Medicare Extra Help, Medicare Savings Programs, Medicaid and PACE

• by Christian Worstell
• November 30, 2021
• Reviewed by John Krahnert

Original Medicare (Part A and Part B) helps make healthcare more affordable to those who are at least 65 years old, or certain younger people with disabilities or diseases.

However, there are still out-of-pocket costs associated with Medicare, such as premiums, deductibles, coinsurance and more.

You may qualify for certain government and private programs that offer help paying for these costs.

These programs include:

• Medicare Savings Programs
• Extra Help
• Medicaid
• Programs of All-Inclusive Care for the Elderly (PACE)

Take a look at some of these programs and find out if you’re eligible.

Medicare Savings Programs

A Medicare Savings Program (MSP) is a federally funded program that helps pay for Medicare costs including premiums, deductibles, copayments and coinsurance.

These programs, also called Medicare Buy-In programs or Medicare Premium Payment Programs, are administered by the individual states in which they are offered and are available to people with limited income and resources.

There are four types of Medicare Savings Programs, each with its own qualifications and benefits. All help cover Medicare premiums and the associated out-of-pocket costs.

Qualified Medicare Beneficiary (QMB) Program

This program helps pay Medicare Part A and Part B premiums. It may also help pay for deductibles, coinsurance and copayments.

If you qualify for QMB, you are automatically qualified for the Extra Help program. Extra Help offers additional assistance in paying for Medicare Part D prescription drug coverage.

2021 Monthly Income Limits*

Individuals: $1,472

Married couples: $1,472

Specified Low-Income Medicare Beneficiary (SLMB) Program

This program reduces Medicare Part B premiums. Those who qualify for SLMB, are also automatically qualified for Extra Help.

2021 Monthly Income Limits*

Individuals: $1,308

Married couples: $1,762

Qualifying Individual (QI) Program

This program helps cover Part B premiums. Applications must be submitted every year, and are accepted on a first-come, first-serve basis.

You can’t use QI benefits if you qualify for Medicaid. However, those who meet the criteria for QI also qualify for Extra Help.

2021 Monthly Income Limits*

Individuals: $1,469

Married couples: $1,980

Qualified Disabled and Working Individuals (QDWI) Program

This program lowers Part A premiums.

To qualify, you must meet one of the following criteria:

• You are working, disabled AND under 65
• You returned to work and lost your premium-free Part A eligibility
• You are not receiving medical assistance from your state
• You meet your state’s income and resource limitations

2021 Monthly Income Limits*

Individuals: $4,379

Married couples: $5,892

How do I apply for Medicare Savings Programs?

To apply for a Medicare Savings Program, call your State Medicaid Program.

Before you do, be sure you can answer “yes” to each of these three questions:

1. Are you currently enrolled in Medicare Part A, or are you eligible to enroll?
2. Is your income for 2021 near or below any of the limits listed for the four types of Medicare Savings Programs listed above?
3. Are your available resources at or below the limits listed above?​

Extra Help for Medicare Part D

This program helps lower the costs of Medicare Part D prescription drugs. It may also lower Part D premiums, deductibles and copayments.

Those who provide proof that they qualify for Extra Help should not pay more than $3.95 for covered generic drugs or $9.85 for covered brand name drugs in 2022.

You may qualify for Extra Help in 2021 if you have up to $19,320 in annual income as an individual, or $26,130 in annual income for married couples.

You may automatically qualify for Extra Help if you already have full Medicaid coverage, if you get Supplemental Security Income (SSI) benefits from the Social Security Administration, or if you get help paying your Medicare Part B premiums from a Medicare Savings Program.

Medicaid

Medicaid is a government assistance program available to those with limited incomes. It can be used alongside Medicare to help pay for health care expenses that aren’t covered by Original Medicare, such as personal and nursing home care services.

Medicaid eligibility requirements vary by state. Check with your state’s Medicaid program to find out more.

Programs of All-inclusive Care for the Elderly

Programs of All-inclusive Care for the Elderly, also referred to as PACE, is a state assistance program for seniors. This program works with Medicare, Medicaid or both to provide community-based care. PACE also offers Medicare Part D prescription drug coverage, adult day care, dentistry, transportation, nursing home care and hospital care.

To qualify for PACE, you must:

• Be at least 55 years old
• Live in a PACE service area
• Require state-certified nursing home level care
• Be able to live safely in the PACE community

Pharmaceutical Assistance Program

Pharmaceutical Assistance Programs are offered by some pharmaceutical companies. These programs help offset some of the cost of prescription drugs.

Eligibility requirements vary between insurance companies. To find out if you qualify, check out the pharmaceutical assistance program page on Medicare.gov.

Supplemental Security Income

This federal program offers cash benefits to seniors and disabled adults and children. The benefits can be used to pay for basic living expenses.

You must meet certain income restrictions to qualify. For more information, visit the SSA.gov website or your local Social Security office.

Assistance Programs for U.S. Territories

If you live in certain U.S. territories and meet income limitations, you may be able to get financial assistance to help pay for Medicare.

U.S. territories include:

• Puerto Rico
• S. Virgin Islands
• Guam
• Northern Mariana Islands
• American Samoa

Are you looking for Medicare Part D prescription drug plan coverage?

You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

You can call to speak with a licensed insurance agent who can help you compare Medicare Advantage plans and Medicare prescription drug plans that may be available where you live.

You can also compare plans online for free, with no obligation to enroll.

*Monthly income limits are higher in Alaska and Hawaii. You may still qualify for benefits if your income is higher than these limits.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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