You may be eligible to save money on medical and drug costs! Read about the following programs to find out how:
Medicaid is a joint federal and state program that helps pay medical costs for some people with limited income and resources and meet other eligibility requirements. Medicaid also offers benefits not normally covered by Medicare, like help with personal care and rides to doctor appointments. If you qualify for Medicaid in your state, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.
How to Apply for Medicaid
Each state has different rules about eligibility and applying for Medicaid. You can call your state Medicaid program to see if you qualify and learn how to apply. Get the contact information for your state’s Medicaid program.
Medicare Savings Programs
You can get help from your state paying your Medicare premiums and, in some cases, may also pay Part A and Part B deductibles, coinsurance, and copayments if you meet certain conditions. There are four types Medicare Savings Programs:
Qualified Medicare Beneficiary (QMB) Program
You must be eligible for Part A to qualify. Enrollment in Part A isn't required.
Specified Low-Income Medicare Beneficiary (SLMB) Program
You must be eligible for Part A to qualify. Enrollment in Part A isn’t required.
If you have income from working, you may qualify for SLMB benefits even if your income is higher than the limits in the chart below.
Qualified Individual (QI) Program
You must be eligible for Part A to qualify, and you must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. QI benefits aren't available to people who qualify for Medicaid.
Qualified Disabled and Working Individuals (QDWI) Program
The QDWI program helps pay the Part A premium. You may qualify if you:
- Are a working disabled person under 65,
- Lost your premium-free Medicare Part A when you went back to work,
- Aren't getting medical assistance from your state, or
- Meet the income and resource limits required by your state.
Income and resource limits for Medicare Savings Programs are listed below. If you qualify for a Medicare Savings Program in your state, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage. To find out more about Extra Help, see Extra Help/Low-Income Subsidy.
**NOTE: The income and resource limits below may change in 2011.
|Qualified Medicare Beneficiary (QMB)
- Part A premiums
- Part B premiums
- Deductibles, coinsurance, and copayments
|Specified Low-Income Medicare Beneficiary (SLMB)
||Part B premiums only
|Qualified Individual (QI)
||Part B premiums only
|Qualified Disabled and Working Individuals (QDWI)
||Part A premiums only
|*Limits are slightly higher in Alaska and Hawaii
|Medicare Savings Program 2010
|Resource limits for all Medicare Savings Programs are
$6,600 for a single person and $9,910 for a married couple.
How to Apply for Medicare Savings Programs
Call your State Medicaid Program to see if you
qualify for a Medicare Savings Program in your state
If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage. Drug costs in 2011 for most people who quality will be no more than $2.50 for each generic/$6.30 for each brand-name for covered drugs. Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level.
You may qualify if you have up to $16,245 in annual income ($21,855 for a married couple) and up to $12,510 in resources ($25,010 for a married couple).
**NOTE: These amounts may change in 2011.
How to Apply for Extra Help
You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:
- Have full Medicaid coverage,
- Get help from your state Medicaid program paying your Part B premiums (in a Medicare Savings Program), or
- Get Supplemental Security Income (SSI) benefits.
Otherwise, you can apply online at Social Security or call Social Security at 1-800-772-1213 to apply by phone or get a paper application. TTY users should call 1-800-325-0778.
State Pharmaceutical Assistance Programs (SPAPs)
Some states have State Pharmaceutical Assistance Programs (SPAPs) that help people pay for prescription drug based on financial need, age, or medical condition.
How to Apply for SPAPs
Each SPAP has different rules about eligibility, how to apply, and how it works with Medicare prescription drug coverage. For more information, call the SPAP in your state. Go to the State Pharmaceutical Assistance Program page to find the contact information for your state’s SPAP.
Pharmaceutical Assistance Programs (PAPs)
Some drug companies have Pharmaceutical Assistance Programs (PAPs) that help people pay for the drugs they make.
How to Apply for PAPs
You can find out more about PAPs and see if any programs are available for the drugs you are taking at the Pharmaceutical Assistance Program site.
Programs of All-inclusive Care for the Elderly (PACE)
PACE is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. PACE covers prescription drugs, doctor visits, transportation, home care, check-ups, hospital visits, and even nursing home stays whenever necessary.
To qualify for PACE, you must meet all of the following conditions:
- Be 55 or older,
- Live in the service area of a PACE organization,
- Need a nursing home-level of care (as certified by your state), and
- Be able to live safely in the community with help from PACE.
For more information about PACE, see "Quick Facts about Programs of All inclusive Care for the Elderly."
How to Apply for PACE
Contact your state’s Medical Assistance (Medicaid) program to find out if you qualify for a PACE program near you.
Other Ways to Lower Your Prescription Drug Costs
- Look into generic drugs. Ask your doctor if there are generics that will work as well as your current prescriptions.
- Ask your doctor about less expensive brand-name drugs.
- Consider using mail-order pharmacies.
- Use the Medicare Plan Finder to compare Medicare drug plans to find a plan with lower costs.