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Medicare Insurance Subsidies

Healthcare costs in America are high and continuing to ascend. You may qualify for government subsidies to offset these costs. Typically, government subsidies are offered to individuals and families based on income and resources. If an individual or family falls into an income and resource bracket that would qualify them for the subsidy, they might want to consider applying for the subsidy. Individuals and families that qualify, are not automatically enrolled into the subsidy, and do have to apply for the specific subsidy they are entitled to. We at Healthcare American know the rules, and can help with this process.

Subsidies that are offered to those on Medicare have distinct income and subsidy requirements. These requirements are also based on income and resources. If an individual or family falls below the income level and their resources are below the allowed resource level allowed for the program, they should consider applying for the program.  

Subsidies can help with a few things when a person has Medicare. The subsidy might pay for monthly premiums, co-pays, and deductibles. We will now discuss the potential subsidies one might want to consider applying for if they fall into the bracket that would qualify them for the program. 

QMB (Qualified Medicare Beneficiary) or Medicaid

QMB income & resource limits in 2019:

 

  • Individual monthly income limit*

$1,060

  • Married couple monthly income limit*

$1,430

  • Individual resource limit

$7,730

  • Married couple resource limit

$11,600

Program helps pay for:

  • Part A premiums
  • Part B premiums
  • Deductibles, coinsurance, and copayments

*Limits are slightly higher in Alaska and Hawaii. If you have income from working, you may qualify for benefits even if your income is higher than the limits listed.

Important Note

Medicare providers are not allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments, except outpatient prescription drugs. Pharmacists may charge you up to a limited amount (no more than $3.80 in 2019) for prescription drugs covered by Medicare Part D. To make sure your provider knows you are in the QMB program, show both your Medicare and Medicaid or QMB card each time you get care, or your Medicare Advantage card if enrolled in a Medicare Advantage plan, along with your QMB card. If you get a bill for medical care that Medicare covers, call your provider or plan about the charges. Tell them that you are in the QMB program and cannot be charged for Medicare deductibles, coinsurance and copayments. If this doesn’t resolve the billing problem, call Medicare at 1-800-MEDICARE (1-800-633-4227) for more information. Please see Medicare Advantage SNP Plans for additional benefits not offered by Medicare and QMB.

SLMB (Specified Low Income Medicare Beneficiary)

SLMB income & resource limits in 2019:

  • Individual monthly income limit*

$1,269

  • Married couple monthly income limit*

$1,711

  • Individual resource limit

 

$7,730

  • Married couple resource limit

$11,600

Program helps pay for:

  • Part B premiums only

*Limits are slightly higher in Alaska and Hawaii. If you have income from working, you may qualify for benefits even if your income is higher than the limits listed.

Please see Medicare Advantage Plans for additional benefits not offered by Medicare and the SLMB.

Medicare Savings Programs QI (Qualified Individual)

You must apply every year for QI Benefits. QI applications are granted on a first-come, first-served basis with priority given to people who got QI benefits the previous year. (You cannot get QI benefits if you qualify for Medicaid).

QI income & resource limits in 2019:

  • Individual monthly income limit*

$1,426

  • Married couple monthly income limit*

$1,923

  • Individual resource limit

$7,730

  • Married couple resource limit

$11,600

Program helps pay for:

  • Medicare Part B premiums only

These amounts may increase in 2020. If your income and resources are slightly higher, you should still apply.

*Limits are slightly higher in Alaska and Hawaii. If you have income from working, you may qualify for benefits even if your income is higher than the limits listed.

Please see Medicare Advantage Plans for additional benefits not offered by Medicare and the Medicare Savings Program.

What items are included in the Medicare Savings Program resource limits?

Countable resources include:

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

Countable resources do not include:

  • Your home
  • One car
  • Burial plot
  • Up to $1,500 for burial expenses if you have put that money aside
  • Furniture
  • Other household and personal items

How do I apply for Medicare Savings Programs?

If you answer yes to these three questions, call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state:

  • If you have, or are you eligible for, Part A.
  • If your income for 2019 is at, or below, the income limits above.
  • If you have limited resources, below the limits above.

It is important to call or fill out an application if you think you could qualify for savings—even if your income or resources are higher than the amounts listed here.

LIS (Low-Income Subsidy – Extra Help)

Medicare offers a program called the Low-Income Subsidy, or Extra Help, for eligible people with limited incomes and resources. If you are enrolled in Medicare and meet the income and resource requirements for the program, you may apply for the Low-Income Subsidy and receive Extra Help from Medicare. If you do qualify, you will get help paying for your Medicare Part D costs, which may include premiums, deductibles, and cost sharing.

You may be automatically eligible for Extra Help if you are in one of the following circumstances:

  • You are entitled to Medicare and get full coverage from a state Medicaid program.
  • You are enrolled in a Medicare Savings Program.
  • You get Supplemental Security Income (SSI) benefits.

LIS Extra Help income & resource limits in 2019:

  • Individual monthly income limit*

$1,561

  • Married couple monthly income limit*

$2,113

  • Individual resource limit

$12,890

  • Married couple resource limit

$25,720

 

If you qualify for Extra Help but do not enroll in a Medicare Prescription Drug Plan yourself, Medicare will enroll you in a plan so that you will get help paying for your prescription drugs. (Medicare will send you a letter telling you when your coverage begins.) If you want to change Medicare Prescription Drug Plans, you can do so with a Special Election Period. For more information about the Extra Help program, contact your local Social Security office, or call 1-800-MEDICARE (1-800-633-4228). TTY users should call 1-877-486-2048. You can talk to a customer service representative 24 hours a day, seven days a week. Or give us a call at 443-537-0555

The Annual Election Period is one of the times that you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan or make changes to your prescription drug coverage. However, if you are enrolled in Extra Help, you may be to make changes outside of this period with a Special Election Period.

Please see Medicare Advantage plans for additional benefits not offered by Medicare and the Low-Income Subsidy program.

Give us a call and we will help you with your individual situation. 

SPAP (Senior Prescription Drug Assistance Program)

https://www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx

The above programs are the main programs available for when a person has Medicare. These programs each have distinct rules for joining. The SPAP programs are offered in specific states. Each state that offers a program will have their own unique rules for joining the program. Typically, if a person does apply for one of these programs, they can get other benefits. These other benefits can include help with monthly premiums associated with a part D Prescription drug plan or Medicare Advantage plan, co-pays, or help in the coverage gap. This is determined by the state SPAP program and their individual benefits offered by their program. In addition, signing up for an SPAP program in your state can sometimes create a special enrollment period for programs like Medicare Advantage and Part D Prescription RX plans outside of the annual enrollment period. Please keep in mind that most subsidies do require you to apply for them and will not automatically enroll you even if you qualify for them.

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