While Medicare was initially designed to provide a means of healthcare that was affordable and accessible to seniors, it can still prove to be a financial burden to some, especially those who are on a low fixed income. If you or someone you love is struggling to keep up with premiums, cover out-of-pocket costs or simply afford medication each month, then rest assured that there are options. You can enroll in original Medicare or Medicare Advantage even if you’re on a lower fixed income. Financial assistance programs and cost-reducing strategies will help you. Here are six ways to keep your health plan without breaking your budget.
#1 – Apply for Medicaid
It is possible to belong to both Medicare and Medicaid depending on your financial situation. Instead of having a secondary insurance from a traditional insurance company, costs that are not covered by Medicare would be picked up by Medicaid, the joint state-run and federally administered assistance program for low-income Americans. Generally, Medicaid would cover your Medicare Part B costs and Part D prescription drug coverage. Sometimes, the program will also help cover costs associated with dental care, medical-related travel expenses, and nursing home stays.
Medicaid eligibility differs from state to state, depending on your income and assets, and many states expanded their programs under the Affordable Care Act. The best way to determine if Medicaid is a viable option is to talk to your local Medicaid office, where they’ll review your situation to see if you qualify.
#2 – Seek State Assistance
State Health Insurance Programs (SHIP) are federally-funded Medicare counseling services. There is no charge to anyone who seeks counseling, and many offices provide free workshops that help individuals find answers to Medicare-specific questions. Because the counselors are not affiliated with any insurance companies, they are able to provide unbiased support and recommendations. All SHIP counselors are highly trained, and have the experience necessary to help you find affordable ways to manage your Medicare costs, including helping you find financial assistance or alternative health insurance options.
#3 — Consider a Private Medicare Plan
If your original Medicare plan is too pricey, consider looking at other plans through Medicare Part C, also known as Medicare Advantage. Advantage plans are held to the same regulations as traditional Medicare plans, but they’re sold through private insurers. This means that they have to offer the same coverage as original Medicare (Parts A and B), but they also tend to offer a variety of extra services without additional costs, or for nominal added monthly fees. These additional services could include dental and vision coverage, prescription drugs, and continuing care facility costs. So while you might pay more upfront for an MA policy, you would be getting more comprehensive coverage, which could cut down on your personal healthcare spending.
Because these plans is are administered by private insurers, you will most likely be limited to doctors and treatment facilities that are in your plan’s network. You may not get to stay with the doctors you currently see, but you could potentially save a considerable amount of money.
#4 – Explore Medicare Savings Programs
If you have limited income and assets but don’t qualify for assistance through Medicaid, there are still options open for saving money. Four different Medicare Savings Programs exist to help people with tight budgets, all with unique eligibility requirements and levels of assistance. Eligibility requirements vary by state, and they may change every year, so currently posted financial requirements may not be accurate. The four different plans are:
- Qualified Medicare Beneficiary (QMB) Program: The QMB program offers help for people who have trouble paying premiums for Parts A and B. It’ll also help cover the costs associated with deductibles, coinsurance and co-payments. Additionally, anyone who qualifies for the QMB program automatically qualifies for a program called “Extra Help,” which helps Medicare beneficiaries cover prescription drug costs.
- Specified Low-Income Medicare Beneficiary (SLMB) Program: If you earn a bit more than the cutoff for assistance with a QMB program, you may qualify for an SLMB coverage plan. This level of assistance will help you with costs related to Medicare Part B coverage, but will not help with any of the other costs like deductibles or co-payments. However, you would still qualify for Extra Help to offset prescription drug costs.
- Qualified Individual (QI) Program:
If you don’t qualify for the first two options, then you may be able to enroll in a QI program. Like the SLMB program, anyone who qualifies for Qualified Individual will receive aid for their Part B premiums and will also receive Extra Help. The catch here is that spaces in this program are limited, and you’ll only get in on a first-come, first-served basis. It’s also only good for one year, at the end of which you’ll have to reapply.
- Qualified Disabled and Working Individual (QDWI) Program: This program is completely different from the other three options. A QDWI plan covers the premium costs associated with Medicare Part A if any of the following situations are applicable: you were out of work and had been a part of Medicare Part A, but after returning to work lost your eligibility; you are under age 65, but you’re disabled and employed; or you’re not receiving any state assistance for medical expenses.
Medicare Savings Programs are subject to change without notice. The best way to know if you meet the eligibility requirements is to talk to a Medicare specialist.
#5 – Get Extra Help for Drug Costs
Anyone who has Medicare and also has limited financial resources may qualify for a program called Extra Help. This program assists with costs related to Part D (prescription drug coverage) or any prescription drug costs, including premiums, deductibles and co-payments. Eligibility is determined by income, and you have access to the plan from all 50 states. The Extra Help program can be used in conjunction with other Medicare Savings Programs. With an estimated value of $4,000, you may find this option especially beneficial if you need a lot of medication.
#6 – Find Cheaper Prescription Drugs
In addition to utilizing some of the programs outlined above, you can also look into other ways to lower how much you’re spending on medication in the first place. If you don’t qualify for Extra Help but you’re still having trouble affording monthly prescriptions, then here are a few tips for lowering your bill:
- Check to see if your state participates in a State Pharmaceutical Assistance Program (SPAP), which can help you save money off the direct cost of your medications. Not every state participates; in fact, fewer than half do. But this is a good option if you live in a state that does.
- Research your medications to see if foundations exist to help cover the costs. For certain medical conditions or specific brands of drugs, there are organizations that offer cost assistance to qualified patients. Co-Pay Relief by the Patient Advocate Foundation is one example, but there are others. If you need a place to start, research your medication’s manufacturer.
- While you’re researching specific drug brands, don’t forget to see if the manufacturer offers coupons or cost assistance directly. Drug manufacturers sometimes help patients afford medication, especially big-name companies and brands.
Finally, talk to your doctor about your medications. If you’re being prescribed brand-name drugs, see if you can switch to a generic version, which is typically cheaper. If you can’t switch to generics, find out if there’s an alternative medication that could work just as well but cost less. Don’t be hesitant to bring up finances with your doctor when it comes to medication. You can work together to find a compromise between getting the drugs that you need and sticking to your budget.
Living on a fixed income isn’t easy, but it can be much harder if too much of your income is being funneled into healthcare costs. If you’re having a hard time affording copays, monthly premiums or drug costs, then reach out for help. There are many programs available to help Medicare enrollees take care of themselves and their loved ones at every stage of life.