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Who is Eligible for Medicare Extra Help?

For Medicare Prescription Drug plans, individuals who have limited assets and income may be eligible for Extra Help, often referred to as Low-Income Subsidy.

In order to automatically qualify for Medicare Extra Help, you must be one of the following:

  1. A person who has a Medicare Savings program (partial dual eligibility)
  2. A person who receives Supplemental Security Income benefits and has Medicare
  3. A person who is eligible to receive Medicaid and Medicare (full dual eligibility)
Extra-Help

Income and Assets Limits 2018

To find out if you qualify for Extra Help for Medicare, the Social Security Administration will need to know your income, assets, and savings. They also need information on whether or not you are married and living with your spouse. Furthermore, you must fill out a specific application (Form SSA-1020). It can be found on www.socialsecurity.gov. In addition, some individuals automatically receive Extra Help without even applying through Social Security.

 

What are the Benefits of Medicare Extra Help?

Individuals who qualify for Extra Help will pay:

For those who have Full Extra Help, they would receive 100% Prescription Drug (Part D) premium subsidy and would pay no more than $8.35 in 2018 for each prescription drug their Medicare plan covers (no deductible).

For those with Partial Extra Help, the Prescription Drug (Part D) premium would vary according to their income and they would pay no more than 15% of coinsurance for each prescription drug their Medicare insurance covers (with no more than $83 annual deductible).

What Information Do You Need to Apply for Medicare Extra Help?

In order to determine if you are eligible for Extra Help with prescription drug plan costs, you will need to provide the following information to Social Security. If you and your spouse are married and living together, they will also need your spouse’s income information.

Documents that will best help you apply for Medicare Extra Help:

  • Social Security card
  • Bank account statements (including checking, savings, and certificates of deposit)
  • Tax returns
  • Payroll Slips
  • Individual Retirement Accounts (IRAs), bonds, stocks, saving bonds, and mutual funds
  • Recent Social Security benefits award letters or statements for Railroad Retirement benefits, pensions and Veterans benefits
  • Extra-Help
Extra-Help

Medicare Savings Programs

Medicare Savings Programs are federally funded programs that are controlled by each individual state and are different than Extra Help. These specific programs are for individuals and families with limited income and resources. They help pay your Medicare Part A and/or Part B premiums, and some Medicare Savings Programs may also help pay copays, deductibles and coinsurance.

Here are the four Medicare Savings Programs:

Qualified Disabled and Working Individuals (QDWI): This Medicare Savings Program is less common compared to the three others. QDWI’s help pay the Medicare Part A premiums. You may qualify if:

  • You are a working disabled person under the age of 65
  • You have lost your premium-free Part A after going back to work
  • You are not getting medical assistance in your state
  • You meet the income and resource limits that are required by your state

QDWI Income and Resource Limits of 2018
Individual Monthly Income Limit: $4,132
Married Couple Monthly Income Limit: $5,572
Individual Resource Limit: $4,000
Married Couple Resource Limit: $6,000
Program Helps Pay For: Part A premiums only

Qualifying Individual (QI or QI-1): Every year, an individual must apply for QI benefits. If you are new to QI benefits, you need to know that the applications are granted on a first-come basis. People who had QI benefits in the previous years have seniority over new applicants. You also are not able to receive QI benefits if you already qualify for Medicaid.

QI Income and Resource Limits of 2018
Individual Monthly Income Limit: $1,386
Married Couple Monthly Income Limit: $1,872
Individual Resource Limit: $7,560
Married Couple Resource Limit: $11,340
Program Helps Pay For: Part B premiums only

Qualified Medicare Beneficiary (QMB) – This program helps low-income beneficiaries pay for their Medicare Part A premiums, Medicare Part B premiums, and some of the costs of Medicare deductibles and coinsurance.

QMB Income and Resource Limits of 2018
Individual Monthly Income Limit: $1,032
Married Couple Monthly Income Limit: $1,392
Individual Resource Limit: $7,560
Married Couple Resource Limit: $11,340
Program Helps Pay For: Part A and Part B premiums + cost sharing (copays, deductibles, coinsurance)

Specified Low-Income Medicare Beneficiary (SLMB): This is a Medicare Savings program that helps pay Medicare Part B premiums for individuals who already have Medicare Part A, limited resources, and a low monthly income.

SLMB Income and Resource Limits of 2018
Individual Monthly Income Limit: $1,234
Married Couple Monthly Income Limit: $1,666
Individual Resource Limit: $7,560
Married Couple Resource Limit: $11,340
Program Helps Pay For: Part B premiums only

  • To learn more about Medicare Prescription Drug Plans, click here.
  • To learn more about Medicare Extra Help, click here.
  • To learn more about Medicare Income and Assets Limits for 2018, click here.
 

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About e-TeleQuote and easyMedicare.com

e-TeleQuote Insurance, Inc. the owner and operator of easyMedicare.com, is an independent digital insurance agency providing consumers the ability to purchase Medicare insurance from the comfort of their homes. The company diligently researches available plan options from multiple insurance carriers, helping consumers choose a plan that best suits their needs. e-TeleQuote provides consumers personal consultation through experienced licensed insurance agents who suggest plan coverage options based on a customer’s particular needs. The company has proudly served tens of thousands of consumers across the United States.