If you’re having trouble paying your Medicare premiums, you’re not alone. Many Americans need help with Medicare premiums. HealthMarkets outlines where you can go for help and how you can qualify for Medicare premium assistance. We also explain specific requirements you need 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 $437 a month as of 2019. 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 standard Part B premium as of 2019 is $135.50, but most people with Social Security benefits will pay less ($130 on ).

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 across all Part C plan types as of 2019 is estimated to be $28, according to My Medicare Matters, a website run by the National Council on Aging.

Medicare Part D plans are also provided through private insurance companies. The national average Part D premium is $33.19, according to My Medicare Matters. But depending on where you live and the type of plan you have, Medicare Part D costs will vary.

Medicare Premium Assistance: How Can I Get Help With Paying Medicare Premiums?

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

  • Qualified Medicare Beneficiary (QMB)
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Qualifying Individual (QI or QI-1)
  • Qualified Disabled and Working Individual (QDWI)

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

Medicare Savings Programs: How it Works?

Couple standing together holding up pink piggy bank

Those with limited income and resources may qualify for premium assistance through Medicare Savings Programs (MSPs). Each state manages MSP 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 citizens with premium payments. However, states can decide  whether to help pay Medicare Advantage premiums . When it comes to Medicare Part D, people who qualify for certain MSPs can receive help with premium payments through a separate program called Extra Help.

What Are the Income and Resources Limits for Medicare Savings Programs?

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.

Program Name 2019 Monthly Income Limits 2019 Resource Limits
Individual* Married Couple* Individual Married Couple
Qualified Medicare
Beneficiary (QMB)
All States: $1,061
Alaska: $1,320
Hawaii: $1,219
All States: $1,430
Alaska: $1,781
Hawaii: $1,642
$7,730 $11,600
Specified Low-Income
Medicare Beneficiary (SLMB)
All States: $1,269
Alaska: $1,580
Hawaii: $1,548
All States: $1,711
Alaska: $2,133
Hawaii: $1,966
$7,730 $11,600
Qualifying Individual (QI) All States: $1,426
Alaska: $1,775
Hawaii: $1,638
All States: $1,923
Alaska: $2,398
Hawaii: $2,210
$7,730 $11,600
Qualified Disabled and
Working Individual (QDWI)
All States: $4,249
Alaska: $5,285
Hawaii: $4,879
All States: $5,722
Alaska: $7,129
Hawaii: $6,572
$4,000 $6,000

* all states label doesn’t include Alaska and Hawaii

What Doesn’t Count as Income and Resources?

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

Doesn’t Count as Income Doesn’t Count as a Resource (Asset)
The first $20 of your monthly income and the first $65 of your monthly wages Primary house
Half of your monthly wages (after $65 is deducted) Your car
Food Stamps Items that cannot be easily converted to cash such as furniture and jewelry (wedding/engagement rings)
Help from others to pay household expenses Burial plot and burial funds valued up to $1,500 for individuals and $3,000 for couples
Earned income tax credit payments Life insurance that has less than $1,500 in cash value

Do I Qualify for Help with Medicare Premiums?

Tips on How to Pay Your Medicare Premiums

  • Pay on time to avoid coverage cancellation. Medicare premiums are due the 25th day of the month.
  • Don’t miss more than 3 consecutive months of payments to Medicare. Coverage will end in the fourth month if payments aren’t made.
  • Sign-up for automatic bank payments if your Medicare Part B premiums aren’t automatically deducted from Social Security (or other pension benefits).
  • If you get Medicare Advantage through a private insurance company, contact the company if you think you will miss a payment. Companies have their own rules on how many payments you can miss before your insurance is cancelled.

You may qualify for help with paying your premiums through Medicare Savings Programs (MSP) 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)

HealthMarkets’ Extra Help Calculator can help you see if you could be saving on prescription drug costs for free.

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 federal poverty level (FPL) 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. All states must provide Medicaid to QMB enrollees for Medicare cost-sharing, according to the Social Security Administration. Cost-sharing is the amount of money you would have to spend in premiums, deductibles, copayments and coinsurance. But if you’re approved as a QMB, you are not responsible for paying any cost-sharing, according to the Center for Medicare Advocacy. This means that your Medicare costs, including your premiums, are 100% covered.

To qualify for the QMB program, your income must not exceed 100% of the FPL. You generally start receiving assistance the month following your approval. So, for example, if you were approved in June, you will start receiving assistance in July.

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:

  • Not be eligible for Medicaid
  • Be an employed disabled person under 65 years of age
  • No longer be eligible for a premium waiver of your Part A benefits because you’re working
  • Not have resources that are more than twice the maximum amount for Social Security Income
  • Not have an income that is more than 200% of the FPL (You may only get partial aid if your income is between 150% to 200% of the FPL.)

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

  • SLMB program: Income must be at least 100% of the FPL but no more than 120% to get aid.
  • QI program: Income must not exceed 135% of the FPL, and you must not be eligible for Medicaid. Aid is provided on a first-come-first-served basis, with preference given to previous year QI enrollees.

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. 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; states are not 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

Portrait-of-senior-couple-seated-at-table-holding-pill-bottle-1024x576.jpg

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. You are automatically eligible  for LIS if you qualify for the QMB, SLMB, or QI program. You will most likely receive 100% assistance in paying your Part D premiums if you qualify for Extra Help, according to My Medicare Matters. The LIS program offers three levels of help based on your income and resources. The fewer income and resources you have, the more assistance you can get. You may qualify if your income and resources are equal to or less than these limits.

 

Low-Income Subsidy Program 2020 Income and Resources Limits

Monthly Income Limits Resource Limits* Amount of
Premium Subsidy
Level 1
(Up to 135% of FPL)
Single: $1,435.50
Married: $1,939.50
Single: $7,860 to $13,110
Married: $13,110 to $26,160
100%
(less help with copays
& deductibles if
resources are
more than
$7,860 or $13,110)
Level 2
(136% to 140% of FPL)
Single: $1,488.67
Married: $2,011.33
Single: $12,890 or less
Married: $25,720 or less
75%
Level 3
(141% to 145% of FPL)
Single: $1,541
Married: $2,083.17
Single: $12,890 or less
Married: $25,720 or less
50%
Level 4
(146% to 150% of FPL)
Single: $1,595
Married: $2,155
Single: $12,890 or less
Married: $25,720 or less
25%

* The LIS program does not count money you set aside for burial expenses as part of your resources, which is $1,500 for individuals and $3,000 for couples.

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 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, as noted by the National Council on Aging. For instance, you may only be able to get help if you have Medicare but don’t qualify for the LIS program or if you have a chronic medical condition.

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).

Evaluating Your Medicare Needs

With the different parts of Medicare and varying premiums for each part, it can be a little confusing to understand how Medicare works. HealthMarkets can be your guide in understanding Medicare insurance plans and helping you evaluate your health insurance coverage needs.

If you’re already enrolled in a plan or will be eligible for Medicare soon, you may want to find out if you should go with a wider range of benefits from a Part C plan. Or, you may need to consider enrolling in a Medicare Supplement insurance plan. These are some of the things that a HealthMarkets FitScore can help you figure out. After answering a few questions, HealthMarkets will search Medicare plans from the leading insurance companies and provide you with a personalized list of suggestions. The plan with the highest FitScore is the best match for coverage that meets your needs.

So along with getting help with Medicare premiums, making sure you’re getting the most out of Medicare insurance is also important. Visit us online today to evaluate and filter Medicare plans based on your needs!

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References

https://www.cms.gov/Outreach-and-Education/Training/CMSNationalTrainingProgram/Downloads/2015-Medicare-Savings-Program-Job-Aid.pdf | https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html#collapse-2625 | https://secure.ssa.gov/apps10/poms.nsf/lnx/0600815023 | https://www.ncoa.org/wp-content/uploads/medicare-advantage-and-duals.pdf | https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/special-needs-plans-faq.html#collapse-3319 | https://secure.ssa.gov/apps10/poms.nsf/lnx/0600801139 | https://www.mymedicarematters.org/costs/getting-help-with-costs/ | http://www.medicareinteractive.org/pdf/MSPFinancialEligibiltyGuidelines.pdf | https://www.ssa.gov/medicare/prescriptionhelp/materials/pdfs/StateManual.pdf | http://www.medicareadvocacy.org/medicare-cost-sharing-for-qualified-medicare-beneficiaries/ | https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html | https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html | https://www.ncoa.org/economic-security/benefits/prescriptions/spaps-paps/ | https://www.mymedicarematters.org/costs/part-d/ | http://www.prnewswire.com/news-releases/study-0-premium-medicare-advantage-plans-increase-in-2016-after-5-years-of-decline-300147004.html | https://www.medicare.gov/your-medicare-costs/paying-parts-a-and-b/pay-parts-a-and-b-premiums.html

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