Help Paying Medicare Premiums: Programs to Know

Fact checked by Nick Blackmer

Medicare is a federally-funded healthcare program for people 65 and older and for people with certain disabilities, as defined by the Social Security Administration (SSA). More than 65 million people rely on the program. But to take advantage of it, they need to be able to afford the monthly premiums.

Whether you sign up for Original Medicare (Medicare Parts A and Part B, run by the federal government) or Medicare Advantage (Part C, run by insurance companies), you will be responsible for paying Part B premiums. For many people, this can be one of the most costly parts of Medicare.

You may also have to pay premiums for other parts of Medicare—Medicare Part A, Medicare Advantage, and/or Medicare Part D if you need prescription drug coverage.

This article will review assistance programs and other ways you can get help paying for Medicare premiums.

Medicare Is Not Free

If you worked in a job that paid Medicare taxes for 40 quarters (10 years) or more, you do not have to pay premiums for Medicare Part A. This is often referred to as premium-free Part A. While you do not have to pay premiums, this does not mean the care you receive is free.

For the care you receive, you are still responsible for paying any deductibles (an amount you must pay before insurance covers expenses), coinsurance (a percentage of the cost of a service received), and co-payments (co-pays, a set amount paid for a service received).

Medicare Savings Programs to Help Pay for Medicare Premiums

The Centers for Medicare & Medicaid has set up four Medicare Savings Programs (MSPs) that can help decrease what you pay for Part A and Part B coverage. Even though these programs are for Medicare, they are run through your state Medicaid office.

Programs That Help With Part A Expenses

Qualified Medicare Beneficiary (QMB) program: This assistance program is the most extensive. It not only helps pay your Part A premium, but it also decreases what you pay for monthly Part B premiums, annual deductibles, coinsurance, and co-pays.

Qualified Disabled and Working Individual (QDWI) program: This program is specifically for people who have a disability but who have lost their Social Security benefits because they returned to work. This program helps pay for their Part A premiums if they haven’t worked 40 quarters or more.

Programs That Help With Part B Expenses

Qualified Medicare Beneficiary (QMB) program: This program helps cover both Part A and Part B costs, including premiums, deductibles, coinsurance, and co-pays.

Specified Low-Income Medicare Beneficiary (SLMB) program: If you are enrolled in both Medicare Parts A and B, this assistance program helps to pay your Part B premiums.

Qualifying Individual (QI) program: Similar to the SLMB program, the QI program pays for Part B premiums if you are enrolled in both Medicare Parts A and B. One important difference is that people who qualify for Medicaid are not eligible for this particular program.

Part B Premium Reduction

Some Medicare Advantage plans offer a Part B premium reduction, also referred to as the Part B giveback. Available since 2003, this benefit has become more common in recent years. Insurance companies are using it to entice more customers.

Simply put, if you sign up for a plan that offers this benefit, the insurance company will pay part or all of the Part B premium for you, as much as $174.70 in 2024. You can change to one of these plans during Open Enrollment.

Income Requirements to Qualify for Medicare Premium Assistance

Every year, the Centers for Medicare & Medicaid Services sets income and resource limits for the four Medicare Savings Programs. These rates tend to be higher in Alaska and Hawaii.

Not everything you own will count toward the resource limit. The programs will look at your bank accounts, retirement accounts, and stocks and bonds, but your primary residence, car, furniture, personal belongings, burial plots, and up to $1,500 of savings set aside for burial expenses will not be counted.

While the federal government sets the standard rates, each state has the final say as to the final numbers. For this reason, you will want to reach out to your state Medicaid office to learn out about their specific income and resource requirements and to access the appropriate application.

The following table lists the standard rates set by the federal government, starting with the lowest income limits.

Inflation Rebates

When the Inflation Reduction Act was passed in 2022, it had a provision that required drug companies to pay money back to Medicare if the cost of their drugs increased more than the rate of inflation. Medicare then passes those savings onto you by decreasing your coinsurance for those drugs. These inflation rebates started on January 1, 2023.

Medicare inflation rebates apply to drugs that are covered by Medicare Part B, not by Part D. Typically, you would pay a 20% coinsurance for each purchase of a Part B-covered drug. If your medication is one of those affected by an inflation rebate, your Part B coinsurance will automatically be decreased by the appropriate amount. You do not need to complete any paperwork.

As an example of the savings, for the period of January to March 2024, about 1 in 4 of the included drugs have a coinsurance below 16% for Medicare recipients.

Medicare Premium Appeals

What you pay in Medicare Part B premiums is based on how much money you make. Medicare will look at your income taxes from two years ago to assign you to an income bracket.

For example, income taxes filed for 2022 will decide how much you will pay for Medicare premiums in 2024. You will pay higher Medicare Part B premiums when you are in higher income brackets.

However, earnings on your tax forms from two years ago may not reflect your earnings today. If you had a major life event that changed your income—such as retirement—you could make an appeal to Medicare to move you to a different income bracket.

Moving to a lower bracket could save you a considerable amount of money on Medicare Part B premiums.

Life-changing events that Medicare will consider include:

• Death of your spouse

• Divorce or annulment

• Employer settlement payment

• Loss of income-producing property

• Loss of pension income

• Marriage

• Work reduction or stoppage

If you had any of the major life events above, you will want to complete Form SSA-44, Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event. The form is available through the Social Security Administration and can be submitted to SSA by mail, fax, or in person.

If you have any questions, you should reach out to your local Social Security office or call 800-772-1213 (TTY 800-325-0778).

Summary

If you find it challenging to afford Medicare, assistance programs are available that can help decrease your Medicare Part A and Part B costs. Four Medicare Savings Programs (MSPs) are available, with qualifications depending on your current income and assets.

You can apply for an MSP through your local Medicaid office. These programs can decrease what you pay in premiums, deductibles, coinsurance, and co-pays.

Medicare Savings Programs are not the only way to save. You may also be able to decrease your Medicare Part B costs by signing up for a Medicare Advantage plan that offers a Part B premium reduction, aka Part B giveaway.

You can also appeal your Part B premium costs if you have had a life-changing event that puts you in a different income bracket than your income tax bracket. Be proactive and get yourself the best rate.

Read the original article on Verywell Health.