How to Escape Medicare Fees

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Robin Mead

If you are on Medicare, you may be charged co-pays and premiums.

This means you pay 20% of all bills for doctor visits, hospitals, medications and equipment, plus your Social Security check may be lowered by about $130 per month to pay premiums.

Good news! You may have some options to escape all this.

Why Do You Want Medicaid Plus Medicare?

Below you will find a list of are several options for help with Medicare fees. We are starting with Medicaid because this is often the best option. Why do you want Medicaid plus Medicare? Here’s why:

  • Pays your co-pays
  • Pays your premiums
  • In some states, provides dental and vision
  • In many areas, provides door-to-door transportation to doctors
  • Can also help you qualify for home aides, if needed
  • Some Medicaid programs do not provide everything above.

Many people (wrongly) think that they can’t get Medicaid. And many people (wrongly) are told that they can’t get Medicaid. And many people (wrongly) are told this by people who work at Medicaid! Why Is Someone Telling Me I Can’t Get Medicaid?

Option #1 – Aged, Blind, Disabled Medicaid

The simplest way to qualify is to apply for “Aged, Blind, Disabled Medicaid.”

  • Look up the income limits and resource limits in your state. Try googling the name of your state and the words: Aged Blind Disabled Medicaid
  • Important: Do not look at or ask about general information about qualifying for Medicaid. You won’t be eligible for regular Medicaid at this point.
  • Income limits are generally $800 – $1,200 per month, depending on the state.
  • Most (but not all) states have resource limits. Resource limits are often $2,000. Higher if married. One car and one house do not count.
  • Pro tip: Some states do not count all your income. For example: In California they do not count anything you spend on health insurance premiums. Many people in California purchase a small amount of supplemental health insurance, causing their countable income to fall below the limit, and allowing them to qualify for Aged Blind Disabled Medicaid.

Option #2 – Medicaid for Working Disabled Adults

If you are disabled and do any kind of work in any amount, you may be eligible for Medicaid for working adults with disabilities. Available in most states.

  • Requirements vary by state. Some require 10 hours per week of work, and some have no minimum work requirements.
  • Many people qualify based on small at-home businesses, such as babysitting, pet sitting, elder care, or making and selling arts and crafts.
  • These programs are often called “buy ins” and charge a small monthly fee
  • Some have very high income limits (i.e. $80,000 per year)
  • Some do not count disability benefits as income.
  • Some do not count spousal income
  • Some have higher asset limits or no asset limit
  • Some states have age limits 18-64
  • Reader’s story: Pansy qualified through her small business making jewelry at home: How Pansy Got Medicaid By Being Smart, Scrappy & Persistent
  • Pro tip: In states with minimum requirements for hours, there is often no minimum requirements for earnings. This is especially important for people who are self-employed. From Mass Legal Services “Advocates report that the MECs apply a flexible standard in recognizing employment, sometimes using a $1 per hour rule of thumb to identify employment.”

Option #3 – Medicaid Waivers

If someone in your life assists you with personal care (such as bathing, feeding, dressing or mobility), or if you need this kind of help – you can look into Applying for Medicaid Waivers. If you only need this kind of help partially or some of the time, in some cases, you may still qualify. Available in all states.

  • Most Medicaid waivers provide all of the benefits listed above.
  • They also provide home aides for personal care and household chores.
  • They often provide other services as well.
  • Income limits are between $800-$2,200 per month.
  • In many states, your spouse’s income will not count.
  • Resource limits are often $2,000. Higher in some states and higher if married.
  • One house and one car do not count
  • If you are above the income or resource limit, there may still be ways to qualify: How to Apply When You Have Too Much Money
  • This program is designed to keep people out of nursing homes.
  • Stories from readers: How I Got Approved for a Medicaid Waiver.

Option #4 – Medicaid Spend Down or Share-of-Cost Programs

In some states, these programs are pretty awful and will leave you impoverished. If you get offered a steep share-of-cost, look into the programs above instead.

Option #5 – Apply for SSI

If your SSDI check is below $770 per month and your other income and assets are low, you may be eligible to also collect SSI. In most states, this means you would automatically get Medicaid as well.

Option #6 – Medicare Savings Programs

Medicare Savings Programs are also run by Medicaid. They may be called QMB or SLMB or something different in your state.

  • This is not as good as getting full Medicaid, but it’s still pretty good.
  • Medicare Savings programs will this will pay for all your premiums. In some cases, it may also pay your deductibles and co-pays.
  • It will not give you other Medicaid services (such as transportation, vision, dental, home aides, and any services not covered by Medicare).
  • Pro tip: Don’t get scared off by Medicare website, which, oddly, does not include the correct information about the financial criteria for all states. Instead, check out this actually accurate guide to Medicare Savings(Update: This page is from 2017 but will give you a general idea. Check your state for updated info)

Option #6 – Call SHIP

Many of our readers report that the SHIP program was very helpful to them in figuring out the best Medicare plan to use.

  • The SHIP program only knows about Medicare – they will not know details about most Medicaid programs listed above.
  • Try Medicaid first. Medicaid is much better!!! If you are completely unable to get Medicaid, and must make it work on just Medicare, SHIP can be very helpful.
  • They may be able to help you navigate Medicare plans, covering your prescriptions, and selecting supplemental insurance to purchase.

Option #7 – Keep Medical Costs Down

More programs that may assist:

What Do You Think? 

Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working. 

Updated May 2018. If you found this page helpful, please share it with others by pressing one of these magic little buttons: 

6 thoughts on “How to Escape Medicare Fees”

  1. This page has been so very helpful. Do you have any plans on expanding your Medicare section? Assistance for finding affordable secondary insurance plans if Medicaid only covers the Part B premium and navigating the rest of what Medicare covers?

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    1. Hi Gigi,

      So glad it helped. I do not know more about Medicare plans, but I’ve met people who said calling a SHIP counselor was very helpful with figuring out this kind of thing ❤

      Like

  2. Super “How To”‘s! If I am eligible for Medicare (because eligible for SSDI), do I have to accept Medicare (or can I just stay on my private Insurance)?

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    1. I don’t know a lot in this area. I believe there is a way to decline the medicare, but then want to get the medicare later there may be a penalty.

      If your private insurance is through the ACA Marketplace, you may lose eligibility for it if your income goes down below the minimum, so that might be another thing to look into.

      Like

  3. I am on Social Security disability. I have called in applied for assistance for medical they told me I had to meet a $500 deductible before they could help I have to live on $1,200 a month after insurance paid. I had a bad Dental problem that caused an abscess and had to have the tooth extracted $600 now if I pay $500 of it I have $600 left to pay my rent food and everything how is this possible I’ve applied for assistance for everything they say I make too much money any ideas

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    1. Hi Patricia,

      Are you already on medicare and you were trying to get on medicaid?

      If that is what happened, they are giving you the information for a medicaid spend down program. That is the worst medicaid program and it leaves people impoverished. You don’t want that program.

      Please see links above. There are many other ways people find to get medicaid and avoid spend downs.

      Another option is to get on a medicare savings program. that won’t pay for dental, but it will pay your co-pays. Again, links are above.

      There are also some ideas for dental here: https://howtogeton.wordpress.com/2017/08/11/how-to-go-to-the-dentist-when-you-cant-afford-to-go-to-the-dentist/

      You also might want to double check and make sure medicaid covers dental for adults in your state. in some states it does not.

      I hope it goes well for you. ❤

      Like

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