Medicare Cost Assitance Basics

Medicare has a number of different state and federal cost assistance options based on income and other factors. These include Medicare Savings Programs for Parts A and/or B and Extra Help for Part D.[1][2][3]

With that covered, assistance options differ by Medicare type and other factors. Below we will cover what you need to know about Medicare and cost assistance subsidies.

Medicare Cost Assitance Options Overview

Here is a quick overview of cost assistance options with Medicare:

  • Medicare Savings programs based on income for help with Part A and Part B costs.
  • Extra Help with Medicare Part D Prescription drug costs based on income.
  • Some Medicare beneficiaries are also eligible for Medicaid. Call your Medicaid office for more information and to see if you qualify. Visit Medicare.gov/contacts, or call 1-800-MEDICARE.
  • Some states have state pharmacy assistance programs. Visit Medicare.gov/pharmaceutical-assistance-program/#state-programs.
  • Many drug manufacturers offer assistance programs called Pharmaceutical Assistance Programs (also called Patient Assistance Programs). Visit Medicare.gov/pharmaceutical-assistance-program.
  • PACE is a state-based Medicare-Medicaid program that allows people who need a nursing home-level of care to remain in the community. You can browse PACE plans on our site if you are eligible.
  • 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. If you qualify for SSI, you automatically qualify for Extra Help. Visit benefits.gov/ssa.
  • There are programs in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa to help people with limited income and resources pay their Medicare costs. Visit Medicare.gov/contacts, or call 1-800-MEDICARE.

Cost Assitance For Part A and Part B: Medicare Savings Programs

Medicare Savings Programs (MSPs) are federally funded state-based programs that can help lower Part A and Part B costs like premiums, deductibles, and coinsurance based on income and resources.[1]

There are four different types of Medicare Savings Programs based on income, resources, and in some cases qualifying life circumstances or conditions:

  • Qualified Medicare Beneficiary (QMB) Program: helps pay Part A and Part B premiums and cost-sharing.
  • Specified Low-Income Medicare Beneficiary (SLMB) Program: helps pay Part B premiums for people who have Part A.
  • Qualifying Individual (QI) Program: helps pay Part B premiums for people who have Part A.
  • Qualified Disabled and Working Individuals (QDWI) Program: helps pay the Part A premium.

You can see the current income-limits and other qualifications at Medicare.Gov.

FACT: If you qualify for the QMB, SLMB, or QI, you automatically qualify for the Extra Help program.

Cost Assitance For Part D: Extra Help

Low-income subsidy (LIS) assistance for Part D, also called “Extra Help,” is a program to help people with lower incomes pay for Part D drug costs like premiums, deductibles, and coinsurance.

Depending on your income and assets you may qualify for full or partial help.

In terms of benefits, the Extra Help program:

  • Reduces your premium up to a state-specific benchmark amount based on income (this means at full assistance, Part D plans with premiums below the benchmark amount can have $0 premiums).
  • Can help lower your out-of-pocket spending on drugs by ensuring you pay either the Extra Help copayment amount or your plan’s copay (whichever is cheaper).
  • Generally pays the full cost of drugs during your plan’s catastrophic coverage phase.
  • Gives you one Special Enrollment Period a year you can use to switch Part D plans.
  • Eliminates the Part D late enrollment penalty.

You can see the current income-limits and other qualifications at SSA.Gov.

Citations

  1. Find your level of Extra Help. Medicare.Gov.
  2. Extra Help basics. MedicareInteractive.com.
  3. Medicare Savings Programs. Medicare.Gov.