Paying for Medicare care costs can be expensive in light of the multiple government loopholes. For some seniors even making basic premium and copayments is impossible or at least very difficult. Luckily, states provide assistance to seniors in such a predicament. Assistance comes from three systems: Medicaid, qualified Medicare beneficiaries, or specified low income Medicare beneficiary.
Medicaid eligibility. If you qualify, Medicaid will cover thoses costs not covered by Medicare. For example, it will cover hospital coninsurance not paid by Medicare, it will pay for Medicare’s deductible, it will pay the 20% approved amount copayment, and it will also pay the monthly premiums for Medicare. In order to receive these benefits you must be eligible. Individuals who are eligible for both Medicare and Medicaid are called “dual eligibles”. In most states eligibility is based on income and assets. Income is how much you earn from all sources on a monthly basis (e.g. retirement or pensions). Assets are what you own (such as a house or car), but not counting excluded items. The income and assets requirements change periodically based on inflation and politics so be certain to check before applying. Even if you are not eligible under the income and assets requirement, some states confer eligibility based on a “Medically Needy” category. Essentially, if you make over the allowable income or assets amount but your medical costs represent a major cost, then you could be eligible for Medicaid coverage. Check with your local state Medicaid office to ensure they have a medically needed category.
Qualified Medicare Beneficiaries. Some states provide qualified Medicare beneficiary programs (QMB) to help people with low incomes but who don’t qualify for Medicaid. The QMB programs usually rely on the same income and assets test that Medicaid relies on: whether you earn below the qualifying amount and the collective value of your property is below the qualifying amount. The income requirement is tied to the national poverty line and changes yearly as determined by the federal government. The asset requirement is as follows: you cannot own more than $4,000 worth of stuff if you’re single or $6,000 if you’re married. The good news is that lots of stuff is exempt. For example, your car and house do not count towards your $4,000 asset cap. If you qualified for a QMB, it will pay all Part A and B premiums, coinsurances, deductibles, and copayments. Programs like QMB could save you thousands of dollars in Medicare costs a year.
Specified Low Income Medicare Beneficiary. Some states provide Specified Low Income Medicare Beneficiary programs (SLMB). Others may offer a program for Qualifying Individuals (QI). These programs are “high end” programs. They are available to people who earn outside of Medicaid and QMBs allowable income and assets amount. Most SLMB programs keep the same assets requirements (with exceptions for house, car, etc.) The big difference is in the amount of income you’re allowed to earn and still qualify. The income requirement uses the national poverty line as the base but allow income 20% to 80% greater than the poverty line. The SLMB programs, however, will not cover as much as Medicaid and QMB cover but will definitely provide some assistance to less well-off seniors.
States provide Medicare assistance for those who qualify. If used, these programs can save seniors money and for the poorest help cover costs that they would not be able to afford. You can look into these programs at your local Medicaid office, which is usually the state or county’s department of social services.
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