It is a common misconception that Medicare is a free program. The reality is that, while most people won’t pay a monthly premium for Medicare Part A (hospital insurance), Medicare Part B (medical insurance) has a monthly premium of $104.90 in 2015 (for most people). In addition to the Part B premium, there are other costs associated with Medicare, including copayments, deductibles, and coinsurance amounts. Most Medicare Part D drug plans also have a premium and additional costs once a person reaches the coverage gap, also referred to as the Medicare “donut hole.” The coverage gap is a temporary limit on how much a plan will cover for drugs, which begins after the plan and the beneficiary have spent a certain amount on prescription drugs.
These costs can make Medicare unaffordable for many seniors with very limited incomes. The good news is that there are options when it comes to getting help with medical expenses. We’ve highlighted four federal and state programs to help low-income seniors.
1: Medicaid (Medi-Cal in California)
This joint federal-state program helps pay for medical costs for individuals and families that qualify based on their income and resources. People who qualify for both Medicare and Medicaid are referred to as “dual eligible.” Each state decides the terms of eligibility, including what counts as income and resources, what services are covered, and the cost of services. In California, an individual with an annual income up to 138% of the federal poverty level (FPL), or $16,105, qualifies for Medi-Cal (California’s Medicaid program).
2: Supplemental Security Income (SSI) Benefits
Seniors 65 and older with limited income and resources may qualify for SSI, which pays a monthly cash benefit to help pay for basic needs including food, clothing, and shelter. According to the Social Security Administration (SSS), “limited income” includes money you earn from work, money you receive from other sources (such as Social Security benefits, unemployment benefits, money from friends and relatives, etc.), free food or shelter, and other resources. For the purposes of SSI, “limited resources” includes things you own, such as cash, land, vehicles, bank accounts, stocks, life insurance, and other resources. To find out whether you qualify for SSI benefits, use the Benefit Eligibility Screening Tool.
3: Medicare Savings Programs
Some states have programs that pay Medicare premiums, deductibles, and coinsurance amounts, referred to as Medicare Savings Programs. Here is a list of the four MSP programs that may be available to you, depending on your income and where you live:
- Quality Medicare Beneficiary (QMB)—This program helps pay Medicare Part A and Part B premiums and copayments for those who qualify based on income.
- Specified Low-Income Medicare Beneficiary (SLMB)—Helps pay Part B premiums for those who qualify based on income and resources.
- Qualifying Individual (QI)—Helps pay Part B premiums for those who qualify based on income and resources.
- Qualified Disabled & Working Individuals (QDWI)—Helps pay Medicare Part A premiums (applies to people under age 65) for those who qualify.
4: Extra Help
Those with limited incomes and resources who qualify for Medicaid, one of the Medicare Savings Programs, or SSI automatically qualify for Extra Help paying for Medicare prescription drug coverage.
Call the experts at CA Medicare for answers to all your Medicare questions and for assistance with Medicare enrollment today.
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