Medicare Extra Help: What if I Can't Afford Medicare?

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. These costs include:

  • Premiums
  • Deductibles
  • Copayments
  • Coinsurance

You may qualify for certain government and private programs that offer help paying for these costs. Take a look at some of these programs and find out if you’re eligible.

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 $3.40 for covered generic drugs or $8.50 for covered brand name drugs in 2019.

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.

Medicare Savings Programs

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.

2018 Monthly Income Limits*

Individuals: $1,032

Married couples: $1,392

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.

2018 Monthly Income Limits*

Individuals: $1,234

Married couples: $1,666

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.

2018 Monthly Income Limits*

Individuals: $1,386

Married couples: $1,872

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

2018 Monthly Income Limits*

Individuals: $4,132

Married couples: $5,572

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 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

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

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.