Everything About Getting Extra Help From Medicaid 2017

Medicaid, or Medicare Savings Program is a federal government program. Basically, it provides healthcare coverage to help pay for Medicare. It attends to eligible categories of seniors who have low income and few assets.  Further, Medicaid supports people over 65 and those with certain disabilities. Every state has its own version of Medicaid. Although, they have slight different regulations and coverage.

What is Medicaid and Medicaid coverage

What Does Medicaid Cover?

Medicaid offers a wide array of health insurance coverage. It includes doctor visits and nursing home care. Also, it includes hospital expenses. And home health care. In addition, it covers long-term care costs. This includes both at-home care and nursing home. In fact, Medicare does not provide this coverage.

Furthermore, they cover Medicare premiums. Also, co-payments and deductibles. There is also a separate part of Medicaid. This covers long-term nursing home care.

Special Medicaid-funded programs cover in-home personal care. Further, including long-term.  Asset eligibility and income rules are looser than regular Medicare.

It is easy to find out what is Medicaid. Also, one may contact a local office of your state. This way, one will know what Medicaid-related programs their state has. One will also know if they are eligible. Also, they will know what it covers.


Brief Comparison: Medicaid and Medicare

Some people confuse the differences between the two. True, their names are similar. However, Medicare and Medicaid are totally different.

Medicare is available for almost everyone. People eligible are those 65 and older. Also, people with long-term disabilities regardless. Regardless of assets and income are eligible.

On the other hand, Medicaid is not for everyone. Further, this program is for people with very few assets and low income.


Can Someone Get Medicaid Who Also Has Medicare?

It is possible to be qualified for both. Medicare covers most of a person’s medical needs. However, there are a few services which Medicare does not cover.

Medicare may leave a patient’s medical bills uncovered. This includes services they do not cover. Such as, Medicare premiums, co-payments and deductibles. Also, remember that Medicare doesn’t cover Part D.

This is where Medicaid comes in. For instance, Medicare Part A and B cover medical services. However, it leaves some parts of the cost unpaid. Then, Medicaid pays the extra amount for someone who’s eligible. Someone eligible for Medicaid and Medicare must enroll in Part D plan. This way, they get their prescription drugs covered. However, Medicaid does not cover drugs.

Later, this article discusses getting extra help for Medicare Part D prescription drugs.



Medicaid and extra help for Medicare Part D prescription plans

Understanding what is Medicaid includes eligibility. This federal state program provides health coverage to over 72.5 million citizens. It is the largest source of health coverage in the country.

The federal law requires covering certain groups. This may refer to low income families. Also, they cover qualified children and pregnant women. Those with Supplemental Security Income (SSI) are mandatory eligibility groups.

Some states also have additional options for coverage. In fact, they may choose to cover other groups. They may cover individuals receiving home and community based services. They include children in foster care who are not eligible.

Moreover, there are 4 kinds of Medicare Savings Programs. Qualification depends on their income. In fact, even if one has higher than the income limits.


Four Kinds of Medicare Savings Programs

One can get help depending on one’s income and assets. Medicaid pays for Part A and Part B Medicare. Part A Medicare is Health Insurance. Part B is Medical Insurance. Medicare Savings Programs help pay co-insurance. Also, co-payments and deductibles. When one meets the conditions, then they can help.

Medicare Savings Program Individual Monthly Income Limit Married Couple Monthly Income Limit Helps Pay For Your
QMB $1025 $1374 Part A and Part B premiums and other costs (deductibles, copayments and coinsurance)
SLMB $1226 $1644 Part B Premiums Only
QI $1377 $1847 Part B Premiums Only
QDWI $4105 $5499 Part A Premiums Only

A higher income may qualify than the limits above. Some states determine incomes and resources differently. One may qualify if their state thinks they are above these limits. Moreover, limits are about higher in Alaska and Hawaii. Also, some states have higher resource levels. Others do not count resources. Just check with your state to find out more.

Qualified Medicare Beneficiary Program (Level 1 Full or Level 2)

QMB helps pay for Part A premiums, Part B premiums. Further, they help pay for deductibles. Including, co-insurance and co-payments. This is also known as Dual Eligible (Medicare and Full Medicaid). Moreover, QMB qualifies members for (SNP). That is Total Core Plan where Premiums are usually $0. That includes doctor and other co-payments.

A person’s QMB qualification depends on their income. They must have about $950 per month. This varies slightly from state to state. Also, those with nonexempt assets of up to $4,000 ($6,000 for couple) qualify.

Specified Low-Income Medicare Beneficiary Program (Level 1 Partial)

An income of $1,150 per month qualifies for this program. Also, those with nonexempt assets of up to $4,000 ($6,000 for couple) qualify. This program pays for the monthly Medicare Part B premiums only.

Qualifying Individual (QI) Program (Level 3)

It is possible to apply annually for QI benefits. In fact, this grants applications on a first-come, first-served basis. Also, it prioritizes people with QI benefits from the previous year.

A person’s income about $1,300 per month qualifies for QI. Also, those with nonexempt assets of up to $4,000 ($6,000 for couple) qualify. They may pay your Medicare Part B monthly premium if one qualifies. However, each QI’s state funds are limited. Therefore, there is no guarantee of coverage.

Note: One cannot get QI benefits if they are not qualified for Medicaid.

Qualified Disabled and Working Individuals (QDWI) Program (Level 4)

The QDWI Program helps pay Part A premiums. One may qualify for the following conditions:

  • Under 65, working and disabled
  • Lost their premium-free Part A when they went back to work
  • They aren’t getting medical assistance from their state
  • Meeting the income and resource limits required by the state


Non-Financial Eligibility

Some may also qualify for non-financial eligibility criteria. This benefits those who are residents of the state. This refers to the state they will receive Medicaid. Further, they must be citizens of the United States. Likewise, certain qualified non-citizens are also welcome. For example, lawful permanent residents. Moreover, some eligibility groups have limits. It depends on the age. Such as, the pregnancy or parenting status.


When Does Coverage Start?

The coverage begins on the date of application. Also, it could be on the first day of the month of application. Benefits may also be covered retroactively. This is up to 3 months prior to month of application. But, one must be eligible during that period. Generally, coverage stops at the end of the month. This is when they no longer meet the eligibility requirements.


Low Income Subsidy For Medicare Part D (Prescription Drug Coverage)

Medicaid and Medicare Part D

Remember that Medicaid does not cover prescription drugs. However, one may get extra help from Medicare. They must meet certain income and resource limits. Low Income Subsidy is also known as “Extra Help”. They pay the costs of Medicare Part D. This is also known as Medicare Prescription Drug Coverage.

Those receiving LIS receive assistance in paying their Part D monthly premiums. In addition, it pays for co-insurance, co-payments and annual deductibles. Also, qualifiers do not have a gap prescription drug coverage. They refer to this as the coverage gap, or Medicare “donut hole.”

Moreover, the amount of subsidy depends on the person’s income. This is in comparison to the Federal Poverty Level. Also, the resource limitations set by the Social Security Act.

LIS Eligibility

One can get extra help for Medicare Part D prescription drugs. They become automatically eligible if they meet any of these conditions:

  • Have full Medicaid coverage
  • Getting help from their state Medicare Savings Program which pays for their Part B premiums
  • Have Supplemental Security Income (SSI) benefits
  • Annual income and assets are below the eligibility magnitude. Further, eligibility limits may change every year.
  • An annual income higher than the eligibility limit. But, they support other family members.

Moreover, assets that may count as eligible are the following:

  • Cash and bank accounts which includes certificates, savings and checking of deposit
  • Real estate outside of the main resident
  • Stocks and bonds
  • Mutual funds and IRAs

Medicare does not count resources such as one’s home. Also, they disregard insurance policies or the number of cars. Most people qualify for Extra Help and unaware of it. The best way to find out is to apply.

One cannot qualify the following year if they were already qualified this year. Changes may occur in one’s income or resources. This may not cause qualifications for any programs. Further, one may get a notice when September ends. In fact, the notice tells if they no longer automatically qualify.

Actually, they may still apply if they receive that notice. They must first find out if they qualify. Here are the conditions:

  • If the copayment amounts change for the following year. They will get a notice in early October for any amount changes.
  • If they did not get any notice from Medicare. Then, they will receive the same level of LIS from last year.



It is definitely easy to get assistance from Medicaid. No matter the qualifications, they can help pay some premiums. Further, one can get extra help for Medicare Part D prescription drugs. Just approach the nearest Medicaid office to see if one qualifies. Also, visit Medicare.gov for more details about the different parts of Medicare.

Leave a Comment

Your email address will not be published. Required fields are marked *