Having trouble paying for Medicare?

If you're having trouble paying your Medicare Part B monthly premium then this article is for you.

If you are having trouble paying for your Medicare supplemental insurance or prescription drug costs then you need to read this article. --> Click here.

Medicare Savings Programs

Here is some information on Medicare Savings Programs, which can help you with the costs of both your Part B premium and your Part D prescription drug costs. These programs do not reduce the costs of your insurance premiums but may reduce some of the out of pocket costs such as co-pays to doctors, hospitals and ambulance as well as reduce your prescription drug costs.

Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs, are state programs that assist you with paying your Medicare costs. The names of these programs may vary by state. In Maine the programs are often referred to as "Quimby" or "Slimby".

These programs can pay up to 100% of your premiums, deductibles, coinsurance charges, and copayments.

There are three MSPs, (https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-...) each with different federal income and asset eligibility limits.

States can raise these limits to be more generous, which allows more people to qualify for the benefits.

All three MSPs cover your Part B premium, which means your monthly Social Security check will increase by the amount you currently pay for your Part B premium if you qualify for and enroll in one of these programs.

Qualifying Individual (QI)

QI pays for your Part B premium and provides three months retroactive Part B premium reimbursement from the month of application. Note: you cannot have Medicaid and QI.

Specified Low-Income Medicare Beneficiary (SLMB)

SLMB ("Slimby") pays for your Part B premium and provides three month retroactive Part B premium reimbursement from the month of application. Note: you can have Medicaid and SLMB.

Qualified Medicare Beneficiary (QMB)

QMB ("Quimby") pays for your Part B premium and Medicare deductibles, coinsurance charges, and copayments. If you have a Medicare Advantage Plan, QMB pays for your plan’s cost sharing.

The program also pays for your Part A premium if you do not qualify for premium-free Part A. It does not provide three months retroactive Part B premium reimbursements; benefits start the first of the month after the month you are approved for the program.

Note: you can have Medicaid and QMB, but you cannot buy a Medigap plan once you are enrolled in QMB. You can however enroll in a Medicare Advantage plan and take advantage of the additional benefits offered on those plans, such as Dental, vision and gym membership reimbursements.

To verify your eligibility, you need to verify that you meet the income and asset limits in your state. 

In Maine

  • If you are single and your income is less than $1759 a month you may get help.

  • If you are married and your income is less than $2369 a month then you may get help.

  • If only one person in a couple wants the help, then the income limit may be as high as $2837 per month.

  • If you have earned income, the income limits may be higher.

  • Most assets do not Count. However, Liquid or cash assets greater than $58,000 for an individual and $87,000 for a couple will count. Liquid assets are those that are easy to convert to cash, such as checking/savings accounts, most retirement accounts, some annuities, etc.

You will apply at the Maine Department of Health and Human Services (DHHS).

In New Hampshire

See if you qualify: https://nheasy.nh.gov/#/screening

Apply online: https://nheasy.nh.gov/#/services/Medicare%20Beneficiary

For all Other States

To apply for an MSP, you will need to apply to your local Medicaid office or other state agency that receives MSP applications. You or a SHIP counselor can contact the local Medicaid office to learn how to apply. Many states allow you to submit your application online, through the mail, and/or through community-based organizations. Some states may require that you schedule an appointment and go in person to the Medicaid office to apply.  (https://www.medicare.gov/Contacts/)

What will you need to apply?

You will need to gather documentation for the application. The list of needed documents varies by state. Some examples of required documentation are:

  • Social Security card and/or Medicare card
  • Birth certificate or passport and driver's license
  • Proof of address, such as a utility bill
  • Proof of income, such as a Social Security Administration award letter, pay stub, or income tax return
  • Information about assets, such as bank statements or life insurance policies

You should make a copy of any application before submitting it. Once you have applied, your state Medicaid program should send you a notice within about 45 days to let you know if your application was approved or denied.

If you are approved for the MSP, you should begin to receive benefits on the date listed on the notice you receive. If there are any issues with your benefit, or if you have not received any decision from your state within 45 days, you should contact the Medicaid office where you applied. 

If you have any questions about how to apply or if you might qualify please contact us for help using this form --> https://www.mainemedicareoptions.com/contact

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