Medicare is a valuable resource for seniors to receive quality healthcare, but for those with low income, it can be challenging to afford. Thankfully, Medicare offers several savings programs to help those with limited resources afford their healthcare expenses. In this blog, we will discuss how programs like the Medicare Savings Program and Low Income Subsidy can help eligible Medicare beneficiaries and how making informed decisions about your Medicare coverage can help with healthcare costs.
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, and depending on the state, it generally includes various levels of assistance.
What are the coverage levels?
Qualified Medicare Beneficiary Program (QMB)/Full Dual Eligible:
For full MSP assistance, a beneficiary must meet certain requirements including receiving full Medicaid benefits, and income below the federal poverty level (FPL). 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.
Other 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.
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.
Low Income Subsidy:
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. LIS may cover a portion of the monthly premium, as well as annual deductibles, and copays associated with Medicare Part D plans.
The amount of assistance provided by LIS varies depending on the individual’s income and assets, and is awarded as either Full LIS or Partial LIS. The level of assistance is determined by the Extra Help income test which is based on the Federal Poverty Levels (FPLs). In our Extra Help blog you can learn more about LIS coverage levels and how to apply.
Take advantage of discount programs:
For beneficiaries that might not qualify for LIS, there are other ways to potentially reduce the costs of prescription drugs.
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.
Choosing the right plan:
Medicare beneficiaries have many plan options, including Original Medicare, Medicare Advantage, prescription drug, 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. 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.
Consider where you receive healthcare services:
When scheduling appointments with healthcare providers keep in mind that some providers do not accept Medicare, which can result in higher out-of-pocket costs. If you join a Medicare Advantage plan, you may have to stay within your plan’s network – a group of healthcare providers that have contracted with a Medicare Advantage plan to provide services to its beneficiaries. Choosing an in-network healthcare provider can help you receive the most cost-effective care.
–Out-of-network services
Additionally, some Medicare Advantage plans such as a PPO cover out of network services, while some may not cover out-of-network services at all, except in emergency situations. It’s important to review a Medicare Advantage plan’s network before enrolling to ensure that your preferred healthcare providers are included in the network. This can be a daunting task, let our agents help! Contact us here for help reviewing plan networks.
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, while utilizing discount programs, choosing the right plan, and considering network restrictions can also lead to savings.
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!
