Help paying for Medicare

Extra Help, also called the Low-Income Subsidy or LIS, is aimed squarely at prescription costs. If you qualify, it reduces or eliminates your Part D premium and deductible and caps what you pay for covered drugs at low fixed amounts. For someone on several medications, the savings over a year can run into the thousands, which is why it is worth a few minutes to check even if you are not sure you qualify.

A recent change widened the door: the program was expanded so that more people now get the full subsidy rather than a partial one. Some people who checked years ago and did not qualify may now qualify for the full benefit. It is income- and resource-based, and the thresholds change each year, so check the current limits rather than rely on an old answer. You apply through Social Security, and the application is short. Extra Help also brings a quieter benefit: people who have it get ongoing flexibility to change Part D plans outside the normal windows.

Where Extra Help targets drugs, the Medicare Savings Programs target your Part A and Part B costs, especially the Part B premium. They are run by your state's Medicaid agency, and there are a few tiers:

• QMB (Qualified Medicare Beneficiary): the most generous tier. It can cover your Part B premium and help with deductibles, coinsurance, and copays.
• SLMB (Specified Low-Income Medicare Beneficiary): helps pay the Part B premium, with somewhat higher income limits than QMB.
• QI (Qualifying Individual): also helps with the Part B premium, with higher limits still, though it is first-come and funded annually, so applying early in the year matters.

Two things make these more valuable than they first appear. Qualifying for any of them automatically qualifies you for Extra Help, so a single application can unlock both drug and premium savings. And the Part B premium they cover is roughly $2,400 a year at the standard rate, which for many people is the single largest piece of help on this page.

If you have QMB, federal rules prohibit Medicare providers from billing you for Medicare cost-sharing, the deductibles, coinsurance, and copays QMB is meant to cover. This is called the balance-billing protection, and it goes routinely unused.

In practice, providers and their billing systems often do not know a patient has QMB, and bills go out anyway. People pay them, assuming they owe the money, when they do not. If you have QMB and receive a bill for a Medicare deductible or coinsurance, you can tell the provider you are a QMB beneficiary, ask them to stop billing you and refund anything you have paid, and contact Medicare if it continues. It is one of the clearest examples of a protection that only helps the people who know it exists.

Some people qualify for both Medicare and Medicaid at the same time. That is called being "dual-eligible," and the two programs are designed to work together. Medicare stays your primary coverage, and Medicaid fills in behind it, often covering costs Medicare leaves and sometimes services Medicare does not, such as long-term custodial care, dental, or transportation, depending on the state.

Dual-eligible status also makes you eligible for a specific kind of Medicare Advantage plan, a D-SNP, built around exactly this situation. They tend to bundle richer benefits for people who qualify and coordinate the two programs so you are not managing them separately.

These programs have historically counted both income and assets, and the asset rules scared off people who would otherwise qualify. That picture has been shifting: a number of states have raised or removed asset limits for the Medicare Savings Programs. The practical takeaway is that an old assumption, "I have some savings, so I won't qualify," may simply be out of date where you live. Some kinds of assets, like your home and your car, are typically not counted at all. It is worth checking your state's current rules rather than ruling yourself out.

Extra Help goes through Social Security, online or by phone. The Medicare Savings Programs go through your state Medicaid office. The applications ask about income and, depending on the program and the state, assets. If the process feels like a lot, that is a fair reason to get help, and it is one of the genuinely useful things a licensed agent or a SHIP counselor can walk you through at no cost.

One thing to plan for: these are not always permanent. Programs periodically ask you to confirm you still qualify, a redetermination, and people sometimes lose coverage simply by missing a piece of mail rather than by actually becoming ineligible. If you are enrolled, keep your address current with the agency and open anything they send.