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Help With Medical and Drug Costs

Medicaid

Medicaid is a joint federal and state program that helps pay medical costs for some people with limited incomes and resources. 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

Medicaid is run by the states, so rules about eligibility and how to apply are different for each state. Call your state to see if you qualify for your state's Medicaid program.

Medicare Savings Programs

Medicare Savings Programs can help pay all or part of your Part A and/or Part B premiums if you meet certain income and resource limits. There are four types Medicare Savings Programs:

  1. Qualified Medicare Beneficiary (QMB) Program

    You must be eligible for Part A to qualify, even if you’re not enrolled.

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

    You must be eligible for Part A to qualify, even if you’re not enrolled. If you have income from working, you may qualify for SLMB benefits even if your income is higher than the limits in the chart below.

  3. Qualified Individual (QI) Program

    You must be eligible for Part A to qualify, and 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. QI benefits aren't available to people who qualify for Medicaid.

  4. Qualified Disabled and Working Individuals (QDWI) Program

    The QDWI program helps pay the Part A premium. You may qualify if you:

    • Are a working disabled person under age 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

Income and resource limits for Medicare Savings Programs are below. 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 will be updated with the 2010 dollar amounts when the official numbers are released.

Medicare Savings Program 2009 Income Limits

Medicare Savings Program Individual Monthly Income Limit* Married Couple Monthly Income Limit* Program Helps Pay For

Qualified Medicare Beneficiary (QMB)

$923

$1,235

•Part A premiums
•Part B premiums
•Deductibles, coinsurance, and copayments

Specified Low-Income Medicare Beneficiary (SLMB)

$1,103

$1,477

Part B premiums only

Qualified Individual (QI)

$1,239

$1,660

Part B premiums only

Qualified Disabled and Working Individuals (QDWI)

$3,695

$4,942

Part A premiums only

*Limits are slightly higher in Alaska and Hawaii

Medicare Savings Program 2010 Resource Limits

Resource limits for all Medicare Savings Programs are $5,600 for a single person and $9,900 for a married couple.

How to Apply for Medicare Savings Programs
Call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state

Extra Help

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. People who qualify for the most Extra Help pay nothing for their Medicare drug plan premium and deductible, and only $2.50 generic/$6.30 brand-name for their covered drugs. Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level.

You may qualify if you have up to $1,354 in monthly income ($1,821 for a married couple) and up to $12,510 in resources ($25,010 for a married couple).

**NOTE: These amounts will be updated when the official 2010 numbers are released.

How To Apply For Extra Help

If you qualify for Medicaid, belong to a Medicare Savings Program, or get Supplemental Security Income (SSI) benefits, you automatically get Extra Help with Medicare drug costs. Otherwise, you can 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.

State Pharmaceutical Assistance Programs (SPAPs)

Some states have State Pharmaceutical Assistance Programs (SPAPs) that help people pay prescription drug costs.

How to Apply for SPAPs

Each SPAP has different rules about eligibility, how to apply, and how it works with Medicare prescription drug coverage. For more information, call the SPAP in your state. Find the phone number on the State Pharmaceutical Assistance Program Site.

Pharmaceutical Assistance Programs (PAPs)

Some drug companies have Pharmaceutical Assistance Programs (PAPs) that help people pay for the drugs they make.

How To Apply For PAPs

You can find out more about PAPs and see if any programs are available for the drugs you are taking at Medicare Pharmaceutical Assistance Program

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. 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:

  • 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)
  • Able to live safely in the community with help from PACE

How To Apply For PACE

Call your State Medical Assistance (Medicaid) office to find out if you qualify for a PACE program near you.

Other Ways To Lower
Your Prescription Drug Costs

  • Look into generic drugs
  • Ask your doctor about less expensive brand-name drugs
  • Consider using a mail-order pharmacies
  • Compare Medicare drug plans to find a plan with lower costs

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