Help with Medical and Drug Costs

You may be eligible to save money on medical and drug costs with these programs:

• Medicare Savings Program
• Extra Help/Low-Income Subsidy
• State Pharmaceutical Assistance Program
• Pharmaceutical Assistance Program
• Programs of All-inclusive Care for the Elderly (PACE)
• Medicaid

Medicare Savings Programs

You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Part A and Part B deductibles, coinsurance, and copayments if you meet certain conditions.

4 Kinds of Medicare Savings Programs

1. Qualified Medicare Beneficiary (QMB) Program
2. Specified Low-Income Medicare Beneficiary (SLMB) Program

   If you have income from working, you may qualify for SLMB benefits even if your income is higher than these limits.

3. Qualified Individual (QI) Program

   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. (You can't get QI benefits if you qualify for Medicaid).

4. Qualified Disabled and Working Individuals (QDWI) Program

   The QDWI program helps pay the Part A premium. You may qualify if any of the following apply to 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
   • Meet the income and resource limits required by your state

How to Apply for Medicare Savings Programs

If you answer yes to these 3 questions, call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state:

1. Do you have, or are you eligible for, Medicare Part A?
2. Is your income for 2012 at or below these income limits?
3. Do you have limited resources, below these limits?

If you qualify for a Medicare Savings Program in your state, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.

**NOTE: The income and resource limits below may change in 2013.

Medicare Savings Program 2012 Income Limits
Medicare Savings Program	Individual Monthly Income Limit*	Married Couple Monthly Income Limit*	Program Helps Pay For
Qualified Medicare Beneficiary (QMB)	$951	$1,281	Part A premiums Part B premiums Deductibles, coinsurance, and copayments
Specified Low-Income Medicare Beneficiary (SLMB)	$1,137	$1,533	Part B premiums only
Qualified Individual (QI)	$1,277	$1,723	Part B premiums only
Qualified Disabled and Working Individuals (QDWI)	$3,809	$5,129	Part A premiums only
*Limits are slightly higher in Alaska and Hawaii
Medicare Savings Program 2012 Resource Limits
Resource limits for the QMB, SLMB, and QI Medicare Savings Programs are $6,940 for a single person and $10,410 for a married couple. Resource limits for the QDWI program are $4,000 for a single person and $6,000 for a married couple. Countable resources include: money in a checking or savings account stocks bonds Countable resources don't include: your home one car burial plot up to $1,500 for burial expenses if you have put that money aside furniture other household and personal items

 

Extra Help/Low-Income Subsidy

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. You may qualify if you have up to $16,755 in yearly income ($22,695 for a married couple) and up to $13,070 in resources ($26,120 for a married couple).

Drug costs in 2012 for most people who qualify will be no more than $2.60 for each generic/$6.50 for each brand-name covered drugs. Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level.

**NOTE: These amounts may change in 2013.

How to Apply for Extra Help

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.

You automatically qualify for Extra Help if you have Medicare and meet any of these conditions:

• Have full Medicaid coverage
• Get help from your state Medicaid program paying your Part B premiums (in a Medicare Savings Program)
• Get Supplemental Security Income (SSI) benefits.

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. Learn more by contacting the State Pharmaceutical Assistance Program in your state.

Pharmaceutical Assistance Programs (PAPs)

Some drug companies have Pharmaceutical Assistance Programs (PAPs) that help people pay for the drugs they make. Find out more about PAPs and see if any programs are available for the drugs you're taking.

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)
• Be able to live safely in the community with help from 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.

Medicaid

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. Call your state Medicaid program to see if you qualify and learn how to apply.

Medicaid Spend Down

Even if your income seems to exceed Medicaid income levels in your state, you may be eligible under Medicaid spend down rules. Under the "spend down" process, some states allow you to become eligible for Medicaid as "medically needy," even if you have too much income to qualify. This process allows you to "spend down," or subtract, your medical expenses from your income to become Medicaid eligible.

To be eligible as "medically needy," your measurable resources also have to be under the resource amount allowed in your state. Call your state Medicaid program to see if you qualify and learn how to apply.

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.