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LOWER YOUR MEDICARE COSTS


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Navigating Medicare can feel like a winding road, but with the right strategies, you can keep more money in your pocket while still getting the care you need. Whether you’re managing copays, prescription costs, or out-of-pocket expenses, there are plenty of ways to maximize your Medicare benefits and reduce unnecessary spending. From choosing the right plan to utilizing cost-saving programs, small adjustments can lead to big savings. In this article, we’ll explore practical tips to help you lower your medical costs, find financial assistance, and make the most of your Medicare coverage—without sacrificing the quality of your care.



Click on the different programs to skip down for more details:


Income Based Programs


Help with Rx Costs:


Specialty Plans



Medicare Savings Programs (MSPs)

There are 4 kinds of Medicare Savings Programs. If you have limited income and resources, you may be able to get help from your state to pay your Medicare costs if you meet certain conditions. 




Qualified Medicare Beneficiary (QMB):

Helps pay for: Part A premiums; Part B premiums, deductibles, coinsurance, and copayments (for services and items Medicare covers).


QMB

Monthly income limit:*

Resource limit:

Single person 

$1,325

$9,660

Married couple

$1,783

$14,470


Specified Low-Income Medicare Beneficiary (SLMB):

Helps pay for: Covers Part B premium only.

SLMB

Monthly income limit:*

Resource limit:

Single person 

$1,585

$9,660

Married couple

$2,135

$14,470

If you qualify for the SLMB Program: 

  • You’ll also get Extra Help paying for your prescription drugs.

You’ll pay no more than $12.15 in 2025 for each drug your Medicare drug plan covers.



Qualifying Individual (QI):

Helps pay for: Covers Part B premium only.


QI is only available for people who don’t qualify for any other Medicaid coverage or benefits. 


QI

Monthly income limit:*

Resource limit:

Single person 

$1,781

$9,660

Married couple

$2,400

$14,470

If you qualify for the QI program:

  • You must apply every year to stay in the QI Program.

  • States approve applications on a first-come, first-served basis – priority is given to people who got QI benefits the previous year.

  • You’ll also get Extra Help paying for your prescription drugs. You’ll pay no more than $11.20 in 2024 for each drug your Medicare drug plan covers


QI is only available for people who don't qualify for any other Medicaid coverage or benefits, but you may qualify for help from another Medicare Savings Program.



Qualified Disabled and Working Individuals (QDWI):

Helps pay for: Covers Part A premium only.

QDWI

Monthly income limit:*

Resource limit:

Single person 

$5,302

$4,000

Married couple

$7,135

$6,000

You may qualify for the QDWI Program if you:

  • Have a disability

  • Are working

  • Lost Your Social Security disability benefits and Medicare premium-free Part A because you returned to work


If you sign up for the immunosuppressive drug benefit and have limited income and resources, but don’t have full Medicaid coverage, you may qualify for help paying the costs through a QMB, SLMB, or QI Program. 


If you qualify for a QMB, SLMB, or QI Program, you qualify automatically for Extra Help, a separate program that helps pay for Medicare drug coverage (Part D). 


How do I qualify? 

  • In most cases, to qualify for a Medicare Savings Program, you must have income and resources below a certain limit. Income and resource limits vary by state. 


  • Even if you don’t think you qualify, you should still apply. Contact your State Medical Assistance (Medicaid) office to get started. 



Extra Help

If you have limited income and resources, you may qualify for Extra Help, a program to help pay some Medicare drug costs, like premiums, deductibles, and coinsurance. 


  • Plan premium: $0

  • Plan deductible: $0

  • Prescriptions you fill at one of your plan's participating pharmacies:

    • Up to $4.90 for each generic drug

    • Up to $12.15 for each brand-name drug


You may qualify for Extra Help if your yearly income and resources are below these limits in 2025: 


Yearly Income 

Resources* 

Single person 

less than $23,475

less than $17,600

Married person living with a spouse and no other dependents 

less than $31,725

less than $35,130

*Resources Include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs). 

*Resources Don’t include your home, car, household items, burial 


If you qualify for Extra Help and join a separate Medicare drug plan or Medicare Advantage Plan with Medicare drug coverage (Part D): 

  • You’ll get help paying your drug coverage costs. 

  • You won’t pay a Part D late enrollment penalty. 


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

  • You have full Medicaid coverage. 

  • You get help from your state Medicaid program to pay your Part B premiums and other Medicare costs.

  • You get Supplemental Security Income (SSI) benefits. 


Medicare will mail you a purple letter to let you know you qualify automatically for Extra Help. Keep this for your records. You don’t need to apply for Extra Help if you get this letter. 


If you don’t already have Medicare drug coverage (Part D), you must get it to use Extra Help. 


  • If you don’t have drug coverage, Medicare may enroll you in a separate Medicare drug plan so you’ll be able to use the Extra Help.

  • If Medicare enrolls you in a plan, you’ll get a yellow letter letting you know when your coverage begins, and you’ll have a Special Enrollment Period to change plans if you want to join a different plan than the one Medicare enrolled you in. 

  • Different plans cover different drugs. Check to find out if the plan you’re enrolled in covers the drugs you use and if you can go to the pharmacies you want.

  • If you have Medicaid and live in certain institutions (like a nursing home) or get certain home and community-based services, you pay nothing for your covered drugs. 

  • Drug costs for people who qualify will generally be no more than $4.90 for each generic drug and $12.15 for each brand-name drug you fill at one of your plan’s participating pharmacies. Look at the Extra Help letters you get, or contact your plan if you have questions about costs.


If you didn’t qualify automatically for Extra Help, you can apply any time at SSA.gov/extrahelp. 


When you apply for Extra Help, you can also begin the application process for a Medicare Savings Program (MSP). These state programs help with other Medicare costs. Social Security will send information to your state to initiate an MSP application, unless you tell them not to on the Extra Help application. 



State Pharmaceutical Assistance Programs (SPAP)


HoosierRx is a program that can help you pay for your monthly medications. It can help you pay your monthly Medicare Part D premium, or the prescription drug portion of the premium for a Medicare Advantage Plan with prescription drug coverage. HoosierRx can pay up to $70 per month to help with your premium if you are eligible and have Medicare Part D or a Medicare Advantage Plan that works with HoosierRx. Please note that HoosierRx cannot provide assistance with other prescription drug costs, such as deductibles and co-pays.


To qualify for HoosierRx, individuals must:

  • Be an Indiana resident

  • Be aged 65 years or older

  • Have an annual income under 150% FPL. For 2024, your annual income cannot be more than $22,830 for a single/widowed person or $30,900 for a married couple living together.

  • Have a Medicare Part D plan through one of the following companies:

    • AARP/United HealthCare

    • CIGNA

    • Aetna/SilverScript

    • WellCare


An easy online application can be accessed at: https://hoosierrx.fssa.in.gov. 



Pharmaceutical Assistance Programs (PAP)


Pharmaceutical Assistance Programs (PAPs) are initiatives, often sponsored by pharmaceutical companies, designed to help individuals who cannot afford their medications access them at little or no cost. While these programs primarily target uninsured or underinsured patients, their interaction with Medicare beneficiaries is nuanced.


For Medicare beneficiaries, especially those enrolled in Part D (prescription drug coverage), PAPs may offer assistance for medications not covered by their plan or during coverage gaps. However, it's important to note that federal health programs, including Medicare, prohibit the use of manufacturer-sponsored, drug-specific PAPs to subsidize costs for medications covered under Medicare Part D.


Find out if there is an Pharmaceutical Assistance Program for your prescription - SEARCH

PACE (Program of All-Inclusive Care for the elderly)


Programs of All-Inclusive Care for the Elderly (PACE) provide comprehensive medical and social services to older adults who need a high level of care but want to remain in their homes and communities rather than move to a nursing facility.


PACE is a joint Medicare and Medicaid program available to individuals who are 55 or older, live in a PACE service area, and require nursing-home-level care. For those who qualify for both Medicare and Medicaid, PACE typically covers all services with little to no out-of-pocket cost.


You can join a PACE Plan if you:

  • Have Medicare, Medicaid, or both.

  • Are 55 or older.

  • Live in the service area of a PACE organization.

  • Need nursing home-level care (as certified by your state).

  • Are able to live safely in the community (with help from PACE).


If a participant is only enrolled in Medicare, they may be responsible for the monthly premium for long-term care services. PACE covers a wide range of healthcare needs, including doctor visits, prescription drugs, home care, therapy, transportation, and even specialized care like dentistry and vision. All services are coordinated through a team of healthcare professionals at PACE centers, ensuring personalized, seamless care. Because PACE is designed to keep seniors independent and out of institutional care, it serves as a valuable option for those seeking an alternative to traditional long-term care settings.


Special Needs Plans (SNPs)


Special Needs Plans (SNPs) are a type of Medicare Advantage plan designed to provide targeted healthcare coverage for individuals with specific conditions, financial needs, or institutional care requirements. These plans help save medical costs by tailoring benefits, provider networks, and drug formularies to the unique needs of their members.


For example, Chronic Condition SNPs (C-SNPs) focus on managing care for individuals with conditions like diabetes or heart disease, often offering lower copays, specialized care coordination, and coverage for necessary medications.


Dual Eligible SNPs (D-SNPs) serve those who qualify for both Medicare and Medicaid, reducing out-of-pocket costs by covering services that Medicaid may help pay for, such as long-term care and transportation.


Institutional SNPs (I-SNPs) provide extra support for those living in nursing homes or needing a high level of care at home. By offering enhanced benefits and care coordination, SNPs help beneficiaries lower their overall healthcare expenses while improving access to necessary treatments and services.



If you’d like me to help you or someone you care about figure out the best Medicare route, please reach out to me TODAY! -> CONTACT BEN <-


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© Just North of 65 - Benjamin Murray - Independent Insurance Broker

I do not offer every plan available in the state of Indiana. Any information provided is limited to those plans offered in your area.

Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

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