There are several programmes that help people pay for Medicare. A large number of people who are eligible for them never apply, and the most common reasons are that nobody told them and that they assumed they earned too much.
This guide describes what exists and how to ask. It carries no income figures, because the thresholds change every year and vary by state and household. Apply and let the programme decide; do not decide for it.
Extra Help, for prescription costs
Extra Help — formally the Low-Income Subsidy — reduces what you pay for Part D. It can lower or remove the premium, reduce the deductible, and cut what you pay at the pharmacy.
Apply through the Social Security Administration. You can do it online, by telephone, or in person at a Social Security office. The application is short by the standards of these things.
Two useful facts. First, some people are enrolled automatically — those on Medicaid, those in a Medicare Savings Program, and those receiving Supplemental Security Income. If you are in one of those groups you should not need to apply, though it is worth confirming that you were.
Second, receiving Extra Help gives you the right to change drug plans outside the usual dates. That is a genuine benefit and few people know about it.
Medicare Savings Programs, for premiums and cost-sharing
These are run by your state Medicaid office and help with Part B premiums, and depending on which programme you qualify for, with deductibles and coinsurance as well.
There are several tiers with different eligibility rules. You do not need to work out which one you fit; the application sorts that out.
Apply through your state Medicaid agency — Ohio, Kentucky and Indiana each run their own, with their own forms and their own processing times. Your State Health Insurance Assistance Program will help you complete the application at no charge.
Qualifying for one of these programmes usually enrols you in Extra Help automatically as well, which is why it is generally worth applying here first if you are unsure where to start.
Medicaid
Some people qualify for both Medicare and Medicaid. If that is you, Medicaid may cover costs Medicare does not, including long-term care in circumstances Medicare will not touch.
Being eligible for both also opens up specific plan options designed for people in that position, and gives you more frequent opportunities to change plans.
The application is through your state Medicaid agency.
Help with a specific medication
Separate from all of the above, there are two routes worth knowing.
Manufacturer assistance programmes. Many pharmaceutical companies run schemes for people who cannot afford a particular drug. Eligibility rules are set by the company, not by Medicare. Ask the prescriber’s office — they usually know which drugs have a programme.
Charitable foundations exist for specific conditions and can help with cost-sharing. Your prescriber’s office or a hospital social worker will know the ones relevant to your condition.
Neither of these affects your Medicare eligibility, and neither is charity in a sense that should trouble anybody. They exist because the manufacturers and the foundations put them there.
The state pharmaceutical assistance programmes
Some states run their own programmes to help residents with drug costs. Availability and rules differ by state and change over time. Ask your State Health Insurance Assistance Program whether your state has one currently, since this is exactly the kind of detail a web page gets wrong.
What to do if you think you might qualify
Apply anyway. The most common reason people miss out is deciding in advance that they earn too much. The rules are more generous than most people assume, some assets are excluded, and certain expenses are deducted from the calculation. It costs nothing to be told no.
Gather the paperwork once. Most of these applications want the same things: proof of income, information about savings and other assets, and your Medicare details. Assembling that once makes the second and third applications straightforward.
Ask for help with the form. State Health Insurance Assistance Program counsellors do this every day, free of charge, with nothing to sell. Area Agencies on Aging often help as well. So will 1-800-MEDICARE, which is answered around the clock.
Reapply if circumstances change. Eligibility is not once and for all. Retirement, a spouse’s death, or a change in savings can move you across a threshold. So can the threshold itself, which is revised annually.
If you are helping a parent
You will need their authorisation to speak to Medicare, to Social Security and to the state on their behalf. Each has its own form. Filling them in before you need them takes an afternoon; doing it in a crisis takes considerably longer.
Bring the paperwork together in one folder — Medicare card, plan card, medication list, income and asset details. Nearly every application in this guide draws on the same folder.
What we do about this
We are not a benefits office and we do not process these applications. What we will do, in any appointment, is ask whether you have looked into them, and point you at the right agency if you have not.
We would be a poor adviser if we sold somebody a plan without mentioning that they might be entitled to help paying for it. The referral costs us nothing and it is not a favour; it is the job.
General information, not advice
This guide describes how Medicare generally works. It is not advice about your situation, and rules, dates and figures change — verify anything that matters to a decision against Medicare.gov,1-800-MEDICARE, or your State Health Insurance Assistance Program, all of which are free.
Rights and rules vary by state; this describes Ohio, Kentucky and Indiana. Clearview Medicare Advisers LLC is not connected with or endorsed by the United States government or the federal Medicare program.
Not sure how this applies to you?
Tell us your birthday and whether you are still working. That is usually enough for us to say which periods apply to you and by when. No charge and no obligation.
