Getting Help with Medicare Costs When Money Is Tight

Medicare provides vital health insurance for 50 million seniors and people with disabilities. But don’t be fooled – even with Medicare, health care isn’t free. Medicare enrollees have to pay premiums and other out-of-pocket costs such as deductibles and coinsurance. These expenses can be overwhelming for low income individuals, especially when you consider the fact that half of them have an annual income of less than $23,500.

Several programs are available to help with health care costs. Unfortunately, many Medicare beneficiaries don’t know about them.

What costs are involved?

  • Medicare Part A covers inpatient care. It also has a $1,216 deductible should you be hospitalized.
  • Medicare Part B covers outpatient care (like doctor visits) and has a monthly premium of $104.90.
  • Doctor visits and lab tests require a 20 percent copayment.
  • Part D drug coverage has an additional premium that averages around $40 a month, plus copayments for prescriptions.

What help is available?

  • Part D’s “Extra Help” program can cover all or some of your Part D premiums and costs.
  • Each state operates three Medicare Savings Programs, all of which will cover your Part B premium. Lower-income individuals can also get their Medicare coinsurance and deductibles covered.
  • Some beneficiaries with low incomes or high health care expenses may qualify for their state’s Medicaid program. This covers numerous services not covered by Medicare.

How can I qualify?

  • Income limits vary from state to state and are adjusted annually. Generally, the 2014 income limit for any type of assistance is $17,500 a year for an individual and $23,600 for a couple.
  • Most programs also look at your assets (bank accounts, retirement, etc.). Typically, the value of your home and car are not taken into account. The asset limit for 2014 is roughly $7,000 for an individual and $11,000 for a couple. Some states have adopted higher limits or eliminated them altogether so check to see what the rules are for your state.

How can I get help?

  • Contact your local State Health Insurance Assistance Program (SHIP) to learn more about your state’s programs and get help navigating the application process. Call 1-800-MEDICARE or go to and click on “Find someone to talk to.”

How do I apply?

  • Visit Social Security’s website at to learn more about the Part D Extra Help Program and file an application.
  • Contact your state’s Medicaid office to apply for the Medicare Savings Programs or Medicaid. A SHIP counselor can help you start the process and advise you if you run into problems.

Are there other options for getting help with Medicare costs?

  • Explore options in your area. Some states offer additional help with prescription drug costs.
  • Veterans may qualify for extra help through the Department of Veterans Affairs (VA).
  • Take advantage of any help you may get from a former employer.
  • Consider getting a Medicare Supplement (Medigap) or Medicare Advantage Plan. Some plans can be costly and others may limit which doctors you can see. A local SHIP counselor can help you assess your options.


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