• Medicare cost-cutting opportunities can include Medicare Savings Program.
  • Each month, your income must be below certain thresholds.
  • Resources and limits must also be below the limit.
  • The Extra Help program may also help you pay for prescription drugs if you qualify for one or more of the Medicare cost-cutting programs.

Medicare Savings Program

Five federally supported programs are designed to help older adults with income and resources that have fallen below specific thresholds. These programs were created because not everyone can handle the expenses of Medicare, such as; copays, coinsurance, deductibles, and prescription costs.

In 2034, there will be 77 million Americans aged 65 and up, and there are differences in retirement income between racial and ethnic groups in the US.

According to a study in 2016 by the Federal Reserve, only 34% of Black families and 30% of Hispanic or Latino families had retirement funds compared to the 60% of white families. Whites have a net worth of $933,000 at retirement age in contrast to Blacks with $138,000 and Hispanics with $191,000.

For lower-income people, Medicare offers many savings options. These health programs will get easier to use as you get older, especially when you live in a state where Medicaid oversees them.

How do I know I qualify for the Medicare savings program?

Medicaid in each state administers these four Medicare cost-cutting measures:

  • The Qualified Medicare Beneficiary program (QMBs)
  • The SLMB program (Specified Low-Income Medicare Beneficiary)
  • Qualifying Individual(QI)
  • Qualified disabled and working individuals (QDWI) program

Other facts about Medicare Savings Program

  • Healthcare providers won’t bill you: You will not be billed for services provided to you in the QMB program; Medicaid will pay the medical providers. Ensure that the doctor is aware you are in the QMB program, so they don’t bill you incorrectly, and also make sure to Inform Medicare of the charge.
  • You must be qualified: QDWI has disabled, working, and under 65 eligibility requirements. To be eligible for the QDWI program, you must be in Medicare Part A’s free coverage gap and not be receiving assistance from your state.
  • Re-enroll each year: Medicaid disqualifies you from receiving QI benefits. So, to stay in the QI program, you must reapply each year.
  • Benefits could be delayed before they begin: You must first be accepted by Medicaid before you can start receiving premium assistance. The money that Medicaid paid will be reimbursed to you.

 

How to Apply for Medicare Savings Program

If you are eligible for Medicare, and your income and resources meet or exceed the financial eligibility requirements for a Medicare savings program, see if you can locate your state’s Medicaid office.

A status update would be available to you within 45 days, and you reserve the right to appeal if Medicaid denies your application.

The application process is as follows:

  • Learn about the types of questions you might be asked when you apply. It is available in multiple languages.
  • Once you have gathered all the necessary supporting documents, you should begin the application process.
  • To apply for the program, contact your state’s Medicaid office. You can check your state’s offices or call Medicare at 1-800-Medicare.
  • You would be notified in 45 days if you’ve been accepted or not. The right to appeal is available if you are turned down the first time. Year-to-year enrollment in one of these programs is necessary.
  • Please feel free to contact your State’s Health Insurance Assistance Program (SHIP).

Prescription drug coverage

It is an effective treatment, so use it with the care that you would with any other prescription medication.

Qualifying for the QMB, SLMB, or QI programs enrolls you in the Extra Help program. This tool will help you pay your Medicare Part D prescription drug plan’s premiums, deductibles, and co-payments. Nevertheless, you pay the lower of your Part D prescription cost or your Extra Help copay even if you have Extra Help.

Additional assistance may be available. Extra Help participants pay reduced premiums, deductibles, and copays. They only pay 15% of the prescription cost until they have spent their yearly out-of-pocket limit. Insurance companies also provide Medicare part D programs. Each insurer will have an application for you to fill out.

Here is a description of various types of documentation:

  • A Medicare notice that you are eligible (purple)
  • Extra help notice of SS extra help award
  • Medicare’s green/yellow notice
  • A letter from Medicare about a change in your copay (orange)
  • Proof that you’re enrolled in Medicaid

Savings to cut Medicare costs

Medigap insurance (Medicare supplement)

Private insurance policies help you cover the costs of Medicare, such as copays, coinsurance, and deductibles. You have ten plans to choose from, all of which provide nationwide coverage.

Medicaid

This program is federally and state coordinated. It provides the same benefits as Medicare and additionally includes nursing homes and personal care.

PACE

In order to avoid living in a hospital, you can stay at home. If you join the PACE program, you will be able to receive medical treatment in the comfort of your own home or community.

These benefits may include the following:

  • Daycare for adults
  • Dentistry
  • At-home personal care
  • Patient care
  • Laboratory tasks
  • Rehabilitation
  • Psychological counselling
  • Meals
  • High-level medical care

PACE centres aren’t always open. See if your state has a PACE centre near you.

The Takeaway

  • Medicare savings programs help low-income people pay Part A and Part B premiums, deductibles, copays, and coinsurance.
  • Although the federal government funds these services but state Medicaid programs provide them. To apply, contact your state’s Medicaid office or apply online.
  • You can use Medicaid, PACE, or a Medigap plan to help you save money on Medicare.
  • You will have to gather the necessary papers and complete the appropriate applications, but these healthcare savings programs may allow you to afford healthcare.

 

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