Help With Paying Medicare Premiums: How to Qualify for Assistance

If you’re having trouble paying your Medicare premiums, you’re not alone. Many Americans need help with Medicare premiums. You may be wondering where you can go for help and how you can qualify. Keep reading to learn about programs that provide Medicare premium assistance. You will also find out specific requirements you need to meet to qualify for help with paying your monthly premiums.

Medicare Premium: What Is It and How Does It Work?

Your Medicare premium is the monthly payment you make to have a Medicare insurance plan. Medicare insurance has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). You pay a different premium for each part of Medicare. Medicare Parts A and B are known as Original Medicare because the insurance coverage is provided directly through the Medicare program.

Premiums for Parts A and B are determined by and billed through Medicare. The premium for Part A can be up to $471 a month as of 2021,¹ but you usually don’t pay any premiums for Part A insurance (because you likely already paid premiums through Social Security taxes if you worked for at least 10 years in the U.S.). The estimated Part B premium for 2022 is $158.50.²

A Part C plan combines other parts of Medicare (Original Medicare and usually Part D) and can provide you with a broader range of benefits. These plans are sold through private insurance companies that are approved by Medicare. Premium rates vary depending on the type plan and where you live, but the average premium for 2022 Part C plans is $19.³

Medicare Part D plans are also provided through private insurance companies. The national average Part D premium is $33 for 2022.³ But depending on where you live and the type of plan you have, Medicare Part D costs will vary.

Medicare Premium Assistance: What Options Are Available?

The Centers for Medicare and Medicaid Services (CMS) provide assistance with premium payments. Medicaid operates four types of Medicare Savings Programs:

• Qualified Medicare Beneficiary
• Specified Low-Income Medicare Beneficiary
• Qualifying Individual
• Qualified Disabled and Working Individual

Most of the help you can get to pay premiums are available through these programs.

Medicare Savings Programs: How They Work

Medicare Savings Programs (MSPs) require that you have limited income and resources to be eligible for premium assistance. Each state manages program funds and decides who qualifies. Programs can pay for all or just some of your Medicare out-of-pocket expenses, which includes premiums. MSPs are primarily designed for Original Medicare (Parts A and B) plan enrollees, so all states must help eligible persons with premium payments. However, states can decide whether or not to help pay Medicare Advantage premiums. When it comes to Medicare Part D, persons who qualify for certain MSPs can receive help with premium payments through a separate program called Extra Help. We’ll talk more about Extra Help later.

Medicare Savings Programs Income and Resource Limits

Your income and resources (assets) are some of the factors that Medicaid uses to determine if you qualify for help with Medicare premiums. MSPs have different monthly income limits, and most states (including the District of Columbia) have the same limits. Alaska and Hawaii are the only two states that have different income limits. Three of the four MSPs have the same resources limits, and these limits are the same for all states including Alaska and Hawaii. If you earn equal to or less than these limits, then you may qualify for assistance.

What Doesn’t Count as Income and Resources?

Federal law requires that states exclude certain types of assets. These are some of the main things that don’t count:

Do I Qualify for Help with Medicare Premiums?

You may qualify for help with paying your premiums through Medicare Savings Programs if you:

1. Are eligible for or have Medicare Part A
2. Meet income limits
3. Have limited resources below the maximum amount (applicable resources include stocks, bonds, and money in checking/savings accounts)

You (or your agent) must contact your state Medicaid office if you think you could qualify for help with paying your Medicare insurance. Even if your income is slightly higher than the limits, you can still be eligible for full or partial premium assistance.

Help Paying Original Medicare (Parts A and B) Premiums

Most MSPs provide help for Medicare Part A or Part B only. All programs require eligibility for Medicare Part A, but the main difference between each is the income range that those seeking help must be within.

Parts A and B: The Qualified Medicare Beneficiary (QMB) program is the only Medicare assistance program that pays premiums for both parts of Original Medicare. If you’re approved as a QMB, you’re the program will help pay for your Medicare costs (including Part A premiums, Part B premiums, deductibles, coinsurance, and copayments).⁴

Part A Only: If you need help with just your Part A premiums, you may get assistance through the Qualified Disabled and Working Individual (QDWI) program. To get full or partial aid, you must:⁴

• Be employed
• Be disabled
• No longer be eligible for a premium waiver of your Part A benefits because you’re working

Part B Only: Both the Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programs will help pay for Medicare Part B premiums.⁴

• SLMB program: Must meet low-income limits to get aid.
• QI program: Aid is provided on a first-come-first-served basis, with preference given to previous year QI enrollees. You must apply for this program each year.

Help Paying Medicare Advantage (Part C) Premiums

You may get help with paying your Part C premiums if you’re eligible for the Qualified Medicare Beneficiary (QMB) program. But it’s not guaranteed that you will receive premium payment assistance because each state can decide whether to cover premiums for those enrolled in Medicare Advantage plans.

If you have both Medicare and Medicaid and are enrolled in a Medicare Advantage Special Needs Plan, Medicaid will pay for most of your insurance costs. However, the same rules apply with states not being required to pay your plan premiums. Although you may not get help with premiums, states are responsible for paying your Medicare Advantage copayments and coinsurance for services covered under Medicare Parts A and B.

Help Paying Medicare Prescription Drug (Part D) Premiums

You may be able to get help with Medicare premiums for your prescription drug coverage through the Part D Low-Income Subsidy (LIS) program, also called Extra Help. This program can lower your copays and coinsurance for generic drugs to no more than $3.70 each ($9.20 for brand-name). Additionally, you could pay less (or nothing) for your Part D premiums and deductibles.⁵

In 2021, the income limits for Extra Help are up to $19,320 annually ($26,130 for married couples). For resources, qualifying limits are up to $14,790 ($29,520 for married couples).⁵ You are automatically eligible for LIS if you qualify for the QMB, SLMB, or QI program.⁴

Alternative Medicare Assistance Programs

Programs outside of Medicare that can help pay premiums are generally for Medicare Part D plans. Depending on the state you live in, you may be able to get help with paying your Part D premiums through State Pharmaceutical Assistance Programs (SPAPs). These programs provide assistance to adults with disabilities and low-income seniors. States that offer Medicare premium assistance for Part D insurance make their own rules on who can qualify.

Some drug manufacturers also offer help with prescription drug costs, but this is for the cost of medicines instead of the actual premium for your Part D plan. If you’re a senior citizen, have limited income, or a disability, you may qualify for discounted or free prescribed medicines through Patient Assistance Programs (PAPs).