Medicare is a low-cost insurance policy, but for some, its costs still make it out of reach. There are ways to combat this, such as with Medicaid or supplemental insurance like Medicare Supplement plans. With Medicare, you have a way to reduce its already low out-of-pocket expenses to make medical debt an afterthought.

How can I qualify for help?

If your earnings are low enough to meet income and resource limits, you can get assistance through Medicaid. Your state sets the criteria for Medicaid eligibility based on your Modified Adjusted Gross Income (MAGI). If you earn too much but are still considered medically needy, you have the option to “spend down”, where you deduct medical expenses from your annual income as a way to meet your state’s income requirement. 

Income requirements are also different depending on whether you’re single or married. Your program will also have resource limits. Stocks, bonds, and your checking and savings accounts all count as resources. Material items such as furniture and personal possessions do not count as resources.

If you’re more interested in what a Medicare Supplement plan can provide you, then all you have to do is be enrolled in Original Medicare. Once you’re enrolled and are 65, you will have a six-month period to enroll in a Medicare Supplement plan and not be denied coverage. There are ten plans available, with each one providing a different level of coverage for specific services, which can include deductibles, coinsurance, excess charges, copayments, and more. 

How do Medicare and Medicaid work together?

When you have both Medicare and Medicaid, the two work side-by-side to leave you with minimal out-of-pocket costs. Once Medicare pays its share of the bill, Medicaid will pay as much as it can of the remaining portion.

Being eligible for both Medicare and Medicaid can help you get enrolled in a Medicare Savings Program or a Dual Eligible Special Needs Plan (D-SNP) from Medicare Advantage.

What is the Medicare Savings Program?

The Medicare Savings Program helps you save according to the amount of monthly income and resources you have. There are four distinct programs – Qualified Medicare Beneficiary (QMB), Qualifying Individual (QI), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Disabled and Working Individuals (QDWI).

Each program has its own income requirements, but QMB, QI, and SLMB all share the same resource requirements – $7,970 for individuals and $11,960 for married couples. For QDWI, the maximum value of resources an individual can have is $4,000, and for married couples, the resource limit is $6,000.

You must have Medicare Part A and Part B to obtain one of these policies. Without them, you will have to wait until the next enrollment period before you can take the next step forward to getting greatly discounted healthcare.

The QMB program helps pay Part A and Part B premiums, deductibles, copayments, and coinsurance. Your healthcare provider is not allowed to bill you for any Medicare-covered services. If you are single, your monthly earnings cannot exceed $1,094. If you’re married, the limit is $1,472 per month.

The QI program only helps pay for your Part B premiums, but you still need Part A to get it. Individuals must earn at or below $1,469 per month, while married couples have a monthly income limit of $1,980. This one also requires annual renewal. It’s best to do this as soon as possible, since policies are assigned on a first come, first serve basis with preference going toward those who were members the previous year.

As for the SLMB program, it also helps with Part B premiums. The individual monthly income requirement is $1,308 or below. Married individuals must have an income that does not exceed $1,762 per month. 

If you are a working and disabled person under 65, or you have lost your Social Security disability benefits due to regaining employment, you can join the QDWI program. However, if you’re an individual, your monthly income limit is $4,379. If you’re married, your monthly income limit is $5,892.

What can I do for my medications?

If you meet the requirements for full Medicaid benefits, you can qualify for what is known as Extra Help. Extra Help makes it so that you will pay no more than $3.70 per prescription for your generic medications, and $9.20 for your brand name medications.

What is the Dual-Eligible Special Needs Plan?

A Dual-Eligible Special Needs Plan (D-SNP) is a form of Medicare Advantage that is designed for those who qualify for both Medicare and Medicaid. It’s an all-in-one bundle, giving you inpatient, outpatient, and prescription drug coverage all within the same plan.

Here, you get your coverage within a network where your plan covers you as long as you see certain healthcare providers. However, not all plans require you to see providers within a network in order to get coverage. This is why it is best to check with your insurance provider so that you can find the ideal plan.

With a D-SNP, you choose a primary care physician who directs the course of your medical treatment. He or she will refer you to a specialist when necessary.

It will cover inpatient expenses such as your room and board when you stay in the hospital, and other services and treatments you receive. Your outpatient coverage ranges from preventive screenings to immunizations, to durable medical equipment. Prescription coverage is required of all Medicare Special Needs Plans.

You can join this during the Annual Election Period, which begins October 15, and ends December 7. Once you join, your plan’s coverage will kick in on January 1 of the coming year. If you are already enrolled in a Medicare Advantage plan, you can switch to this one during the Annual Election Period or during the Medicare Advantage Open Enrollment Period, which lasts from January 1 to March 31.

Get assistance with your Medicare payments today

Medicare Peace of Mind is here to alleviate all anxiety when it comes to your Medicare-related costs. Whether that be a Medicare Savings Program, Extra Help, or a Medicare Supplement plan, we’ve got you covered.

Call us today at 970-233-0633 to get started on getting the best available Medicare plan at the lowest possible price!