If you're finding it hard to afford your Medicare costs, you're not alone. Many older adults face challenges when it comes to managing healthcare expenses. The good news is that there are programs designed to help ease the financial burden. With a little guidance, you can access resources to make Medicare more affordable.

Medicare Savings Programs (MSPs)

One of the best options available is the Medicare Savings Programs (MSPs). These state-run programs help people with limited income and resources pay for Medicare premiums, deductibles, coinsurance, and copayments. There are four different types of MSPs:

  • Qualified Medicare Beneficiary (QMB) Program: This program helps pay for Part A and Part B premiums, deductibles, coinsurance, and copayments.
  • Specified Low-Income Medicare Beneficiary (SLMB) Program: It helps cover Part B premiums.
  • Qualifying Individual (QI) Program: Like SLMB, this program also helps with Part B premiums, but it's available on a first-come, first-served basis.
  • Qualified Disabled and Working Individuals (QDWI) Program: This program is specifically for disabled individuals under 65 who are still working and need help with their Part A premiums.

Eligibility for these programs depends on your income and resources. For example, as of 2024, a single person's income limit for the QMB program is $1,275 per month, while a married couple's limit is $1,724. These amounts can vary by state, so it's essential to check the guidelines where you live.

Extra Help with Prescription Drug Costs

If you are struggling to afford prescription medications, the Extra Help program could be a game-changer. This federal program helps cover costs associated with Medicare Part D (prescription drug coverage). It can significantly reduce your out-of-pocket costs for prescriptions, including premiums, deductibles, and copayments.

Eligibility is based on your income and resources. In 2024, your annual income must be below $22,590 for an individual or $30,660 for a married couple to qualify. If you qualify, you could pay as little as $0 for your Medicare drug plan premium and deductible, and up to $4.50 for each generic drug and $11.20 for each brand-name drug.

State Pharmaceutical Assistance Programs (SPAPs)

In addition to Extra Help, many states offer State Pharmaceutical Assistance Programs (SPAPs), which provide further assistance with prescription drug costs. These programs vary widely, with each state having its own eligibility requirements and coverage options. You can find out if your state has an SPAP and what assistance it offers by visiting Medicare.gov or contacting your state's health department.

Medicaid

If your income is especially limited, you might qualify for Medicaid, a state and federal program that provides health coverage for low-income individuals. If you're eligible for both Medicare and Medicaid, you are considered "dual-eligible" and can receive additional benefits such as help with Medicare out-of-pocket costs. Medicaid benefits vary by state, but if you qualify, it can significantly reduce your healthcare expenses. Contact your state's Medicaid office to learn more and apply.

Programs for Veterans

For veterans who qualify for both Medicare and VA health benefits, there are ways to minimize out-of-pocket healthcare costs. VA health care can often cover services that Medicare doesn't, and you may be able to coordinate benefits to get comprehensive coverage with little or no cost. If you're a veteran, contact the VA to see how your benefits can work with Medicare.

How to Apply for Assistance

Navigating these programs can feel overwhelming, but there are plenty of resources to help you get started. The first step is checking your eligibility. You can do this by visiting Medicare.gov, or by contacting your local Medicaid office, Social Security office, or Area Agency on Aging. Each of these organizations can help you determine which programs you're eligible for and how to apply.

Don't wait to seek help if you're struggling to afford your Medicare costs. With resources like Medicare Savings Programs, Extra Help, SPAPs, Medicaid, and veterans' benefits, there are multiple ways to reduce your healthcare expenses. Take the time to explore these options and reach out for help—you might be surprised by how much support is available.

Take the next step in mastering your Medicare knowledge by joining a Medicare class on GetSetUp. You’ll gain confidence in making decisions about your health coverage and learn from experts who understand the unique needs of older adults.

Reviewed By: Keith Gilbert