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Medicare Premiums: How to Qualify for Assistance

It is one thing to have Medicare assistance, which is hugely beneficial and highly impactful to many people’s lives. It is another thing to be able to pay for Medicare premiums, deductibles, and other expenses related to the program. When people are having trouble paying for Medicare insurance premiums, the first thing they should realize is that they are not alone. Many people in the United States need help with their health insurance premiums, including Medicare premiums. If you need help with Medicare premiums, researching where to go to get this help is an important first step.

The tools on this website, including this article, will give you critical information that can help you find ways to ease the financial burden that comes with Medicare premiums. You can learn about the various Medicare premium assistance programs, as well as find out the specific requirements that need to be met in order to qualify.

Medicare Premium: What Is It And How Does It Work?

A Medicare premium is the monthly payment a person pays in order to have a Medicare insurance plan. There are four parts to Medicare insurance, including Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D. Part A is the hospital insurance coverage through Medicare. Part B is the medical insurance that is available through Medicare. Medicare Part C, which is also called Medicare Advantage, covers everything in Medicare Part A and Medicare Part B but also has additional benefits. Part D through Medicare covers a person’s cost for prescription drugs. Each type of Medicare has different premiums.

The premiums that people pay for Part A and B Medicare, also called Original Medicare, are both determined by Medicare and billed through them. Premiums for Part A Medicare Insurance can get quite high. Most people do not pay for these premiums; however, because they have paid through their Social Security taxes already if they have worked for at least ten years in the United States. Medicare Part B also has premiums, and people who have Social Security benefits generally pay less for these premiums, although in many cases not by much.

Part C is a combination of other parts of Medicare that provides a broader range of benefits. Plans in this category are sold by private insurance companies that are approved by Medicare. In addition, Medicare Part D plans, which are also provided by private insurance companies, have a premium for them.

What Options Are Available?

People are happy to find out that there are numerous Medicare premium assistance programs in the United States. The Centers for Medicare and Medicaid Services can provide assistance with premium payments. Medicaid, which is designed for people who have low incomes or qualify in other ways, operates for different types of Medicare Savings Programs.

Programs through Medicaid to help with Medicare premium expenses include Qualified Medicare Beneficiary, Specified Low Income Medicare Beneficiary, Qualifying Individual, and Qualified Disabled and Working Individual. These are, by far, the most popular ways to get assistance on premiums for Medicare.

Medicare Savings Programs are also available. These programs require a person to have limited income and resources in order to be eligible. States all manage program funds, meaning that each state has different qualifications in order to enter this program. In some cases, Medicare Savings Programs can cover all expenses that are out-of-pocket within Medicare. In other cases, the programs will only pay for some of these out-of-pocket expenses. Out-of-pocket expenses can include premiums, as well as other assistance.

A person’s income, as well as their assets, are some of the variables that Medicaid uses to determine whether a person will qualify for help with their Medicare premiums. Medicare Savings Programs can have different monthly income limits, though most states do have the same limits. Alaska and Hawaii are two states that have different income limits. In addition, 75% of the Medicare Savings Programs, which are listed above, have the same resource limits as each other. These similarities extend to all of the mainland states. If you are equal or less than the limits provided, you can qualify for assistance.

For Qualified Medicare Beneficiary, QMB for short, the 2018 monthly income limits for individuals in mainland states was $1,032. For married couples, the income limits were $1,392. For people in Alaska and Hawaii, the monthly income limits are higher. In terms of resource limits for QMB assistance, the individual resource limit is $7,560, and the married couple resource limit is $11,340.

For Specified Low Income Medicare Beneficiary, also referred to as SLMB, the monthly income limits for individuals in 2018 was $1,234. For married couples, the monthly income limits in 2018 were $1,666. There were also 2018 resource limits of $7,560 for an individual and $11,340 for a married couple. The income limits for people living in Alaska and Hawaii were higher.

Another option, Qualifying Individual, also referred to as QI, had individual monthly income limits of $1,386 and monthly income limits for married couples of $1,872. For QI eligibility, the 2018 resource limits for individuals was $7,560. For married couples, the resource limits for eligibility to QI assistance was $11,340.

The numbers change for Qualified Disabled and Working Individuals, which is also known as QDWI. For eligibility with this type of assistance, the monthly income limits for individuals in mainland states is $4,132. Married couples have in monthly income limit of $5,572 in the mainland states. The monthly income limits in Hawaii and Alaska are higher. This is also where people will see a change in the resource limits for both individuals and married couples. To be eligible for QWDI assistance, in the year 2018, individuals had resource limits of $4,000. Married couples had resource limits in 2018 for the QDWI program of $6,000.

What Doesn’t Count As Income And Resources

States are required to provide exclusions for certain types of assets and income. This is federal law. Some of the things that are not counted as income include the first $20 of your monthly income and the first $65 of your monthly wages. In addition, half of your monthly wages after the $65 is deducted is not counted as income.

Food stamps are also not counted towards your income totals, nor is help from other people to pay for household expenses. Additionally, earned income tax credit payments are not counted as income. There are other things that also do not count as income, but these are some of the main items.

Numerous resources a person owns are also not counted as assets when it comes to determining a person’s eligibility for Medicare premium assistance. A person’s primary house does not count as a resource, as an example. In addition, their vehicle, such as a primary car, is not counted as a person’s asset when determining eligibility for this type of assistance. Other items that are not included are items that cannot be converted into cash easily. This includes things like furniture and jewelry.

Many people have burial plots, as well as burial funds. Up to $1,500 for individuals and up to $3,000 for couples, of these funds are not counted as a resource. Additionally, if a person has life insurance that is less than $1,500, it is not counted as an asset.

How To Qualify For Help With Medicare Premiums

Qualifying for assistance with Medicare premiums has specific requirements. A person must be eligible for or have Medicare Part A in order to qualify for assistance. In addition, the income limits for the programs must be met. In addition, a person must have limited resources below the maximum amount accepted. Resources can include things like money in checking and savings accounts, bonds, stocks, and other resources as well. Look at each of the programs you are considering to determine what is and is not included in terms of income and resources.

If you believe that you qualify for assistance, either you or your agent should contact your states Medicaid office. Even if you believe that your income is slightly higher than the acceptable limits, you could still be eligible for premium assistance, including in some cases full premium assistance.

Most MSPs only provide assistance for Original Medicare. Original Medicare can include either Parts A or Parts B. Each program requires a person to be eligible for Medicare Part A to provide assistance. The difference between the programs that are available is, in most cases, the difference between the federal poverty level range of the people seeking help.

Qualified Medicare Beneficiary is the only program that will pay for premiums in both parts of Original Medicare.

For people who are looking for assistance with Medicare Part A only, you can get assistance through the Qualified Disabled and Working Individual program.

Those who are looking for Part B Medicare assistance only can utilize Specified Low Income Medicare Beneficiary or Qualifying Individual programs to help pay for these premiums.

Alternative Medicare Assistance Programs

There are also programs to help people pay for Medicare Part D premiums. Most alternative Medicare assistance programs are for assistance with Medicare Part D. Take a look at the State Pharmaceutical Assistance Programs in your area, and remember to utilize the tools on this website to get top Medicare insurance information and be pointed in the right direction.