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Because the cost of healthcare continues to rise, especially for seniors, it is important for them to have access to Medicare financial assistance.  There are several ways for Medicare beneficiaries to access financial assistance to help alleviate the burden of medical expenses.  We will go over a few ways beneficiaries can get financial assistance with their medical expenses.

Medicare Basics

Before we go over financial assistance programs, it’s important to understand the different parts of Medicare.

1. Part A (Hospital Insurance) – Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

2. Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and some home health care.

3. Part C (Medicare Advantage): A private insurance plan that includes coverage from both Part A and Part B.

4. Part D (Prescription Drug Coverage): Offers prescription drug coverage through private insurance plan.

Medicare Savings Programs

Qualified Medicare Beneficiary (QMB) Program: This program helps pay for Part A and Part B premiums, deductibles, copayments, and coinsurance for individuals with limited income and resources.

Specified Low-Income Medicare Beneficiary (SLMB) Program: Offers assistance with Part B premiums for those with slightly higher income levels than QMB.

Qualified Individual (QI) Program: Provides help with Part B premiums on a first-come, first-served basis for those who meet income requirements.

Qualified Disabled and Working Individuals (QDWI) Program: Assists certain disabled individuals who lost premium-free Part A due to returning to work.

Find out about MSPs (Medicare savings programs)

Extra Help with Prescription Drug Costs

The Extra Help program assists with Part D prescription drug plan costs, including premiums, deductibles, and copayments. Eligibility is based on income and resources.

State Pharmaceutical Assistance Programs (SPAPs)

Some states offer additional assistance for prescription drug costs beyond what Medicare provides. These state-sponsored programs vary, so beneficiaries should check with their state’s health department for details.

Find out what’s available in your state.

Click here to learn about the Medicare prescription payment plan.

Medicare Advantage Plans additional benefits

Some Medicare Advantage plans offer additional financial assistance beyond original Medicare.  Medicare beneficiaries who have limited income and assets qualify to enroll in DSNP MAPD plans. These may include reduced copayments, coverage for vision and dental care, and other benefits for groceries rides to medical appointments and much more.

Medicare and Medicaid – Dual eligible benefits

For individuals eligible for both Medicare and Medicaid (dual eligible), both programs work together to provide comprehensive coverage. Medicaid can help cover costs that Medicare doesn’t, such as long-term care, and assistance with co-pays, coinsurance and more.

Click here to learn more about Medicare and Medicaid

Appealing Decisions and Seeking Help:

Beneficiaries have the right to appeal if they disagree with a Medicare decision. Additionally, various organizations and resources, such as the State Health Insurance Assistance Program (SHIP), can provide guidance and assistance in navigating the complexities of Medicare.

Medicare financial assistance programs play a crucial role in providing seniors access to the healthcare they need without facing overwhelming financial burdens. It is essential for beneficiaries to be aware of the programs available, understand eligibility criteria, and seek assistance when they need it. By taking advantage of these resources, individuals can navigate the Medicare maze and enjoy the peace of mind that comes with comprehensive healthcare coverage.