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Section 5: ready to enroll 
 

How to Get Help Paying for Medicare

Premiums, deductibles, copayments and drug costs can be too expensive for some Americans

 

ESTIMATED READ TIME: 7 MINUTES

  

IN THIS ARTICLE

 

• Reducing your costs for Parts A and B

• Are you eligible?

• Making Part D more affordable

• How to apply for Part D Extra Help

• More assistance with medication costs

Several programs provide financial assistance to people with limited resources or certain diseases. They can help pay Medicare premiums, deductibles, copayments and prescription drug costs.

 

Here’s how the programs work and how to find out if you’re eligible.

 

REDUCING YOUR COSTS FOR PARTS A AND B
 

State-run Medicare Savings Programs can help people with low incomes pay their Part B premiums. Some of these programs can also help pay Part A premiums for those who aren’t eligible for free Part A. Coverage could also include deductibles, coinsurance and copayments.
 

To be eligible for a Medicare Savings Program, your income — and sometimes your savings — must be below certain limits, which vary by state. These limits are generally higher than those required to qualify for Medicaid, and some states don’t count your savings.
 

Certain assets are never included in the calculation, such as your primary residence, one car and household goods. Some states may exclude other assets while other states don’t set asset limits to be eligible for their Medicare Savings Programs.
 

The subsidies can help with premiums whether you have original Medicare or Medicare Advantage.
 

People who are 65 and older and younger adults with disabilities who are enrolled in Medicare but don’t qualify for Medicaid also may be eligible for the following programs (income limits are slightly higher in Alaska and Hawaii):

 

• The Qualified Medicare Beneficiary Program pays your premiums, deductibles, coinsurance and copayments for Parts A and B and Medicare Advantage plans. For those in original Medicare, it operates like a Medigap plan. In most states, you can qualify if your gross monthly income in 2024 doesn’t exceed $1,275 for individuals or $1,724 for couples. And in most states, individuals can’t have more than $9,430 in assets and couples can’t have more than $14,130 in assets.

• The Specified Low-Income Medicare Beneficiary Program pays Part B premiums. In most states, you can qualify if your gross monthly income in 2024 doesn’t exceed $1,526 for individuals and $2,064 for couples. Likewise, in most states, individuals can’t have more than $9,430 in assets and couples can’t have more than $14,130 in assets.

• The Qualifying Individual Program pays Part B premiums with a slightly higher income limit than the Specified Low-Income Medicare Beneficiary Program. In most states, you can qualify if your gross monthly income in 2024 doesn’t exceed $1,712 for individuals and $2,320 for couples. Likewsie, in most states, individuals can’t have more than $9,430 in assets and couples can’t have more than $14,130 in assets.
 

In addition to benefits, if you qualify for any of the three Medicare Savings Programs above, you’re automatically eligible for Extra Help, which helps cover Part D prescription drug plan premiums and out-of-pocket costs. If you receive a late enrollment penalty for Part B, Extra Help will waive it.

 

A fourth Medicare Savings Program, the Qualified Disabled Working Individuals Program, is designed specifically for people with disabilities who have returned to work, lost Social Security disability benefits and don’t qualify for premium-free Part A of Medicare because they’re working again. In most states, its monthly income limits in 2024 are $5,105 for individuals, $6,899 for couples. Its asset limits in most states are $4,000 for individuals and $6,000 for couples.

 

ARE YOU ELIGIBLE?

 

To find out if you qualify for a Medicare Savings Program, contact your local Medicaid office or State Health Insurance Assistance Program or call 800-MEDICARE.


Application requirements vary by state, but you usually need to provide proof of income and information about your assets. If you apply for the Extra Help program (more details below), it will automatically forward your application to your state to determine whether you qualify for a Medicare Savings Program, unless you specify otherwise.

 

Puerto Rico and the U.S. Virgin Islands don’t have Medicare Savings Programs. But Medicaid, which provides health insurance to people with low incomes, may be able to assist.
 

For more information about Medicaid in Puerto Rico, visit Medicaid.pr.gov. In the U.S. Virgin Islands, Medicaid is called the Medical Assistance Program.

 

MAKING PART D MORE AFFORDABLE
 

If you need assistance paying the premiums, deductibles and copayments for Part D prescription drug plans, you can apply for a federal program called Extra Help.
 

To qualify in 2024, your savings, investments and real estate — not counting the home you live in — must be worth $17,220 or less for individuals or $34,360 or less for married couples living together. Those limits include an allowance of up to $1,500 per person for burial expenses. 


For Extra Help, you won’t need to include your primary residence, vehicles, personal possessions and life insurance policies in your calculations.

 

Your income in 2024 must be less than $22,590 for an individual or $30,660 for married couples living together. The income limits, which change annually, are based on the federal poverty level and are higher for Alaska and Hawaii. The Inflation Reduction Act expanded the income limits to qualify for full Extra Help in 2024 and eliminated partial Extra Help benefits. 

 

For more information about eligibility, see the Social Security Administration publication Understanding the Extra Help With Your Medicare Prescription Drug Plan. Note that you’ll automatically qualify for the program if you have Medicare and SSI benefits or Medicaid coverage.
 

If you qualify for Extra Help, you'll also need to enroll in a Part D prescription drug plan. If you don’t choose a plan, Medicare will enroll you in one automatically. Check the Medicare Plan Finder to find a plan that covers your medications.


6 STEPS TO APPLY FOR PART D EXTRA HELP
 

1. Gather the following documents:

• Social Security card
• Bank account statements
• IRA and investment statements
• Pay stubs
• Tax returns
• Your most recent Social Security benefits award letters or statements for Railroad Retirement benefits, Veterans Affairs benefits, pensions and annuities. You need the information to help complete the application, but you won't have to submit these documents unless a Social Security representative contacts you.
 

2. Go to the SSA’s Extra Help page and click on Apply online. Scroll down to the bottom of that page and select Apply Now.
 

a screenshot of the medicare prescription drug plan financial aid application "how can you get extra help" secton with "apply now" button circled in red


3.
The next screen will explain how to fill out the online application. When you’re done reviewing it, click Next.


4. Now you’ll be asked a series of personal questions. Answer them and click Next.
 

5. Your answers to the previous questions are early steps in determining your eligibility for the program. If you qualify so far, you’ll be asked to apply. Click Apply Now.
 

 a screenshot of the social security website extra help with medicare prescription drug plan page with the apply now button circled in red


6. On the next screen, enter your name, Social Security number, date of birth and if you worked this year and last year. You’ll also need to supply information about your spouse, such as whether he or she wants to apply for Extra Help, too.
 

You’ll be asked about your income and assets, which will help determine if you’re eligible for the program.

 

Complete the application. You’ll be able to review it before you submit it.

 

If you need help completing the application, contact Social Security at 800-772-1213 or your State Health Insurance Assistance Program (SHIP). The Social Security Administration provides instructions in several languages for filling out the application. Click on the box with your preferred language and you'll see links to instructions for many Social Security forms. 
 

Medicare will send you a notice about the level of assistance from the Extra Help program that you’ll receive. You may get full or partial assistance depending on your income and assets and whether you have Medicaid coverage or receive aid from a Medicare Savings Program. For more information, visit Medicare.gov.

 

 

Once you’ve enrolled in Extra Help, Medicare will notify your Part D plan. If you notice that the credit isn’t applied when you fill your prescription, show the pharmacist the approval letter from Medicare.


MORE ASSISTANCE WITH MEDICATION COSTS
 

State pharmaceutical assistance programs (SPAPs) are typically offered in all states. Washington, D.C. and Puerto Rico to help eligible individuals pay for their prescription drugs. 
 

Each state’s program works differently. In most states, residents qualify based on their income but in some states, people also must have certain illnesses, such as HIV/AIDS or end-stage renal disease, to qualify. In some cases, the income eligibility requirements levels are higher than ones for Medicaid or Part D’s Extra Help.
 

To find out more about your state’s SPAPs, visit Medicare.gov. You can also call 800-MEDICARE or contact your State Health Insurance Assistance Program.


This story was updated March 27, to include 2024 figures from the federal government.
 

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