Medicare Low Income Assistance
Programs and Plans for Assisting Seniors with Medicare Coverage and Expenses
Medicare Savings Program
Through each state's Medicaid program, there is a Medicare Savings Program for helping individuals pay their Medicare Part A and Part B premiums, deductibles, copays and coinsurance.
There are 4 levels of eligibility depending on individual monthly income and resource levels as determined each year by Medicare. More information is available on Medicare.gov.
Level 1: Qualified Medicare Beneficiary (QMB)
- Two categories of eligibility
- QMB Only – Individual receives assistance for paying Medicare Part A and Part B premiums, deductibles, copays and coinsurance.
- QMB Plus – Full Medicaid benefits in addition to assistance of the QMB only category.
Level 2: Specified Low-Income Medicare Beneficiary (SLMB)
- Individual receives assistance paying the Part B premium.
Level 3: Qualifying Individual (QI)
- Individual receives assistance paying the Part B premium.
Level 4: Qualified Disabled Working Individual (QDWI)
- Individual receives assistance paying the Part A premium.
Check Eligibility for the Medicare Savings Program in Your State
Click here to find more information about the resource limits for Medicaid in your state and directions to apply to see if you qualify for the Medicare Savings Program.
Medicare Advantage Dual Eligible Special Needs Plan (D-SNP)
Someone who is Medicare eligible and also eligible for full Medicaid benefits in their resident state is considered a full-benefit dual eligible (FBDE) and may enroll in this special type of Medicare Advantage plan. Part D drug coverage is included with the plan.
In addition to very limited cost sharing for services, these plans have additonal value-added services and offerings not found in standard Medicare Advantage plans.
Additional information can be found in our blog post, Medicare and Medicaid: Dual Eligibility.
Help Enrolling in a D-SNP Plan
If you qualify for Medicaid and Medicare, we are here to help you choose and enroll in a plan that will meet your needs and then provide you with ongoing support throughout the year.
Coordinating Care between Medicare and Medicaid
It's important for current enrollees to find providers who accept Medicare and Medicaid so the they can maximize their benefits.
- Medicare providers who accept DSNP plan participants as patients may only receive the lesser of the patient cost share through Medicaid or through the Medicare Advantage plan.
- Medicaid may provide coverage for additional items and services not provided by Medicare. So, Medicaid will only pay for those items and services if they are furnished by Medicaid participating providers.
Other Types of Medicare Advantage Special Needs Plans
There are a number of other special Medicare Advantage plans determined by someone's special situations. They may not be available in all service areas.
- Chronic Condition SNP (C-SNP): Limited to eligible individuals with chronic or disabling chronic conditions, such as diabetes, heart failure, cancer, lung conditions, HIV, or certain other conditions.
- Institutional SNPs (I-SNP): Limited to eligible individuals expected to need the level of services provided for 90 days or longer in a long-term care (LTC) skilled nursing facility, a LTC nursing facility (NF), an intermediate care facility for the individuals with intellectual and developmental disabilities, a long-term care hospital, an inpatient psychiatric facility, or certain other facilities specified by CMS.
- Institutional Equivalent (IE-SNP) : Limited to eligible individuals who live in the community but require an institutional level of care. Eligibility for an IE-SNP may be limited to certain Assisted Living Facilities.
Part D Prescription Drug Assistance Programs
There are a number of programs available to help qualifying individuals with their drug costs. Some of them include the following.
- Low Income Subsidy (LIS): Receive assistance with your Part D plan premium and cost sharing for prescription drugs. Eligibility based on income and resource limits. Also referred to as Extra Help (EH). Apply through your state Medicaid office.
- Pharmaceutical Assistance Program: Such programs are operated by some drug manufacturers to assist low-income individuals in obtaining drugs at reduced or no costs. Some programs are "qualified" which means the cost of drugs is applied to the "True Out-of-Pocket" (TrOOP) annual calculation within Part D drug coverage.
Contact Your State Medicaid Office for Assistance
Please don't ignore these opportunities! Check on these opportunities for assistance through your state Medicaid plan. Its important to apply and learn more about all programs for which you may be eligible.
By contacting the phone number on this website you will be directed to a licensed agent.