Social Security disability benefit and premium-free Part A because you went back to work

For individuals:

• Monthly income limit: $4,945
• Resource limit: $4,000

For married couples:

• Monthly income limit: $6,659
• Resource limit: $6,000

Two programs for help paying your Part B premium only
Specified Low-Income Medicare Beneficiary (SLMB) Program

To qualify, you:

• Have Part A
• Have limited income and resources

For individuals:

• Monthly income limit: $1,478
• Resource limit: $9,090

For married couples:

• Monthly income limit: $1,992
• Resource limit: $13,630

Qualifying Individual (QI) Program

To qualify, you:

• Have Part A
• Have limited income and resources
• Don’t qualify for Medicaid

For individuals:

• Monthly income limit: $1,660
• Resource limit: $9,090

For married couples:

• Monthly income limit: $2,239
• Resource limit: $13,630

Note that this is an annual program, and you must reapply every year.

For help paying all Medicare costs
Qualified Medicare Beneficiary (QMB) Program

The program helps pay for Part A and Part B premiums, deductibles, coinsurance, and copayments for services and items Medicare covers. Under QMB, providers don’t bill you for services and items covered by Medicare, except for outpatient drugs.

For individuals:

• Monthly income limit: $1,235
• Resource limit: $9,090

For married couples:

• Monthly income limit: $1,663
• Resource limit: $13,630

Other Low-Income Programs

PACE (Program of All-Inclusive Care for the Elderly)

PACE is a Medicare and Medicaid program helping people meet their health care needs in the community instead of a nursing home or other care facility. PACE covers all Medicare- and Medicaid-covered care and services. It also covers other services the PACE team of health care specialists decides are necessary for improving and maintaining your health. This includes drugs and other medically necessary care, such as doctor or health care provider visits, transportation, home care, hospital visits, and nursing home stays.

To qualify, you:

• Have Medicare or Medicaid, or both
• Are 55 or older
• Live in the service area of a PACE organization (available in 32 states)
• Need nursing-home level of care
• Can live safely in the community with help from PACE

To apply, call your state Medicaid office.

Extra Help

Helps pay for your prescription drug costs. For 2023, your drug costs are less than $5 for each generic drug and less than $11 for each brand-name drug.

To automatically qualify, you have Medicare and any of the following:

• Full Medicaid coverage
• Help from your state Medicaid program paying your Part B premiums (from a Medicare Savings Program)
• Supplemental Security Income benefits

For individuals:

• Yearly income limit: $21,870
• Resource limit: $16,600

For married couples:

• Yearly income limit: $29,580
• Resource limit: $33,240

If you don’t automatically qualify, complete the Extra Help application: secure.ssa.gov/i1020/start .

Where to Go From Here

If you have a limited income and resources, planning how to pay for Medicare can be as stressful as planning an unexpected trip. Our licensed insurance agents will help you get from where you are to where you need to be.