Medicaid and Medicare each offer help for seniors to cover healthcare costs. Other assistance programs can also help with medical costs and here, we will look at these in more detail.
This article discusses how to get help with costs for Medicare.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare is a federal health insurance plan for people ages 65 years and over. Some younger people with disabilities are also qualified to enroll.
There are several parts to Medicare. A person must enroll in each part separately.
Medicare parts A and B are called Original Medicare.
Private medical insurance companies approved by Medicare offer Medicare Part C and Part D, as well as Medicare supplementary insurance (Medigap).
Here is a breakdown of the different Medicare parts:
- Medicare Part A is hospital insurance. It covers a percentage of charges for inpatient hospital admissions, hospice, some home healthcare, and skilled nursing facility care.
- Medicare Part B is outpatient medical insurance. Part B helps pay for doctor’s office visits, medical supplies, mental health services, preventive care, and some limited prescribed medication.
- Medicare Advantage, also known as Medicare Part C, is a plan administered by private medical insurance companies that are contracted with Medicare to provide benefits. Insurers combine Parts A and B under one policy.
- Medicare Part D covers a broader range of prescription medication.
- Medicare plans that help pay for some out-of-pocket expenses are known as supplementary insurance or Medigap plans.
- Medicaid is a government health plan administered by a person’s state. The program receives funding from both the state and the federal government.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
If a person is struggling to pay for Medicare, they can receive help paying for Medicare Part A and Part B premiums through one of four Medicare Savings Programs (MSP).
If a person qualifies, MSPs may also pay for Part A and Part B deductibles, coinsurance, and copayments.
A person applies for a MSP through their state. The state will determine which program or programs a person qualifies for.
To qualify for a MSP, a person must have a financial income and financial resources below a certain limit. Resources include stocks, bonds, and money in a checking, savings, or retirement account.
A person can contact their state here for information on MSPs.
The 2024 eligibility criteria for the four MSPs are detailed below.
Qualified Medicare Beneficiary (QMB) Program
This program can help pay for Part A premiums, Part B premiums, deductibles, coinsurance, and copayments that are part of Medicare.
To qualify, a person or couple must not have income and resources that exceed the following limits.
| Individual | $1,275 | $9,430 |
|---|---|---|
| Married couple | $1,724 | $14,130 |
If a person qualifies for the QMB program, Medicare will not charge for services and items Medicare covers, such as deductibles, coinsurance, and copayments.
A person can also get extra help paying for prescription drugs, paying no more than $11.20 in 2024 for each Medicare-covered drug.
Specified Low-Income Medicare Beneficiary (SLMB) Program
The SLMB program can help pay for Part B premiums. A person must have both Parts A and B to qualify.
To qualify for this program, a person or couple must not exceed the following limits.
| Individual | $1,526 | $9,430 |
|---|---|---|
| Married couple | $2,064 | $14,130 |
Through SLBM, a person can also get extra help paying for prescription drugs, paying no more than $11.20 in 2024 for each Medicare-covered drug.
Qualifying Individual (QI) program
A QI program can also help pay for Part B premiums. A person must have both Parts A and B to qualify.
To qualify for this program, a person or couple must not exceed the following limits.
| Individual | $1,715 | $9,430 |
|---|---|---|
| Married couple | $2,320 | $14,130 |
QI offers extra help paying for prescription drugs. A person will pay no more than $11.20 in 2024 for each Medicare-covered drug.
To remain in the QI program, a person must apply every year. States approve applications on a first-come, first-served basis and prioritize those who received QI benefits the previous year.
Anyone who qualifies for Medicaid cannot receive help from the QI program, but they may be able to apply for another MSP.
Qualified Disabled & Working Individual (QDWI) program
The QDWI is for disabled and working individuals, and pays for Part A premiums only.
To qualify, a person must:
- have a disability
- work
- have lost disability benefits and Medicare premium-free Part A because of returning to work
The income and resource limits are as follows.
| Individual | $5,105 | $4,000 |
|---|---|---|
| Married couple | $6,899 | $6,000 |
Medicare plans that help pay for some out-of-pocket expenses are known as supplementary insurance or Medigap plans.
Types of out-of-pocket expenses covered may include:
- copayments
- deductibles
- coinsurance
Some Medigap plans also cover medical treatment required when traveling outside of the United States.
Some exclusions apply to Medigap policies. The following are generally not covered:
- eyeglasses
- long-term care
- hearing aids
- vision care
- dental treatment
- private nursing
Learn more about Medigap plans and costs.
Medicaid is a government health plan administered by a person’s state.
The program must follow federal requirements. The program receives funding from both the state and the federal government.
Millions of people living in the United States are eligible for Medicaid, including:
- low income families
- pregnant people
- older adults
- those with disabilities
Each state administers the program differently, but they all use a person’s modified adjusted gross income (MAGI) to determine eligibility.
Other criteria include a person’s citizenship, state of residency, and immigration status.
Older adults may also qualify for other programs to help pay healthcare expenses.
Supplemental Security Income (SSI)
A person may be eligible for Supplemental Security Income (SSI). Run by the federal government, SSIs are needs-based programs. This means certain income and asset requirements apply.
Extra Help
Medicare has a program called Extra Help for those with limited income and resources. The program helps pay for costs associated with prescription drugs, such as premiums, deductibles, and coinsurance.
PACE
Programs of All-Inclusive Care for the Elderly (PACE) programs are available through both Medicare and Medicaid. They help people pay for healthcare within the community.
For people who qualify for PACE, healthcare professionals work as a team to coordinate care.
To qualify, a person must have Medicare, Medicaid, or both and live in an area where PACE is available.
A helpful tool is available to find PACE plans in specific locations.
Healthy aging resources
To discover more evidence-based information and resources for healthy aging, visit our dedicated hub.
Medicaid and Medicare help older adults pay for medical and healthcare costs.
Medicare has several options to help pay for hospital stays, doctor visits, and prescription medication.
Medicaid is a state-run, income-based program that can help older adults pay for medical costs. A person must qualify under their state program rules.
A person can also apply for MSPs through their state.
Older adults may qualify for SSI, Extra Help, or PACE to help pay for medical costs.