What If I Can’t Afford Medicare?
Medicare might be costly, but depending on your circumstances, there are programs that can help.
According to a November 2021 letter from the Centers for Medicare & Medicaid Services, at least 1.2 million Medicare enrollees pay premiums for Medicare Part B despite the fact that they are likely eligible for it for free through a Medicare Savings Program.
Those premiums quickly mount up. Part B alone costs $164.90 per month in 2023, or slightly under $2,000 per year. Other factors to consider include premiums, deductibles, copays, and coinsurance.
Various programs that can pay some or all of those fees are available, but they are not always easy to find. There are free tools available to assist you in navigating the particulars of your circumstance.
Medicare Savings Programs (Part A and Part B)
According to a 2022 data study by KFF, a health policy firm, more than 10 million Medicare beneficiaries received assistance in paying for their coverage through a Medicare Savings Program in 2019.
Medicare Savings Programs, or MSPs, assist in covering Medicare Part A and Part B payments. You are eligible for an MSP based on your income and/or resources. There are four MSPs, each with its own set of eligibility conditions and benefits.
Depending on the program and how you qualify, an MSP may cover some or all of your Medicare Part A and/or Part B premiums, deductibles, copays, or coinsurance.
Income criteria are calculated as a percentage of the federal poverty line, or FPL. Money in bank or retirement accounts, stocks and bonds are counted as resources, but your home, vehicle, or goods are not.
Income and resources are counted differently in different states, and specific requirements vary by state and program.
It is not necessary to know which of the four MSPs you wish to apply for. "Go to the state [Medicaid] agency and say you need help," Ann Kayrish, senior program manager for Medicare at the National Council on Aging, advises. According to Kayrish, there is normally a single application to fill out in order to get placed in the appropriate program.
Low-Income Subsidy or Extra Help (Part D)
The Extra Help program assists almost 14 million Medicare recipients in affording Medicare Part D. It's also known as the Medicare Part D Low-Income Subsidy.
Medicare Part D premiums, deductibles, coinsurance, and copays are covered by Extra Help.
If you are enrolled in any of the following programs, you are immediately eligible for Extra Help:
- Complete Medicaid coverage.
- A Medicare Savings Program that assists in the payment of Medicare Part B premiums.
- Supplemental Security Income, or SSI.
If you do not automatically qualify, you can apply for Extra Help through the Social Security Administration to check if you satisfy the resource and income restrictions. People earning up to 150% of the FPL may be eligible.
The annual income limit for an individual is $21,870, or $29,580 for a pair.
The individual resource limit is $16,660, while the couple limit is $33,240. (Note: The mentioned resource limits include a $1,500 allowance for individuals and $3,000 for couples who intend to spend some of their resources for funeral expenditures.)
Medicaid
Medicaid is a federal program that covers health-care expenditures for low-income individuals, children, pregnant women, and persons with disabilities.
It is possible to have both Medicare and Medicaid at the same time. According to CMS, more than 12 million people are eligible for both Medicare and Medicaid.
Medicaid may cover some of your health care and certain Medicare costs, such as premiums, copays, coinsurance, and deductibles, depending on your state and eligibility. If you qualify for full Medicaid coverage, you are also immediately eligible for Extra Help with Medicare Part D coverage.
Enter your information at healthcare.gov/lower-costs to check if you qualify based on your state's criteria and begin the application process for coverage.
Get personalized help
"It does matter where you live, very much," Kayrish adds of enrollment restrictions and standards. She suggests the following free resources to assist you navigate the details of your location:
- Medicaid administration. The Medicaid agency in your state is a good place to start. Because it manages both programs, it may assist you in applying for both Medicaid and MSPs. Furthermore, if you qualify for Medicaid or most MSPs, you are immediately eligible for Extra Help.
- State Health Insurance Assistance Programs. Each state has a State Health Insurance Assistance Program, or SHIP, which provides free, unbiased Medicare counseling. To locate yours, go to shiphelp.org.
- BenefitsCheckUp. The National Council on Aging keeps an online directory of benefit programs for seniors and people with disabilities. It is not limited to Medicare; there are programs for food, electricity, housing, and taxes as well. To find out what's available in your area, go to benefitscheckup.org and enter your ZIP code.