Help with Medicare Costs

dollar sign yellowI am meeting today with a couple who are having trouble paying their drug co-pays. It sounds like they qualify for help with their Medicare costs and their drug costs – but they had never heard about programs that help people on Medicare with low income.

There are two separate programs to help with Medicare costs and drug costs: 1) The Medicare Savings Program is administered by the states.  2) Extra Help for Part D is run through Social Security.

The income limits provided below apply to most states, but not all. Hawaii and Connecticut have much higher income limits for getting help.

Eight states do not consider assets when their residents apply for the Medicare Savings Program, which is administered through state Medicaid offices. Those eight states are:  Arizona, Alabama, Connecticut, Delaware, Maine, Mississippi, New York, Vermont.


1. Qualified Medicare Beneficiaries (QMBs)

States must pay all Medicare cost-sharing for Medicare beneficiaries with incomes up to 100% of the federal poverty level (FPL) (+ $20) and resources below $7,280 ($10,930 if married).  A beneficiary must have income below $1,001/month for an individual; $1,348/month for a couple.

2. Specified Low-Income Medicare Beneficiaries (SLMBs)

States must pay the Medicare Part B premium for Medicare beneficiaries with incomes between 100% and 120% FPL (+$20) and resources below $7,280 ($10,930 if married). The income limit for this group is $1,197 /month for an individual; $1,613/month for a couple.

3. Qualified Individual (QI)

States have a limited amount of money from which they must pay, on a first come, first served basis, the Medicare Part B premium for Medicare beneficiaries with incomes between 120% FPL and 135% FPL (+$20) and resources below $7,280 ($10,930 if married).  The income limit for this group is $1,345/month for an individual; $1,813/month for a couple.


Full Subsidy:  People who qualify for the help described above will also qualify for a full subsidy for Medicare Part D.  They do not pay a Part D premium and they pay only $6.60 (or less) for any brand name drug and $2.65 (or less) for generics.

This is a huge savings over “regular” Part D co-pays for brand drugs, which range from $35 to $45 for a one-month supply.   For example, a person taking insulin, with a regular co-pay of $45, would pay only $6.60.  On most Part D plans, “non-preferred brand” drugs have a co-pay of $75 to $95, but that is reduced to $6.60 if a person gets Extra Help.

People who get Extra Help do not have a donut hole/coverage gap in their drug plan.

Partial Subsidy: Medicare Part D provides a partial subsidy of premium, deductible and co-insurance to Medicare beneficiaries with incomes up to 150% FPL and resources below $13,640 ($27, 250 if married). The income limit for this group is $1,471/month for an individual; $1,991/month for a couple.  They will have a reduced Part D premium and 15% co-insurance for their drugs (or the co-pay on their plan if it is less than 15%).

People who think they qualify for the partial subsidy can only apply through  Those who qualify for the Medicare Savings Program and Extra Help can apply through their state Medicaid office (or website) or through

People in Arizona can use an online application at

First you set up a user name and password and then you ask for help with Medicare costs.  It takes about 20 minutes to complete the application.  If your only income is from Social Security, the program will access your Social Security information and tell you if you qualify.  ARIZONA DOES NOT ASK IF YOU HAVE SAVINGS OR OTHER ASSETS.

Confirmation will be received by mail within about one week.  It’s amazingly fast if you apply on line.  Otherwise, it can can 45 days to process a paper application.


3 comments for “Help with Medicare Costs

  1. Denise
    05/04/2015 at 3:49 pm

    The couple I met with will only qualify for a partial subsidy for Part D. If not for the wife having worked in the cafeteria in the local high school and thus having a $300 monthly pension check, they would qualify for the Medical Savings Program as well as Extra Help with their Part D cost.

    The application took only five minutes on the web site and they will get a confirmation letter in about two weeks. I will be interested to see what their “partial subsidy” entails.

  2. 05/14/2015 at 11:19 am

    But doesn’t it also matter on the provider of the medicare supplemental insurance to determine the cost?

  3. Denise
    05/18/2015 at 8:10 am

    Plans Medicare: You seem to be promoting your web site about Medicare supplements, but you don’t seem to understand how Part D works. That’s not a good thing for a broker who sells Medicare supplements. A broker needs to also help the client get a Part D plan – and understanding how Part D works is critical.

    The unfortunate thing is that there are many brokers and agents who do not know about the programs I wrote about above. I’ve run into too many people who have always qualified for help with their drug costs or their Medicare premium, but nobody ever told them about the assistance.

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