Updated: May 18
The costs associated with Medicare often change from year to year, but one thing remains the same: many low-income seniors struggle to pay for Medicare expenses. The good news is that if you are a senior struggling to pay for your health care costs because of limited income and resources, there are Medicare Savings Programs that may be able to help you pay for your Medicare premiums and in some cases, your deductibles, coinsurance, and copayments.
As Medicare agents we hate to see kupuna worry about the cost of health care; it’s our job to connect you with all the programs you qualify for and find the plans that best fit your budget and your needs. Please contact us today to discuss your options.
4 Medicare Savings Programs That Could Save You Money
Below are four Medicare savings programs that can help seniors. In Hawaii, eligibility for each program is based on individual or married couple income limits and resources, though you should still apply if your income or resources are slightly higher than the limits. The amounts may change each year so it’s important to check back for the current year’s limits.
Check with your local Medicare agent to confirm your eligibility as income limits are slightly higher in Hawaii.
Qualified Medicare Beneficiary (QMB) Program
The Qualified Medicare Beneficiary (QMB) Program helps eligible kupuna pay for Part A and B premiums, deductibles, coinsurance, and copayments. You also automatically qualify for the Extra Help program that helps pay for Medicare drug coverage.
Medicare providers are not allowed to bill seniors who are on the QMB Program for any services or items that Medicare covers, including coinsurance, copayments or deductibles. The one exception is outpatient prescription drugs, though out-of-pocket expenses are capped. In 2020, pharmacists were allowed to charge no more than $3.90 for prescription drugs covered by Medicare Part D.
What should I do if I receive a bill for Medicare expenses?
If you receive a bill for any Medicare charges other than appropriate prescription drug charges, tell your health care provider (or the debt collector if it gets that far) that you are enrolled in the QMB program. If you’re a member of a Medicare Advantage Plan, contact the plan to ask them to stop the charges. You are entitled to a refund for any payments that you made for services and items covered by Medicare.
Specified Low-Income Medicare Beneficiary (SLMB) Program
The SLMB Program is a program run by each state that helps Medicare recipients pay Part B premiums. This program is for people who have Part A but have limited income and resources to pay for the Part B premiums.
This program only helps pay for Part B premiums but you also automatically qualify for the Extra Help program that helps pay for Medicare drug coverage.
Qualifying Individual (QI) Program
The QI Program is a state program that helps pay Part B premiums for seniors who have Part A and limited income and resources.
What you need to know about the QI program:
Those who qualify for Medicaid are not eligible for QI benefits.
Seniors must apply for QI benefits every year and approval is based on a first-come, first-served basis.
People who were enrolled in the program the prior year are given priority.
The QI Program only helps pay for Part B premiums but you also automatically qualify for the Extra Help program that helps pay for Medicare drug coverage.
Qualified Disabled and Working Individuals (QDWI) Program
The QDWI Program is designed to help pay for the Part A premium. Most seniors do not pay a premium for Part A but it may be as high as $471 in 2021, depending on how long you or your spouse worked and paid Medicare taxes. You may qualify for the QDWI program if any of the following apply to you:
You went back to work and lost your premium-free Part A
You are a disabled person under the age of 65 who works
You meet the income and resource limits laid out by your state
You are not receiving medical help from your state
The QDWI Program only helps pay Part A premiums.
How do I apply for Medicare Savings Programs?
If you have or are eligible for Medicare Part A and you have low income and resources, you may be eligible for a Medicare Savings Program. Call your local Medicare agent or the Hawaii Medicaid Program to see if you qualify and for help filling out your application.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.