Applying For Extra Help
Extra Help enrollment is simple. If you are enrolled in Medicare and also receive Medicaid, SSI, or help with Part B premiums from an MSP, youll automatically receive Extra Help benefits.
Otherwise, you can apply for Extra Help through the SSA. You can apply online, at your local Social Security office, or by calling Social Security at 1-800-772-1213 .
After you apply, Social Security will review your application and send you a letter to let you know if you qualify. If you do, you can select a Medicare Part D plan or let the Centers for Medicare and Medicaid Services choose one for you.
The sooner you choose a plan, the sooner you can start receiving benefits.
If you dont qualify for Extra Help, you can reapply to the program at any time if your income and resources change. In the meantime, you can look for other state programs that could help you with your Medicare prescription drug costs.
Contact your state Medicaid office or SHIP for information.
How To Get Help Paying Your Medicare Premiums And Other Costs
When you first sign up for Medicare, be prepared for some sticker shock. Because youve been paying Medicare taxes all through your working life, you may have assumed that once you retire, all your health care costs will be covered.
It can come as a rude awakening to learn that all those taxes you paid only cover one part of your Medicare costs Medicare Part A, or hospital insurance. You must continue to pay premiums for Medicare Part B and Part D , as well as other expenses like deductibles, copayments, and coinsurance.
All these expenses can add up to quite a sizable sum. According to a 2020 AARP analysis, people using traditional Medicare spent an average of $5,801 on health care costs in 2017. For about 1 in 10 people, total costs extended to five figures.
For many senior citizens, especially those on fixed incomes, this amount of money is a serious financial burden. According to AARP, half of all people on traditional Medicare in 2017 spent at least 16% of their income on health care. For 1 in 10 beneficiaries, health care costs ate up more than half their income.
Fortunately, there are several federal and state programs to help Medicare recipients with these unmanageable costs. If youve crunched the numbers and found that the total out-of-pocket cost for Medicare looks like more than you can afford, its worth looking into whether one of these programs can help you.
Finding Help With Prescriptions Guide
“Finding Help with Prescriptions” Guide is a free publication. It provides helpful information for lowering your prescription costs including low-income assistance, patient assistance programs, mail order prescription services, veterans pharmacy benefits, and Community Health Centers.
To request a copy, call SHIP free of charge 1-800-452-4800.
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Help Paying Medicare Costs
A Medicare Savings Program can help pay some out-of-pocket costs, including:
- Your monthly Medicare Part B premium
- Prescription drug costs through the Part D Extra Help program, which you automatically qualify for with a Medicare Savings Program
- In certain cases, your out-of-pocket Part A and Part B costs, such as coinsurance and deductibles
- In certain cases, your Part A premium, if you have one
Is There Help For Me If I Cant Afford Medicares Premiums
Medicare Savings Programs can pay Medicare Part A and Medicare Part B premiums, deductibles, copays, and coinsurance for enrollees with limited income and limited assets.
Reviewed by our health policy panel.
Q: Is there help for me if I cant afford Medicares premiums?
A: Yes. Medicare Savings Programs can help with premiums and out-of-pocket costs.
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Help Paying Original Medicare Premiums
Most MSPs provide help for Medicare Part A or Part B only. All programs require eligibility for Medicare Part A, but the main difference between each is the income range that those seeking help must be within.
Parts A and B: The Qualified Medicare Beneficiary program is the only Medicare assistance program that pays premiums for both parts of Original Medicare. If youre approved as a QMB, youre the program will help pay for your Medicare costs .4
Part A Only: If you need help with just your Part A premiums, you may get assistance through the Qualified Disabled and Working Individual program. To get full or partial aid, you must:4
- Be employed
- Be disabled
- No longer be eligible for a premium waiver of your Part A benefits because youre working
Part B Only: Both the Specified Low-Income Medicare Beneficiary and Qualifying Individual programs will help pay for Medicare Part B premiums.4
- SLMB program: Must meet low-income limits to get aid.
- QI program: Aid is provided on a first-come-first-served basis, with preference given to previous year QI enrollees. You must apply for this program each year.
Extra Help Benefits For People Who Have To Apply
There are different levels of Extra Help available. They depend on your income and assets. People with a lower income and fewer assets get more help with their Medicare drug plan costs. These numbers apply as of 2016, but may change later. For individuals or couples with income less than or equal to 135% of the federal poverty level . For those with resources of $8,180 or less for individuals and $13,020 or less for couples:
- Premium subsidy: 100%
- Deductible: You pay no deductible
- Co-payment: $2.95 for generic drugs and $7.40 for brand name drugs on your plans drug list
- Coverage gap: there is no coverage gap and all drugs remain covered
- Catastrophic coverage: There are no co-pays
For individuals or couples with income less than or equal to 135% of FPL but with resources between $8,181-12,640 for individuals and between $13,021-25,260 for couples:
- Premium subsidy: 100%
- The deductible is $74
- The copayment after deductible will be 15% of drug up to $4,850 in out-of-pocket drug costs
- The coverage gap: there is no coverage gap and all drugs remain covered
- Catastrophic coverage: After $4,850 in out-of-pocket covered drug costs paid by beneficiary, co-pays will be $2.95 for generic drugs and $7.40 for brand name drugs
For individuals or couples with income between 136% and 149% of FPL and resources are $12,640 or less for individuals, or $25,260 or less for couples: .
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Ways To Pay Your Medicare Part D Medicare Advantage And Medicare Supplement Plan Premiums
How you can pay your Medicare plan premiums depends on the insurance company. However, most private insurance carriers have the following payment options.
- Electronic Funds Transfer
You will need to check with your insurer to figure out which payment options are available. Here at Boomer Benefits, we usually recommend setting up electronic funds transfer for your premiums. This payment method is often the most secure and requires the least amount of effort.
Help Paying For Medicare
Medicare is not free there are premiums and deductibles. If you don’t qualify for Medicaid and can’t afford a Medigap policy, you may be able to get help paying for the costs of Medicare.
There are four Medicare assistance programs, called Medicare Savings Plans:
- Qualified Medicare Beneficiary : The QMB program pays for Medicare Part A deductibles, Medicare Part B premiums and deductibles, and coinsurance and deductibles for Part A and Part B.
- Specified Low-income Medicare Beneficiary : The SLMB program pays for Medicare Part B Premium.
- Qualifying Individual Program: The QI-1 program is an expansion of the SLMB program that you must apply for each year. It pays for Medicare’s Part B Premium.
- Qualified Disabled and Working Individuals Program: The QDWI Program helps pay for Medicare’s Part A premium.
To qualify for these programs, you must be eligible for Medicare Part A and have limited income and resources. The income and resource requirements can vary from state to state, so check with your state before applying. In general the following limits are applied.
In 2021, personal assets, including cash, bank accounts, stocks and bonds must not exceed $7,970 for an individual and $11,960 for married couples . Your house and car do not count as personal assets. Some states allow additional resources above these figures for example, New York has no resource limits for the QI-1 Program.
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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 and Medicare Part B deductibles, coinsurance, and copayments if you meet certain conditions. There are four kinds of Medicare Savings Programs:
- Qualified Medicare Beneficiary 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 Program – helps pay for Part B premiums.
- Qualified Individual Program – helps pay for Part B premiums and funding for this program is limited.
- Qualified Disabled and Working Individuals 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.
Who Qualifies For Medicare Extra Help
You will automatically qualify for Medicare Extra Help if you have Medicare and also meetany of these conditions:
You have full Medicaid coverage.
You use a Medicare Savings Program to help pay your Part B premiums.
You get Supplemental Security Income benefits.
To learn more about whether or not you qualify for Medicaid, check our state-by-state guide to Medicaid.
If you donât qualify for Extra Help based on the criteria above, you may still qualify if you are at least 65 years old, live in the U.S., have Medicare Part A and Part B, and your annual income is within the annual income and total asset limits.
Income and asset limits are based on the federal poverty guidelines . The poverty guidelines change each year, so make sure to check again around February or March.
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Below are the Medicare Extra Help income and asset limits for 2021, sorted by filing status.
How Do I Apply For Medicare Savings Programs
Eligibility for MSPs is determined by your state Medicaid office, as the funding for MSPs comes from the Medicaid program. Medicaid is jointly run by the federal and state governments. If you think you might be eligible, you can apply for an MSP at your Medicaid or social services office .
Medicare urges beneficiaries to apply for MSP benefits if theres any chance they might be eligible, even if they initially think that their income or resources are too high to qualify. This is particularly important given that states can have more lenient eligibility rules than the federal guidelines. So depending on the state, a person might end up being eligible for an MSP even if they assumed they wouldnt after looking at the federal eligibility rules.
This page explains what documentation is needed for the MSP application process, and what to expect when youre applying for benefits.
Its important to understand that you have to reapply and re-qualify for your MSP benefits each year. You may get a renewal notice in the mail from your state Medicaid office explaining what you need to do. If not, youll need to reach out to your state Medicaid office to see what needs to be done to qualify for ongoing MSP benefits in the coming year.
You can also contact your State Health Insurance Assistance Program with questions related to MSPs.
How Does Florida Regulate Long
Medicare beneficiaries increasingly rely on long-term services and supports or long-term care which is mostly not covered by Medicare. In fact, 20 percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015. Medicaid fills this gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. Whats more eligibility rules vary significantly from state to state.
Florida is known as an income cap state, because applicants only qualify for Medicaid long-term care benefits if their income is below the eligibility limit. Florida does not allow seniors with slightly higher incomes to pay what they can afford toward their care, and have Medicaid pay the rest. This means applicants with modest incomes just above the eligibility limit can struggle to pay for long-term care. Fortunately, these individuals can become eligible for long-term care benefits by depositing income into a Qualified Income Trust .
Applicants seeking long-term care benefits have to undergo a level of care assessment.
Medicaid nursing home coverage
Most seniors used to receive long-term care in nursing homes. Today, more Americans receive LTSS in their homes. But some enrollees medical or living circumstances make nursing home care a better fit.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married .
Home and Community Based Services waivers
Permitted home value in Florida
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Extra Help Paying For Medicare Prescription Drug Coverage
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, also called the low-income subsidy if your yearly income and resources are below the following limits in 2022:
- Single personIncome less than $1,469 monthly and resources less than $9,900
These amounts may change each year. You may qualify even if you have a higher income . Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts . Resources dont include your home, car, household items, burial plot, up to $1,500 for burial expenses , or life insurance policies. If you qualify for Extra Help and join a Medicare drug plan, you will get the following:
- Help paying your Medicare drug plans monthly premium, yearly deductible, coinsurance, and copayments
- No coverage gap
- No late enrollment penalty
- You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:
- You have full Medicaid coverage
- You get help from your state Medicaid program paying your Part B premiums
- You get Supplemental Security Income benefits
Medicare Part D Premiums
Your Part D Premium will depend on the plan you choose. Just like with your Part B coverage, youll pay an increased cost if you make more than the preset income level.
In 2022, if your income is more than $91,000 per year, youll pay an IRMAA of $12.40 each month on top of the cost of your Part D premium. IRMAA amounts go up from there at higher levels of income.
This means that if you make $95,000 per year, and you select a Part D plan with a monthly premium of $36, your total monthly cost will actually be $48.40.
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Once You Give Your Plan This Information Your Plan Must:
- Make sure you pay no more than the LIS drug coverage cost limit. In 2021, prescription costs are no more than $3.70 for each generic/$9.20 for each brand-name covered drug for those enrolled in the program. In 2022, these costs will be no more than $3.95 for each generic/$9.85 for each brand-name covered drug.
- Contact Medicare so we can get confirmation that you qualify, if it’s available. Your request can take anywhere from several days to up to 2 weeks to process, depending on the circumstances. Call us at 1-800-MEDICARE . TTY: 1-877-486-2048.
Be sure to tell your plan how many days of medication you have left. Your plan and Medicare will work to process your request before you run out of medication, if possible.
Whos Eligible For Medicaid For The Aged Blind And Disabled In Florida
Medicaid for the aged, blind, and disabled can pay for Medicare cost sharing expenses, and cover some services not covered by Original Medicare. Beneficiaries whose incomes and assets make them eligible for Medicaid can receive coverage for those additional services if theyre enrolled in Medicaid for the Aged, Blind and Disabled .
This program is called Medicaid for the Aged and Disabled in Florida.
In Florida, Medicaid ABD covers dental services in emergencies. According to this website, Medicaid may also cover non-emergency dental benefits for some enrollees.
Medicaid ABD also covers eyeglasses , contact lenses, eyeglasses repairs, and will pay for prosthetic eyes.
Medicaid spend-down for Medicaid ABD in Florida
If an individuals income is over the eligibility limit for Medicaid for the aged, blind and disabled but their assets are below the resource limit, they can enroll in the Medicaid spend-down, which is also called the Medically Needy Program.
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How To Pay Medicare Premiums Online
July 3, 2020 By Danielle Kunkle Roberts
Many folks new to Medicare are surprised when they find out that Medicare is not free. Thats right! Most people pay no monthly premium for Medicare Part A because its part of your Medicare payroll tax. Unfortunately, the same is not true for Part B, so you will have to pay the monthly Part B premium.
If you receive Social Security benefits for at least four months before Medicare eligibility, you will be auto enrolled in Part A and Part B at 65. In this case, your Part B premium will be automatically deducted from your Social Security benefits monthly payment. However, if you arent receiving Social Security while enrolled in Medicare, you will be billed quarterly for your Part B premium.
If youre able to pay your quarterly Part B premium all at once , and youre prepared for the delays of snail mail, mailing a check may be a fine option for you. On the other hand, paying your Medicare premiums online or via electronic funds transfer may be a more safe and sustainable option.
While you have several options to pay your Medicare premiums, there is one specific way that allows you to set it and forget it. Well discuss each of the ways you can pay Medicare premiums below.