Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs). Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state's payment limit.
Medicare provides health care coverage for people over the age of 65 as well as those with disabilities, but it is not designed specifically for people with low incomes. There is a monthly premium cost associated with Medicare, as well as deductibles for some services; and it doesn’t pay for everything. It’s still possible to get stuck with very large medical bills even though you have Medicare.
Medicaid is the government program designed for people with lower incomes. Medicaid pays for a wider array of services, with lower associated costs. However, you have to qualify for Medicaid—and the income qualifications are quite strict.
There are plenty of people who need Medicaid, even though they don’t qualify for it. However, Medicare itself has a few programs designed specifically for lower-income people.
What Medicare offers whether you qualify for Medicaid...or not.
Medicare savings programs: Medicare savings programs come in several different varieties. Which one you qualify for depends on how much you make per month; the qualifying income limit is higher for most of these programs than for Medicaid, but you can qualify for both. They include, in order of lowest to highest monthly income limit to qualify
Qualified Medicare Beneficiary: This pays your Medicare Part A and Part B premiums as well as associated coinsurance and deductibles.
Specified Low-Income Medicare Beneficiary: This pays only for the Medicare Part B premium. You need to have Medicare Part A in order to be eligible.
Qualifying Individual: This pays only for Medicare Part B; and you cannot be eligible for both this program and Medicaid.
Qualified Disabled and Working Individual: This pays for only Medicare Part A premiums, and is designed for disabled employees younger than 65 who returned to work and, as a result, lost their Part A benefits.
Program of All-Inclusive Care for the Elderly. This program is designed to help people find healthcare resources near their homes so they can stay independent longer. The program colors dentistry, emergency and home care, hospital stays, laboratory and x-ray costs, occupational and physical therapy, preventive care, caregiver services, and prescription drugs, among other things. Medicare Part D Low income subsidy for medications
Medicare Part D low-income subsidy. This Medicare low-income subsidy helps pay for prescription drug costs. Depending on your income level, you could get your prescription drug costs either fully or partially covered.
Medicare is a federal program administered
on a state-by-state basis, and every state is slightly different in
terms of what types of help are available. It should also be noted
that you may qualify for one of these programs even if your monthly
income is slightly higher than the cut-off, because some resources
are not counted toward your eligibility.
In Texas these resources include:
Depending on your income and assets, you may be able to find some assistance in paying health care costs associated with Medicare.
For more information about Medicare programs and subsidies for people with low incomes in Texas, Check out the Texas Department of Insurance website: www.tdi.texas.gov
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