Medicare Savings Programs are a form of financial assistance provided by the government to help low-income individuals and families pay for their Medicare costs. These programs are designed to help cover expenses such as premiums, copayments, and deductibles for Medicare Part A and Part B. There are different levels of assistance available depending on income level and asset limits, and eligibility criteria vary by state. If you’re seeking help understanding your options, our team can also assist with exploring health insurance plans in Houston TX that fit your needs and budget. Here, we’ll outline eligibility requirements, how to apply, and more about the different programs available.
The 4 Medicare Savings Programs & What You Need to Know
You’ll have to apply through your state, which you can do so over the phone or online. During the application process, it’ll automatically be determined which program you qualify for.
- Qualified Medicare Beneficiary Program
This program covers the costs of Medicare Part A and Part B premiums, copayments, deductibles, coinsurance, and prescription costs. Drugstores cannot charge individuals more than $11.20 for a prescription covered under Part D as of 2024. In most states (except Alaska and Hawaii), an individual must not make more than $1,275 per month and married couples must not make more than $1,724 per month to be eligible. Your resources will also be taken into account to be eligible, for example, bonds, stocks, savings accounts, etc. An individual’s resource limit is $9,430 and a married couple’s resource limit is $14,130.
- Specified Low-Income Medicare Beneficiary Program
You must have both Part A and Part B to qualify, however, only Part B premiums will be paid for as well as help with prescription drugs. As of 2024, an individual must not make more than $1,526 per month and a married couple must not make more than $2,064 per month to be eligible. An individual’s resource limit must not exceed $9,430 and a married couple’s resource limit must not exceed $14,130. You will also pay no more than $11.20 for prescription drugs.
- Qualified Individual Program
Just as in the program above, you must have both Part A and Part B to qualify, however, only Part B premiums will be paid for as well as help with prescription drugs – you will not have to pay more than $11.20 for each prescription that your plan covers. In most states (except Alaska and Hawaii), an individual’s monthly income must not exceed $1,715 and a married couple’s income must not exceed $2,320. An individual’s resource limit must not exceed $9,430 and a married couple’s resource limit must not exceed $14,130. You must apply each year to remain in this program, which also comes on a first-come, first-serve basis. You’ll be given priority if you were part of the program the previous year.
- Qualified Disabled & Working Individual Program
This program helps pay for Part A premiums. You are eligible if:
- You are a working, disabled person under 65
- You are not getting medical assistance
- You lost your premium-free Part A when you returned to work
- You do not make more than $5,105 per month or $6,899 as a married couple
- Your resource limit does not exceed $4,000 or $6,000 as a married couple
Again, those limits will be different in Alaska and Hawaii.
If you’re exploring coverage options for multiple individuals or employees, consider reaching out to an employer insurance broker or a group insurance broker in Houston to help guide your selection and ensure you’re making the most cost-effective choices.
What is Medicare Extra Help?
The Extra Help program aims to help individuals with lower incomes cut their Part D costs for drug coverage. It will help with the cost of deductibles, premiums and copays which you can apply for any time after you apply for Part D. However, some people may automatically be eligible. You’ll get Extra Help (and receive a letter in the mail) automatically if:
- You get Full Medicaid coverage
- You get help from your state paying for your Part B premiums, like from a savings program mentioned above
- You get Supplemental Security Income payments from Social Security
If you haven’t automatically been enrolled, you can apply through your state online or over the phone. To be eligible in most states, your yearly income must not exceed $22,590 as an individual or $30,660 as a married couple. Your individual resources must not exceed $ 17,200 and your resources as a married couple must not exceed $34,360.
Your Best Bet is to Seek Help From an Experienced Medicare Agent
We get it – the whole Medicare process can be extremely confusing! This is why it’s important to seek help from a Medicare plan advisor who can help you determine which plan best suits your specific needs and budget, saving you time and frustration in trying to navigate the system on your own. An agent can help you compare different plans, explain the benefits and costs associated with each, and ensure that you are enrolled in the right plan for your situation. An agent can also educate you on the different Medicare Savings Programs and how they can benefit you. Medicare agents work hard to provide you with the peace of mind and confidence that you are making the best decision for your healthcare needs.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
