Help With Medicare Premiums: How to Get Assistance - HealthMarkets
Turning 65 soon? Transitioning to dual Medicare and Medicaid ...
TURNING 65 SOON? TRANSITIONING TO DUAL MEDICARE AND MEDICAID COVERAGE AND GETTING HELP WITH COSTS
If you’re enrolled in Medicaid and will soon have Medicare eligibility, it’s not too soon to start planning ahead. Once Medicare eligibility begins, you’ll have a 7 month Initial Enrollment Period to sign up. For most people, this is 3 months before, the month of, and 3 months after their 65th birthday.
Once you have Medicare and Medicaid coverage, Medicare will cover your Part D prescription drugs and you’ll automatically qualify to get Extra Help paying for your drug costs. If you have limited income and resources, you may also qualify for help paying for your Medicare Part B premium and other Medicare costs, like deductibles and coinsurance. Medicare and your state Medicaid program work together to provide you with this help, called the Medicare Savings Programs.
The 4 Medicare Savings Programs (MSPs)
If you have income from working, you may qualify for these 4 MSPs, even if your income is higher than the income limits listed below. Each program has a different income and resource eligibility limit. Even if you don’t qualify for Medicaid, you may qualify for one of these programs to help you cover your Medicare costs.
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individuals (QDWI) Program
How do I apply for Medicare Savings Programs?
If you answer yes to these 3 questions, call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state:
- Do you have, or are you eligible for, Part A?
- Is your monthly income for 2015 at, or below, $1,333 (single) or $1,790 (married or living together)?
- Do you have limited resources, less than $7,160 (single) or $10,750 (married or living together
It’s important to call or fill out an application if you think you could qualify for savings—even if your income or resources are higher than the amounts listed here.
What items are included in the Medicare Savings Program resource limits?
Countable resources include:
- Money in a checking or savings account
- Stocks
- Bonds
Countable resources don’t include:
- Your home
- One car
- Burial plot
- Up to $1,500 for burial expenses if you have put that money aside
- Furniture
- Other household and personal items
How can I keep my costs down?
- Make sure your Medicare card is valid and that you’ve paid your Part B premium.
- Go to a doctor, other health care provider, or supplier that acceptsassignment.
- Read about how to get help with medical and prescription drug costs.
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SSI How to Qualify
Supplemental Security Income (SSI) is a disability program designed for those with a demonstrated financial need and a disability that prevents them from substantial gainful activity. In some cases, those over 65 years old may qualify for SSI even if they are not completely disabled according to the Social Security Administration (SSA)’s definition of total disability.
For those under 65 years of age, you must establish that you are both completely disabled and that you do not have adequate other means of support to qualify for SSI benefits. This means proving that your disability makes it impossible for you to perform any work, including both work which you have done before and any work for which you could otherwise be trained.
To qualify financially for SSI, you cannot own more than $2,000 worth of total countable assets (if you are married, you may jointly own up to $3,000 in assets). Countable assets are basically anything of value which you own except for the home which you live in and one vehicle. Your assets include such things as money in savings and checking accounts, IRAs and other retirement accounts, cash value in life insurance policies, vehicles (other than one vehicle for transportation), and virtually anything else of significant value.
If you are both disabled (according to the SSA definition) and can demonstrate your financial need (insufficient or no income and less than $2,000 in assets), you may qualify for SSI.
If you have worked during the past ten years, you should look into applying for SSDI while you are applying for SSI. Some people qualify for both. The main difference between the programs is that SSDI is an insurance program designed for those who had been working prior to their disability. SSI is also for disabled persons, but is specifically for those who have demonstrated a financial need. If you are disabled, you may qualify for SSI whether you have worked in recent years or not.
Generally speaking, the best time to file for SSI is as soon as you realize you may have a disability which is likely to last over a year. You should also apply if you have a disability which is expected to lead to your death, especially if it is expected to be terminal within the next year.
Children with certain disabilities may also qualify for SSI. If you suspect your child may qualify for SSI, check with the SSA concerning the current list of accepted conditions. The list of accepted conditions does change periodically, but once a child is medically qualified for SSI, he or she will continue to collect SSI (generally paid to a representative payeesuch as a parent or other guardian) even if his condition is taken off the list of accepted disabilities.
If your initial Social Security Disability claim is denied, you should consider having a disability lawyer represent you. Disability advocates deal with the SSA on a regular basis and represent your best chance of having your disability claim approved during the appeals process. While you certainly may represent yourself, a professional disability advocate can help the process go much smoother and the representation won’t cost you anything unless you are approved for disability benefits.
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Year of Birth * | Full Retirement Age |
---|---|
1937 or earlier | 65 |
1938 | 65 and 2 months |
1939 | 65 and 4 months |
1940 | 65 and 6 months |
1941 | 65 and 8 months |
1942 | 65 and 10 months |
1943--1954 | 66 |
1955 | 66 and 2 months |
1956 | 66 and 4 months |
1957 | 66 and 6 months |
1958 | 66 and 8 months |
1959 | 66 and 10 months |
1960 and later | 67 |
*If you were born on January 1st of any year you should refer to the previous year. (If you were born on the 1st of the month, we figure your benefit (and your full retirement age) as if your birthday was in the previous month.) |
The earliest you can start receiving Social Security retirement benefits will remain age 62.
Note: If you delay your retirement benefits until after full retirement age, you also may be eligible for delayed retirement credits that would increase your monthly benefit. If you decide to delay your retirement, be sure to
sign up for Medicare at age 65.
In some circumstances, medical insurance costs more if you delay applying for it.
Related Information
- Apply Online For Retirement Benefits
- Retirement Age Calculator
- Retirement Benefits By Year Of Birth
- Earnings Test Calculator
- Life Expectancy
Note: If you qualify for benefits as a Survivor, your full retirement agemay be different.
Publications
https://www.ssa.gov/planners/retire/retirechart.html