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-savings-program/medicare-savings-programs.html#collapse-2625) 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

Need more help comparing the different health insurance plans?  I can help you.

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
Have a question that needs to be answered right away? Just give me a call at your convenience.  You can talk to a licensed insurance agent at (207) 370-0143
or call toll free 866-976-9038.
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Get Help With Your Healthcare Costs

You may qualify for help with your premiums, deductibles, copayments, or prescription costs with Extra Help or with a Medicare Savings Program.


Medicare has 4 savings programs that can help with your healthcare costs:


Qualified Medicare Beneficiary (QMB) Program (also known as the Medicare Buy-in)

Individual monthly income limit* – $1,001
Married couple monthly income limit* – $1,348
Program helps pay for:  Part A premiums, Part B premiums, Deductibles, coinsurance, and copayments

Specified Low-Income Medicare Beneficiary (SLMB)

Individual monthly income limit* – $1,197
Married couple monthly income limit* – $1,613
Program helps pay for:  Part B premiums only

Qualified Individual (QI) Program

Individual monthly income limit* – $1,345
Married couple monthly income limit* – $1,813
Program helps pay for: Part B premiums only

Qualified Disabled and Working Individuals (QDWI)

Individual monthly income limit* – $1,962
Married couple monthly income limit* – $2,655
Program helps pay for:  Part A premiums only


Save on Drug Costs

If you have limited income and resources, you may also qualify for “Extra Help” to help pay your Medicare prescription drug costs, like premiums, deductibles, and co-payments.
In 2015, drug costs for most people who qualify are no more than $2.65 for each generic/$6.60 for each brand-name covered drug.  Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. 
In 2015, you may qualify if you have up to $17,505 in yearly income ($23,595 for a married couple) and up to $13,440 in resources ($26,860 for a married couple).
If you don’t qualify for Extra Help, your state may have programs that can help pay your prescription drug costs. Contact your State Medical Assistance (Medicaid) office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.  (To apply online follow the link at the end of this article.)

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

Apply for Extra Help – Contact Social Security.

Find out if you qualify for a Medicare Savings Program. You can apply online or visit your local State Health Insurance Program. Call Social Security toll-free at:  1-800-772-1213 or TTY 1-800-325-0778, Monday-Friday 7am-7pm

Would you like my help?

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.  The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

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*Medicare Savings Program Income Limits are for 2015 (2016 amounts are released in March).