Need Help Paying for Your Medicare Premiums?

Having difficulty paying for your Medicare premiums? You’re far from the only one. Many Medicare recipients find themselves having trouble shouldering the cost. Fortunately, there are resources that can help you. Read on to learn more.

What are the Current Medicare Premiums?

For 2022, the Medicare premiums are as followsⁱ:

• Part A: $0 for most people, but can run up to $499 monthly if you don’t get Part A premium-free
• Part B: $170.10 is the standard Part B monthly premium amount for most people (higher income consumers may pay more)
• Part D: The national base premium of $33.37 per month plus an adjusted monthly amount dependent on your yearly income

What if I Can’t Pay My Premium?

Resources exist to help you afford your Medicare costs provided you fall within income limits, including Medicare Savings Programs, Medicaid, PACE, Extra Help and SSI. Let’s break these down.

Medicare Savings Programs (MSPs)

Medicare Savings Programs, or MSPs, are Medicaid-administered and state-run programs for people who are on Medicare and have limited income. Depending on which program you qualify for, they can help pay Medicare premiums, deductibles, coinsurance, copayments and prescription drug costs.

NOTE: If you qualify for any of the below programs, you’re automatically qualified to get financial help to pay for your Medicare drug coverage.

There are four types of MSPs, each with their own income limits:ⁱⁱ

• Qualified Medicare Beneficiary
  • Helps pay Part A and Part B premiums and other costs such as deductibles, coinsurance and copays
  • Individual monthly income limit: $1,153
  • Married couple monthly income limit: $1,546
• Specified Low-Income Medicare Beneficiary
  • Pays Part B premiums only
  • Individual monthly income limit: $1,379
  • Married couple monthly income limit: $1,851
• Qualifying Individual
  • Pays Part B premiums only
  • Individual monthly income limit: $1,549
  • Married couple income limit: $2,080
• Qualified Disabled and Working Individuals
  • Pays Part B premiums only
  • Individual monthly income limit: $4,615
  • Married couple income limit: $6,189ⁱⁱⁱ

Qualification is also contingent on the demonstration of limited resources.  In 2022, resource limits for the first three programs above (Qualified Medical Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual) programs are $7,970 for one person and $11,960 for a married couple.

Limits for the Qualified Disabled and Working Individuals program are $4,000 for one person or $6,000 for a married couple.

Countable resources include:

• Money in a checking or savings account
• Stocks and bonds

When you tally your resources, don’t count:

• Your home
• One car
• Burial plot
• Up to $1,500 in burial costs (if that money has been put aside)
• Furniture or other household and personal items.^iv

Reminder! You must re-apply for MSPs each year. You should get a renewal notice in the mail from your state Medicaid office with instructions.

Medicaid

This joint federal and state program offers help with medical costs for those with limited income and resources. It also offers benefits that Medicare typically does not, such as personal care services and nursing home care.

In some states, you can spend down to become eligible if you have too much income to qualify. This means subtracting your medical expenses from your income, resulting in being considered eligible due to medical neediness. Each state has its own eligibility rules, so call your local Medicaid office for more information.

Have both Medicare and Medicaid? You may be dual-eligible.

Some people choose to get a D-SNP, Dual-Eligible Special Needs Plan tailored exclusively for those who qualify for both Medicare and Medicaid. These are part of a larger category of Special Needs Plans (SNPs) which limit membership to those with specific diseases or characteristics.

One of the most notable benefits of an SNP is care coordinators, who help you stay on track with your care. For those with a D-SNP, their care coordinator can help find local doctors and specialists in-network that accept both Medicare and Medicaid.

Program of All-Inclusive Care for the Elderly (PACE)

PACE covers all your Medicare and Medicaid services as well as other care that your providers deem necessary, including prescription drugs, doctor and provider visits, home care, hospital visits, transportation and nursing home stays. When enrolled in PACE, you may need to use one of their preferred doctors.

Medicaid recipients don’t pay a premium for the PACE long-term care benefit. However, if you have Medicare but not Medicaid, you will need to pay a monthly fee plus a premium for Medicare drug coverage, also known as Part D. That said, PACE never charges a deductible or copayment for approved medications, care, or services.

To qualify, you must:

• Have Medicare, Medicaid or both
• Be 55 or older
• Live in the service area of a PACE organization
• Need a nursing home-level of care
• Be able to safely live in the community with assistance from PACE

PACE services include:

• Adult day primary care
• Dentistry
• Emergency services
• Home care
• Hospital care
• Lab tests/X-ray services
• Meals
• Medical specialty services
• Nursing home care
• Nutritional counseling
• Occupational therapy
• Physical therapy
• Prescription drugs
• Preventive care
• Social services
• Social work counseling
• Transportation to the PACE center if medically necessary

Learn more by searching for PACE plans in your region or by calling your local Medicaid office.

Extra Help

Extra Help helps pay for Medicare drug coverage, including premiums, deductibles, copays and coinsurance. In 2022, drug costs are $3.95 for each generic and $9.85 for each brand name.^v You may qualify if you have yearly income up to $20,385 ($27,465 for a married couple) and up to $15,510 in resources ($30,950 for a married couple). These types of resources include:

• Money in a checking or savings account
• Stocks
• Bonds

They do not include:

• A home
• One car
• Burial plot
• Up to $1,500 for burial expenses if you have put that money aside
• Furniture
• Other household and personal items

You are automatically qualified for Extra Help if you have Medicare and:

• Full Medicaid coverage
• Help from your state Medicaid program (Medicare Savings Program) with paying your Part B premiums
• Supplemental Security Income benefits

Supplemental Security Income

Supplemental Security Income, also known as SSI, gives monthly payments to adults and children who have a disability or blindness and income and resources below specific financial limits. Additionally, those 65 and older without disabilities are also eligible provided they meet the financial criteria. Even if you are already getting Social Security Disability Insurance or retirement benefits, you may find that you are eligible for SSI monthly payments as well.

These payments are designed to meet basic needs: food, clothing and shelter. The amount you receive varies with your living situation and countable income as well as your state of residence. Additionally, you may get less if you have other income including pensions, Social Security benefits or wages, if you live with a spouse and they have income or if someone else pays your household expenses.

If your resources are worth $2,000 or less ($3,000 or less if you are a married couple), you may be able to get SSI. You are eligible if you are:

• At least age 65 or blind and disabled
• Are on limited income
• Have limited resources
• Are a U.S. citizen, U.S. national or in some cases a non-citizen
• A resident of one of the 50 U.S. states, the District of Columbia or the Northern Mariana Islands, with some exceptions

The Bottom Line

If you’re having trouble paying your Medicare premiums, there are resources. Specifically, there are four main programs that offer government help. These programs differ in level of help provided, and each has its own income and resource limits. You may qualify for more than one of these programs.

Wondering if you may qualify for help paying your Medicare premiums? Call a licensed Ensurem agent at the number on this page. Help is available.