Are you on Medicare, but struggling with co-payments, co-insurance, deductibles, and the generally high cost of healthcare in 2016? You may qualify for one or more of the federal government’s assistance programs if your income and assets fall below a certain level. These programs may help you pay your monthly Medicare premiums as well as out-of-pocket costs like those mentioned above.

Key Takeaways

  • Medicare and Medicaid offer Savings Programs for beneficiaries with limited income.
  • The four Savings Programs are Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI), and Qualified Disabled and Working Individual (QDWI).
  • The Extra Help program curbs the high costs of prescription drug services.
  • State programs, such as the State Pharmaceutical Assistance Program (SPAP) Patient Assistance Programs (PAP) can assist with additional healthcare costs.

Help through federal programs

If you need help with Original Medicare Part A and Part B costs, you should ask your local Medicare and Medicaid offices about Medicare Savings Programs. You may qualify for these programs if you have limited income and assets, either jointly with your spouse or by yourself if you are single. There are four separate programs, each with its own income and asset eligibility limit. They are the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, the Qualified Individual (QI) program, and the Qualified Disabled and Working Individual (QDWI) program. See our individual articles for each of these programs to determine if you meet eligibility requirements.

If you need help with Medicare Part D prescription drug costs, you’ll want to see if you qualify for a federal program called Extra Help. This program is sometimes called the Part D low-income subsidy program, or LIS. However you refer to it, it is designed to mitigate the high cost of prescription drugs and some Part D plans by doing away with premiums, deductibles, and charging no more than $7.40 (in 2016) for each drug on a particular Part D plan. Extra Help qualification involves three tiers, which you can view in detail on our Extra Help page. Link. Costs vary on a sliding scale based on your qualifying tier.

Getting help through state programs

If you don’t meet the requirements for a Medicare Savings Program or the Extra Help program, you may be able to obtain assistance from a state-sponsored program. You should contact your local State Pharmaceutical Assistance Program (SPAP) and ask them about brand-name drug discounts and Patient Assistance Programs (PAP). Don’t forget to properly submit your out-of-pocket costs to Medicare, otherwise, they will not count toward your total drug costs. Ask a PAP representative or the administrator of your Medicare Part D plan about the proper procedure for your plan.

Other options

When getting help with Medicare costs, You should also compare your Medicare Part D plan to other plans available in your local area to see if switching plans during the annual Open Enrollment period can either save you money or improve your coverage, or both.

If the total drug costs paid by both you and your plan exceed $3,310 (in 2016), you will likely hit what is known as the coverage gap or doughnut hole. Should that happen, you can expect to pay a discounted percentage of your actual costs. If you qualify for Extra Help, however, you will not have a coverage gap and will instead pay reduced or zero co-pays for each prescription drug. If your drug costs exceed $7,062.50, they may be further reduced.

You should also consider applying for assistance from a certified charity of co-pay foundation. If you’re struggling to afford brand-name drugs, ask your doctor about generic substitutes. These almost always cost less than name-brand drugs, and some Part D plans may cover generics when you reach your coverage gap. Your doctor may also be able to give you free samples of your necessary medication. Finally, don’t forget to contact your county public health organization and ask if they have a free medication program. Getting help with Medicare costs is always an option.

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
WRITE A COMMENT