If you’re considered low-income based on your Supplemental Security Income (SSI), you can avoid most, if not all, of your Medicare payments through Medicaid.
The Cost of Medicare
Medicare Part A is very low-cost compared to many other insurance options out there, even without financial aid. Most people qualify for premium-free Part A by working at least 10 years while paying taxes. The only thing you would have to pay for Part A (besides cost-sharing) is the deductible, which is $1,484 in 2021.
You must pay both a premium and deductible for Part B. In 2021, the premium is $148.50, and the deductible is $203.
For Part D, your costs are dependent on the type of drugs you need and the provider you choose. Because they are variable, there are no specific regulated costs like Parts A and B.
Medicaid Eligibility
Generally speaking, Medicaid eligibility is based on your Modified Adjusted Gross Income (MAGI). However, for seniors who also qualify for Medicare, eligibility is instead based on your Supplemental Security Income (SSI).
So, if you have a low income by this standard, you qualify for Medicaid. This standard does vary by state, so be sure to research and call your Social Security office to better determine this.
And, even if you have too high of an income to be considered for Medicaid, you may still qualify if you have high medical expenses. Some states allow Medicare beneficiaries to “spend down,” i.e. subtract their medical expenses from their income. In that case, you may still qualify for Medicaid.
What’s Covered Through Medicaid
When you do qualify for both Medicare and Medicaid, you can enroll in what’s called a Medicare Advantage Dual-eligible Special Needs Plan (D-SNP). Through this program, you’ll receive help covering your premiums, deductibles, and various out-of-pocket costs.
With a D-SNP, Medicare will pay its share of the medical costs first, than Medicaid. This means that a large majority of costs you would have to cover under Original Medicare alone are now covered.
Some states are also offering a new form of D-SNP called a Medicare-Medicaid plan. These plans simply make it easier to receive coverage for the medical costs you need. These, however, are fairly new and limited, so be sure to check and compare what’s available in your area.
Extra Help for Part D
If you qualify for a D-SNP, you also automatically qualify for Part D coverage. Not only that but you will also automatically be enrolled in the Part D extra help program. Like the additional cost coverage provided through the D-SNP for Original Medicare, the extra help program covers a majority of your costs, including premiums, deductibles, coinsurance fees, and more depending on your needs.
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