If you’re having trouble paying your Medicare premiums, you’re not alone. Many Americans need help with Medicare premiums. You may be wondering where you can go for help and how you can qualify. Keep reading to learn about programs that provide Medicare premium assistance. You will also find out specific requirements you need to meet to qualify for help with paying your monthly premiums.
Your Medicare premium is the monthly payment you make to have a Medicare insurance plan. Medicare insurance has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). You pay a different premium for each part of Medicare. Medicare Parts A and B are known as Original Medicare because the insurance coverage is provided directly through the Medicare program.
Premiums for Parts A and B are determined by and billed through Medicare. The premium for Part A can be up to $471 a month as of 2021, 1 but you usually don’t pay any premiums for Part A insurance (because you likely already paid premiums through Social Security taxes if you worked for at least 10 years in the U.S.). The estimated Part B premium for 2022 is $158.50. 2
A Part C plan combines other parts of Medicare (Original Medicare and usually Part D) and can provide you with a broader range of benefits. These plans are sold through private insurance companies that are approved by Medicare. Premium rates vary depending on the type plan and where you live, but the average premium for 2022 Part C plans is $19. 3
Medicare Part D plans are also provided through private insurance companies. The national average Part D premium is $33 for 2022. 3 But depending on where you live and the type of plan you have, Medicare Part D costs will vary.
The Centers for Medicare and Medicaid Services (CMS) provide assistance with premium payments. Medicaid operates four types of Medicare Savings Programs:
Most of the help you can get to pay premiums are available through these programs.
Medicare Savings Programs (MSPs) require that you have limited income and resources to be eligible for premium assistance. Each state manages program funds and decides who qualifies. Programs can pay for all or just some of your Medicare out-of-pocket expenses, which includes premiums. MSPs are primarily designed for Original Medicare (Parts A and B) plan enrollees, so all states must help eligible persons with premium payments. However, states can decide whether or not to help pay Medicare Advantage premiums. When it comes to Medicare Part D, persons who qualify for certain MSPs can receive help with premium payments through a separate program called Extra Help. We’ll talk more about Extra Help later.
Your income and resources (assets) are some of the factors that Medicaid uses to determine if you qualify for help with Medicare premiums. MSPs have different monthly income limits, and most states (including the District of Columbia) have the same limits. Alaska and Hawaii are the only two states that have different income limits. Three of the four MSPs have the same resources limits, and these limits are the same for all states including Alaska and Hawaii. If you earn equal to or less than these limits, then you may qualify for assistance.
| Program Name | 2021 Monthly Income Limits 4 (limits are slightly higher in Alaska and Hawaii) | 2021 Resource Limits 4 | ||
|---|---|---|---|---|
| Individual | Married Couple | Individual | Married Couple | |
| Qualified Medicare Beneficiary (QMB) | $1,094 | $1,472 | $7,970 | $11,960 |
| Specified Low-Income Medicare Beneficiary (SLMB) | $1,308 | $1,762 | $7,970 | $11,960 |
| Qualifying Individual (QI) | $1,469 | $1,980 | $7,970 | $11,960 |
| Qualified Disabled and Working Individual (QDWI) | $4,379 | $5,892 | $4,000 | $6,000 |
Federal law requires that states exclude certain types of assets. These are some of the main things that don’t count:
| Doesn’t Count as a Resource (Asset) |
|---|
| Primary house |
| Your car |
| Items that cannot be easily converted to cash such as furniture and jewelry (wedding/engagement rings) |
| Burial plot and burial funds valued up to $1,500 for individuals and $3,000 for couples |
| Life insurance that has less than $1,500 in cash value |
You may qualify for help with paying your premiums through Medicare Savings Programs if you:
You (or your agent) must contact your state Medicaid office if you think you could qualify for help with paying your Medicare insurance. Even if your income is slightly higher than the limits, you can still be eligible for full or partial premium assistance.
Most MSPs provide help for Medicare Part A or Part B only. All programs require eligibility for Medicare Part A, but the main difference between each is the income range that those seeking help must be within.
Parts A and B: The Qualified Medicare Beneficiary (QMB) program is the only Medicare assistance program that pays premiums for both parts of Original Medicare. If you’re approved as a QMB, you’re the program will help pay for your Medicare costs (including Part A premiums, Part B premiums, deductibles, coinsurance, and copayments). 4
Part A Only: If you need help with just your Part A premiums, you may get assistance through the Qualified Disabled and Working Individual (QDWI) program. To get full or partial aid, you must: 4
Part B Only: Both the Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programs will help pay for Medicare Part B premiums. 4
You may get help with paying your Part C premiums if you’re eligible for the Qualified Medicare Beneficiary (QMB) program. But it’s not guaranteed that you will receive premium payment assistance because each state can decide whether to cover premiums for those enrolled in Medicare Advantage plans.
If you have both Medicare and Medicaid and are enrolled in a Medicare Advantage Special Needs Plan, Medicaid will pay for most of your insurance costs. However, the same rules apply with states not being required to pay your plan premiums. Although you may not get help with premiums, states are responsible for paying your Medicare Advantage copayments and coinsurance for services covered under Medicare Parts A and B.
You may be able to get help with Medicare premiums for your prescription drug coverage through the Part D Low-Income Subsidy (LIS) program, also called Extra Help. This program can lower your copays and coinsurance for generic drugs to no more than $3.70 each ($9.20 for brand-name). Additionally, you could pay less (or nothing) for your Part D premiums and deductibles. 5
In 2021, the income limits for Extra Help are up to $19,320 annually ($26,130 for married couples). For resources, qualifying limits are up to $14,790 ($29,520 for married couples). 5 You are automatically eligible for LIS if you qualify for the QMB, SLMB, or QI program. 4
Programs outside of Medicare that can help pay premiums are generally for Medicare Part D plans. Depending on the state you live in, you may be able to get help with paying your Part D premiums through State Pharmaceutical Assistance Programs (SPAPs). These programs provide assistance to adults with disabilities and low-income seniors. States that offer Medicare premium assistance for Part D insurance make their own rules on who can qualify.
Some drug manufacturers also offer help with prescription drug costs, but this is for the cost of medicines instead of the actual premium for your Part D plan. If you’re a senior citizen, have limited income, or a disability, you may qualify for discounted or free prescribed medicines through Patient Assistance Programs (PAPs).
To see Medicare plans in your area, please click the button above and enter your ZIP code.
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To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week).
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.
Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.
HealthMarkets Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, PPO and PPFS organizations and stand-alone prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion.
This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.
© 2024 HealthMarkets Insurance Agency. All rights reserved.
To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week).
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.
Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.
HealthMarkets Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, PPO and PPFS organizations and stand-alone prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion.
This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.
© 2024 HealthMarkets Insurance Agency. All rights reserved.
To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week).
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.
Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.
HealthMarkets Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, PPO and PPFS organizations and stand-alone prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion.
This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.
