It easy to understand how to qualify for Medicare savings program. All you need is the right source of information and expert agents to help you along the way. Truthfully, you have come to the right place!
Most seniors do not fully perceive the difference between Medicare and Medicaid and how the two work together. Here, you will learn everything about Medicare and Medicaid… what is the difference. Also, we will tell you all about the different Medicare savings program and Low-Income Subsidy.
We have plenty in store for you and later, you shall have a full grasp on Medicare and Medicare Financial Assistance.
Medicare Vs Medicaid
Medicare and Medicaid… what is the diff is easy to understand. Sure, the words are similar but technically they have distinct features. Let us generally define the two.
Medicare is an insurance program that covers medical bills. It serves people over 65, whatever their income. Eligible clients pay part of costs through deductibles for hospital and other costs. Further, Medicare is a federal program which is basically the same everywhere in the United States. Also, it is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.
Meanwhile, Medicaid is an assistance program. Thus, it serves low-income people of all ages. Usually, patients pay no part of costs for covered medical expenses. Sometimes, a small co-payment is required. Notably, the program varies from state to state. It is run by state and local governments within federal guidelines.
Refer to the table below to easily understand their basic differences:
|Coverage||Medicare Part A: Hospital Care
Part B: Doctor Visits, Laboratory Fees, Outpatient Care (may include medical equipment)
Medicare Part D: prescription drug coverage
|Doctor and Hospital visits, as well as dental care
May also cover vision benefits
|Cost||Yearly deductible applies to all parts
Part A: copayments for lengthy hospitalizations
Medicare Part B: 20-35% of medical bills, plus a monthly premium
Part D: Medicare does not cover total drug costs after it exceeds $2,960-35% of generic drugs and 45% of brand-name will be paid by recipient
|Medicaid sometimes charges small fees for certain services
Medicare deductibles and premiums are often paid by Medicaid
Medicaid can cover the 20% of medical costs of Medicare Part B
Now that you have the basic idea between Medicare, and Medicaid, you must also know the components of each and how to become eligible.
What is Medicare?
First of all, we must define Medicare. Generally, it is a federal health insurance program for people aged 65 or older. Also, it covers people under 65 with specific disabilities such as end-stage renal disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS).
Furthermore, this program is being managed by the federal agency which is The Centers for Medicare & Medicaid Services. Also, Social Security part-funds the program.
Medicare has four parts: A, B, C, and D. It is crucial to make sense of these four parts because you will be dealing with them when you become eligible for Medicare. Likewise, your knowledge on these four parts will guide you which program to choose. Remember, the choices you make may affect your finances and where you can receive health care.
The Four Parts of Medicare
Those four different elements of Medicare help you in covering distinct services. Correspondingly, there is a difference between Original Medicare and Part C Medicare which you must know. Because, you can get your Medicare coverage from either of the two. Likewise, both OM and Part C Medicare includes Part A and Part B Medicare.
This program is directly administered by the federal government. Generally, this is how most seniors get Medicare coverage. It includes two parts which are Part A Medicare and Part B Medicare.
Part A Medicare (Hospital Insurance)
This part generally covers basic healthcare such as inpatient care in hospitals and skilled nursing facility. Also, it covers home health care and hospice care.
Part B Medicare (Medical Insurance)
Also called Medical Insurance, Part B helps cover services which you can get from doctors and other health care providers. Further, it includes home health care, and outpatient care. In addition, it covers x-rays, laboratory tests, durable medical equipment, some preventive services and mental health care.
Part C Medicare (Medicare Advantage Plan)
Medicare Advantage plan is an alternative way of getting Medicare coverage. It is administered by Medicare-approved private insurance companies. Further, this plan includes benefits and services covered under Part A and B Medicare. Generally, it provides all benefits and services with different rules, costs and restrictions. Some plans even include dental, eye, hearing aid services and Medicare prescription drug coverage.
Moreover, you can become eligible for Part C especially when you have health coverage. This can be from your union, former or current employer. You can choose stay with your current plan or switch to Original Medicare.
Part D Medicare (Medicare Prescription Drug Coverage)
Medicare Part D basically covers prescription drug costs. Likewise, it is run by Medicare-approved private insurance companies. This plan is added drug coverage to your Medicare with an additional monthly premium. Significantly, it covers and lowers drug costs therefore protecting you against higher medical costs in the future. You may get Part D Medicare through your Medical coverage plan if it included. Otherwise, you may join a separate Medicare Prescription Drug Plan.
What is Medicaid?
Can’t afford Medicare? Medicare savings program is the answer. Widely known as Medicaid, it is likewise a federal government program. Generally, it provides healthcare coverage to help pay for Medicare. Further, it caters eligible seniors with low income and fewer assets.
Moreover, Medicaid also considers those under 65 with certain disabilities. Every state has its own Medicaid version although with slight difference on regulations and coverage.
What does Medicaid Cover?
Medicaid covers a wide array of health insurance. It includes doctor visits, nursing home care, hospital expenses, and home health care. In addition, it covers long-term care costs which includes both at-home care and nursing home.
Essentially, they cover Medicare premiums encompassing co-payments and deductibles. There is also a separate part of Medicaid which covers long-term nursing home care which is not included in Medicare coverage. In fact, Medicaid is the country’s largest (single) source of long-term care coverage.
Can you get help paying for Medicare? Yes, with Medicare financial assistance, you can get help depending on the program you are eligible. Thus, asset eligibility and income rules are looser than regular Medicare. This program is designed to assist those financially struggling. So, most states require candidate seniors to have no more than a few thousand dollars in their liquid assets to be in the program. How to qualify for Medicare savings program is easy if you understand all the concepts.
How To Qualify For Medicare Savings Program
Thankfully, there are four types of Medicare Savings Program which can help you become eligible. Your eligibility depends on you income and assets. Generally, Medicare financial assistance helps pay co-insurance, co-payments and deductibles for Part A and B Medicare. When you meet the conditions below, then you can get 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|
If you have higher income, you may qualify than the limits above. In fact, some states determine incomes and resources differently. For instance, you may qualify if your state thinks you are above the limits. Notably, limits are higher in Hawaii and Alaska. Meanwhile, some states have higher resource levels while others do not count resources. The best thing to do is check with your state to find out if you can qualify.
Let us further discuss the four programs of Medicaid…
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
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.
Different QMB Programs That Work With Medicare
Furthermore, there are four QMB programs that work together with Medicare. It gets complicated but we shall make it easier for you.
To be eligible for this, you must be receiving Medicare Part A or be conditionally enrolled through DHS. If you become eligible for this program, they will pay Medicare Part A and B premiums, including co-insurance and deductibles for Medicare covered services. But, this does not cover any Part D costs. Further, the adjusted income limit for QMB-BAS is up to and including 100% of the Federal poverty level.
Likewise, you must be receiving Medicare Part A to qualify for this program. This includes those seniors who has to pay premiums for the coverage. QMB-SMB eligibility is limited to whose income is above 100 and below 120% of the federal poverty level. Further, the coverage limits to the payment of our Medicare Part B premium. An SMB client’s eligibility initiates on the first of the month when their eligibility is determined and verified.
To qualify for this, you must be receiving Medicare Part A. If you are receiving any other Medicaid program, you will not be eligible for this program. This eligibility is limited to seniors whose income is equal to 120 up to 135% of the federal poverty level. Further, coverage limits to payment of their Medicare Part B premium.
QMB-DW (Disabled Worker)
This program has the highest allowable income for a Medicare Savings Program. It is at 200% of the Federal Poverty level. You can be eligible for this program if you have Medicare Part A and a qualified disabled worker under Section 1818 (A) of the Social Security Act. Further, the Social Security Administration makes the decision whether you meet the eligibility criteria as a qualified disabled worker.
To meet the criteria, you must be under 65 years and receive no more Social Security disability benefits because you have become gainfully employed. Although, you may still continue to receive Medicare Part A if you pay the premium. Moreover, QMB-DW only pays for Medicare Part A premiums.
Applying for Medicaid (Medicare Savings Program)
You will have to call your local Medicaid office to know the rules on how to apply in your state. But, we will explain further the general guide or process for you.
Contact Your Local Medicaid Office
First of all, contact your local Medicaid office to ask the process on submitting your application. Most states enable you to process your application online, through mail, through community health centers or through other organizations. Meanwhile, some states still demand you to schedule an appointment and proceed in person to the Medicaid office for your application process.
Documentation/requirements for your Medicare savings program application
- Social Security Card
- Medicare card
- Birth Certificate
- Passport or Green Card
- Proof of Income (i.e. income tax return, Social Security Administration award letter, pay stub)
- Proof of address (i.e. phone bill or electric)
- Information about your assets. For instance, stock certificates, bank statements, life insurance policies, etc.
Moreover, the list of documents or requirements on how to qualify for Medicare savings program application varies by state. Some states do not demand that you submit information about your assets or income. Thus, call your local Medicaid office to know which documents to submit.
Low-Income Subsidy / Extra Help
You can also get financial help to pay for medications or prescription drug costs. Low-income subsidy, or extra help pay the costs of Medicare Part D. Take note that Medicaid does not include coverage for prescription drugs.
If you become eligible for LIS, you will receive assistance in paying for your part D monthly premiums. Further, it helps pay for co-insurance, co-payments and annual deductibles. Also, you will not have a gap prescription drug coverage with LIS. Most refer to this as the coverage gap, or Medicare “donut hole.”
Moreover, the amount of subsidy still depends on your income which is in comparison to the Federal Poverty Level. Also, the resource limitations set by the Social Security Act comes into consideration.
You can become automatically eligible if you meet any of these conditions:
- Have full Medicaid coverage
- Getting help from your state Medicare Savings Program which pays for your 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, you 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
Extra Help’s Worth
Medicare does not count resources such as your home. Also, they do not include insurance policies or the number of cars you have. Extra help’s worth is estimated at about $4,000 per year. Most people qualify for extra help and are unaware of it. The best way to find out is to apply.
You cannot qualify the following year if you were already qualified this year. Because, changes may occur in your income or resources. This may not cause qualifications for any programs. Further, you can get a notice when September ends. In fact, the notice tells if you are no longer automatically qualified.
Actually, you may still apply if you receive that notice but you must first find out if you qualify. Here are the conditions:
- If the co-payment 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.
To assist Social Security in determining your eligibility for Extra Help, you will need to file an application form. The form is Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020).
What are the Resource Limits?
To qualify for Extra Help, your resources must be limited to $13,820 for an individual or $27,600 for a married couple living together.
Resources include the value of the things you own. Some examples are:
- Real estate (other than your primary residence)
- Bank accounts including checking, savings and certificates of deposit
- Bonds, including U.S. Savings Bonds
- Mutual Funds
- Individual Retirement Accounts (IRAs)
- Cash at home or anywhere else
What Does Not Count As A Resource?
- Your primary residence;
- Personal possessions;
- Your vehicle(s);
- Resources you couldn’t easily convert to cash, such as jewelry or home furnishings;
- Property you need for self-support, such as rental property or land you use to grow produce for home
- Non-business property essential to your self-support;
- Life insurance policies;
- Burial expenses;
- Interest earned on money you plan to use for burial expenses; and
- Certain other money you are holding is not counted for
nine months, such as:
- Retroactive Social Security or Supplemental Security Income (SSI) payments;
- Housing assistance;
- Tax advances and refunds related to earned income tax credits and child tax credits;
- Compensation you receive as a crime victim; and
- Relocation assistance from a state or local government
Extra Help’s Income Limit
Just like Medicaid, there is an income limit to qualify for extra help. You annual income must limit to $18,090 for an individual or $24,360 for a married couple who are living together. Even if you have a higher annual income, you may still be able to get extra help. For instance, you can still get extra help if your income is higher, or if you or your spouse:
- Support other family members who live with you;
- Live in Alaska or Hawaii
- Have earnings from work
What doesn’t count as income?
Not all cash payments count as income. For examples:
- Supplemental Nutrition Assistance Program (food stamps);
- Housing assistance;
- Home energy assistance;
- Medical treatment and drugs;
- Disaster assistance;
- Earned income tax credit payments;
- Assistance from others to pay your household expenses;
- Victim’s compensation payments; and
- Scholarships and education grants.
For sure, you already understand how to qualify for Medicare savings program. No matter the qualifications, they can help pay some premiums. Just remember to prepare your requirements and determine which program you are most likely to become eligible. Further, you can get extra help to pay for prescription drug coverage. Just approach your local Medicaid office to see if one qualifies. Also, visit Medicare.gov for more details about the different parts of Medicare.
Moreover, call Inzur agents at 1-888-999-0089 for more information on Medicare savings program. As experts, they can help you start your application process.