Medicare is a valuable resource for seniors to receive quality healthcare, but for those with low income or high prescription and health costs, it can be a financial burden. Thankfully, Medicare offers several programs to help beneficiaries afford their healthcare expenses. In this blog, we will discuss how programs like the Medicare Savings Program, Low Income Subsidy, and the new Medicare Prescription Payment Plan (M3P) can help eligible Medicare beneficiaries manage costs. We will also cover how making informed decisions about your Medicare coverage can help everyone manage costs.
What is the Medicare Savings Program?
The Medicare Savings Program (MSP) helps low-income Medicare beneficiaries pay for their Medicare Part A and Part B premiums. Depending on eligibility, they may also pay other out-of-pocket Medicare expenses. The MSP is available to those who meet certain income and asset limits.
What are the MSP coverage levels?
Qualified Medicare Beneficiary Program (QMB)/Full Dual Eligible: This MSP coverage level is referred to as QMB, or Qualified Medicare Beneficiary program. It helps qualifying beneficiaries pay for Medicare Part A and Part B premiums, deductibles, coinsurance, copayments, and the Part B penalty. For full MSP assistance, a beneficiary must meet certain requirements including receiving full Medicaid benefits, and income below the federal poverty level (FPL).
Other MSP coverage levels:
For Medicare beneficiaries that don’t meet QMB requirements, there are other coverage levels of the Medicare savings program that they may qualify for. Depending on the coverage level, eligible beneficiaries may receive help paying for their Medicare Part A and/or B premiums, and Part B penalty if they have one.
For more information on the Medicare Savings Program including qualifying income levels, how to apply, enrollment options/periods for MSP, and what happens to those already on Medicaid that then gain Medicare eligibility, check out our Medicare Savings Program blog.
What is the Low Income Subsidy program?
Low Income Subsidy (LIS), also known as Extra Help, is a program designed to help low-income Medicare beneficiaries pay for out-of-pocket costs associated with Part D prescription drug coverage. Extra Help may cover the monthly premium, the annual deductibles, and copays associated with Medicare Part D plans.
The new prescription drug law, the Inflation Reduction Act, expanded the Extra Help
program. The income threshold for Extra Help benefits is now 150 percent of the federal poverty level (FPL). This is up from 135% of the FPL in 2023. This means more people will qualify for Extra Help. Also, everyone who is eligible for partial extra help will now automatically get full Extra Help. Read our Extra Help blog to learn more about LIS coverage levels and how to apply.
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What is the Medicare Prescription Payment Plan (M3P)?
The Medicare Prescription Payment Plan (M3P) is a new payment option that works with your current Part D coverage to help you manage your out-of-pocket costs for covered drugs. This is ideal for people with high deductibles and higher drug costs early in the year before they reach the $2,000 maximum out of pocket. They can smooth out their copay costs over the year to make them more manageable on a monthly basis. Starting January 1, 2025, all Part D plans must offer beneficiaries the option to enroll in the M3P program.
What prescription discount programs are available?
For beneficiaries that might not qualify for Extra Help or who have prescriptions that are not covered by their plans formularies, there are prescription discount options available.
GoodRx
The cost of prescription drugs can vary depending on the pharmacy, online services such as GoodRx can help consumers compare the price of prescription medications at different local pharmacies. You can then use GoodRx coupons to pay less than the cash price for those prescription medications.
Check manufacturer websites:
Many pharmaceutical companies offer coupons for their medications. Check the manufacturer’s website or ask your doctor if there are any coupons available for the medication you need.
How to save by choosing the right plan?
Medicare beneficiaries have many plan options, including Original Medicare, Medicare Advantage, stand alone prescription drug plans, and Medicare Supplement Insurance. Each plan has its own benefits and costs, so it’s essential to choose the one that best fits your healthcare needs and budget. When your costs are high on a plan, it is worth comparing other plans in our area to see which plans may save you money and cover what you need. Our friendly, licensed agents can help you review your options and compare the costs of each plan before making a decision. You can contact us here.
In conclusion, there are several programs and strategies available to help Medicare beneficiaries save on healthcare costs. The Medicare Savings Program and Low Income Subsidy provide financial assistance to those who meet certain income and asset requirements. But if you don’t qualify for subsidies, the other options mentioned here are available to everyone to help manage costs.
We offer unbiased assistance for no fee, our goal is to help you make informed Medicare decisions that work for your budget and healthcare needs. Get to know our agents here!
