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Medicare Minute: Cost Saving Programs

From premiums to copays and deductibles, it can feel so difficult to afford health insurance—especially with rising costs all around us. In this Medicare Minute, we’ll tell you about programs that can help you save on your Medicare costs. Expect to hear about programs like the Medicare Savings Program, Extra Help, and more. You can also attend our “SHINE Medicare Financial Assistance” webinar held by our SHINE Medicare experts at the beginning of every month. Visit our event calendar for dates.

What is the Medicare Savings Programs?

Medicare Savings Programs (MSPs) are state programs that help cover your Medicare costs. To qualify for a MSP, you must meet your state’s income and asset limits. Below are the baseline federal income and asset limits for each MSP. Most states use these limits, but some states have different guidelines, such as different income limits or not imposing asset limits. You should consider applying for the MSP even if you are over the limits, because some income and assets are not counted toward the limits. There are three main programs, each with different benefits and eligibility requirements:

MSP

Benefits

Monthly income limit

Asset limit

Qualified Medicare Beneficiary (QMB)

– Pays Part A and B premiums

– Eliminates cost-sharing for Medicare-covered services

Individual: $1,275

Couple: $1,724

Individual: $9,430

Couple: $14,130

Specified Low-income Medicare Beneficiary (SLMB)

– Pays Part B premium

Individual: $1,526

Couple: $2,064

Individual: $9,430

Couple: $14,130

Qualifying Individual (QI)

– Pays Part B premium

Individual: $1,715

Couple: $2,320

Individual: $9,430

Couple: $14,130

What is Extra Help?

Extra Help is a federal program that helps pay for most of the out-of-pocket costs of Medicare prescription drug coverage. If you have Medicaid, and MSP or receive Supplemental Security Income, you will be automatically enrolled in Extra Help. If you are not enrolled in these programs, you must apply directly and meet the eligibility requirements below:

Income limit

Asset limit

Benefits

Individual: $1,903 /month

 

Couples: $2,575 /month

Individual: $17,220

 

Couples: $34,360

$4.50 generic copay

$11.20 brand-name copay

$0 deductible and premium (for a basic Part D plan with a premium at or below your state benchmark)

Medicare Cost Assistance Programs

Below is information on programs that can help you save on your Medicare costs. To learn more about these programs and receive help with applications, contact your local State Health Insurance Assistance Program (SHIP), known as SHINE (Serving Health Insurance Needs of Elders) in Southwest Florida, at 866-413-5337 or email shineinfo@aaaswfl.org.


What other programs can help me save money on my care?

State Pharmaceutical Assistance Programs (SPAPs)

• Many states offer SPAPs to help residents pay for prescription drugs.
• Each program works differently and has different requirements for eligibility.
• To learn if your state has an SPAP and find out if you qualify, call your SHIP.

Facilities that may offer care at a reduced cost

  • Human Resources and Services Administration (HRSA) facilities
    • HRSA facilities may also be called Federally Qualified Health Centers (FQHCs).
    • Hundreds of these government-funded health centers around the country provide medical care regardless of your ability to pay.
    • For more information, contact your SHIP.
  • The Hill-Burton Program
    • The Hill-Burton Program offers free or reduced cost care at Hill-Burton facilities.
    • Most states have the Hill-Burton program.
    • Services that are fully covered by other types of insurance (like Medicare or Medicaid) are not eligible for Hill-Burton coverage.
    • Eligibility for the Hill-Burton program is based on your income and family size.
    • To apply, call the Admission, Business, or Patient Accounts office at a Hill-Burton facility.

Medicaid

  • People can be eligible for both Medicare and Medicaid.
  • Medicaid can cover services that Medicare does not, like long-term care.
  • It can also pay secondary to Medicare, picking up Medicare’s out-of-pocket costs, like copayments or coinsurances.
  • Generally, your income and assets must be below a certain amount to qualify, but this amount varies from state to state and from program to program.
  • Call your local Medicaid office to learn about Medicaid programs in your state.

What other benefits, rights, and protections come with MSP? Download the full handout on Medicare Savings Programs this post is an excerpt from for more. 

Call your local SHIP and SMP at 866-413-5337 or email shineinfo@aaaswfl.org for assistance.

The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. [July 2024]

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