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. On top of all this, if you are currently on Medicaid, in most cases, your Medicaid will automatically end when your Medicare starts.

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

Option #1 – Aged, Blind, Disabled Medicaid

The simplest Medicaid program is “Aged, Blind, Disabled Medicaid.” Sometimes when people are already on Medicaid, they automatically get switched to this program if their income is not too high.

  • Financial Criteria: Income limits vary by state and are generally $800-$1000 per month. Higher in California. Higher if married.
  • There are also resource and asset limits.
  • There are some exceptions to the financial rules, see link above.
  • Covers all co-pays and premiums (raising your monthly check by $130). In some states, also provides: dental and vision, transportation to doctors, salary for home aides, if needed.
  • Learn more: About Aged Blind Disabled Medicaid

Option #2 – Medicaid Buy Ins

Medicaid program for working people with disabilities. Many people with disabilities who are not able to work a regular job are still able to qualify for this program if they are doing any kind of self-employment or at-home work, for example: babysitting, pet sitting, tutoring, elder companion, helping neighbors, or making and selling art. Some states require ten hours per week, and other states have no minimum. Available in most states. Requirements vary by state.

  • Financial Criteria: Income limits are often high (like up to $80,000 year!). Many states do not count spousal. May or may not have resource limits. Some states exclude all disability income and only look at work income.
  • Covers all co-pays. Sometimes covers premiums (raising your monthly check by $130). In some states, also provides: dental and vision, transportation to doctors, salary for home aides, if needed.
  • Learn more: Medicaid Buy In Programs

Option #3 – Medicaid Waivers

Designed to help keep people out of nursing homes and institutions. For people who need assistance in their homes. Some states also have medicaid waiver programs for mental illness.

  • Financial criteria: Varies by state. Also has a resource limit.
  • Ignore if you see figures for married couples. Most states do not count spouse’s income if your spouse is not also needing aides.
  • Ignore if you see charts with medicaid income limits. This is a different form of medicaid with different rules.
  • Monthly limits are typically $800-$2,200. For higher income, you may still have options: How to Apply When You Have Too Much Money
  • What’s covered: Salary for home aides. Self directed care (select your own aide). Usually covers all co-pays. In some states, also provides: assistive technology, home modifications, home delivered meals, dental and vision, transportation to doctors, many other services, and premiums (raising your monthly check by $130).
  • Learn more: The Sleepy Girl Guide to State Home Aides

Option #4 – Medicaid Spend Down, Medically Needy 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 other programs on this page instead.

Option #5 – Don’t Give Up On Medicaid

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?

Reader’s story: Pansy was on Medicare and the Medicaid offie told her that she could not get Medicaid. She did not give up, and Medicaid covered her $40,000 hospital bill: How Pansy Got Medicaid By Being Smart, Scrappy & Persistent

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.
  • Some programs will also pay co-pays, some will not.
  • 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

Option #7 – Adult Disabled Children

  • This is a special benefit for people who first became disabled before the age of 22 (doesn’t matter what age you are now)
  • Some people lose SSI when they switch to disabled adult child benefits
  • There is a special rule that can help you keep your Medicaid in this situation. Learn more: Disabled Adult Child Benefits

Option #8 – Call SHIP

Many of our readers report that the SHIP program was very helpful to them:

  • SHIP can help you figure out the best supplemental Medicare insurance to purchase and which Medicare plan to use
  • They may also be able to advise you on using other Medicare programs, that can cut your bills down
  • If you cannot get on Medicaid, then purchasing Supplemental medicare insurance can be a big help with your medical bills
  • Pro tip: Act quick! If you are going to get supplemental insurance, it is best to purchase this within the first six months of your Medicare starting. After that it can become much more expensive and difficult to get. This process is called “underwriting.”
  • Pro tip: The SHIP program only knows about Medicare programs – they probably will not advise you on Medicaid waivers and Medicaid buy ins.
  • One popular form of supplemental insurance that assists with Medicare costs: Medicare Advantage plan.

Option # 10 – Hospital Charity Care

  • Some of our readers report that when they had expensive surgeries or medical testing, Medicare paid 80% and the hospital waived the other 20% as part of their charity care program.
  • Contact your hospitals billing and financial aid offices to inquire.

Option #11 – Cheaper Meds

Option #12 – Medicare Assignment

If none of the above programs work, and you still have co-pays….

  • Providers that “accept Medicare assignment” agree to charge a fixed fee set by Medicare. This often means your co-pay will be lower.
  • Cheaper doctors and hospitals: Check the Medicare Provider Directory and/or look for providers that “accept medicare assignment.”
  • Cheaper medical supplies and equipment: Check the Medicare Supplier Directory and/or look for suppliers that “accept medicare assignment.” Some areas have changed to a bidding system, and instead there will only be a limited number of suppliers that won the bid to sell you medicare equipment.

Option #13 – Paying Out of Pocket 

  • Documenting medical expenses can lower your taxes and raise your food stamps. How to Document Medical Expenses
  • If you are in subsidized housing, this can also lower your rent.

Option #14 – More Options for Low Cost Health Care

Option #15 – Save Money Other Ways

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: 

15 thoughts on “How to Escape Medicare Fees”

  1. First of all, thank you for creating such a comprehensive webpage for resources and information on SSDI! Amazing. I have a few questions that maybe you know the answer to. I was just sent a Notice of Decision by the ALJ which states a “Fully Favorable” outcome. In reading about it more, I understand there is still a long wait while the case is possibly reviewed by the appeals council and so on. I have a lot to consider with this…like $300K in both private and federal student loan debts (mainly federal, I think), and also 2 young children, and the fact that I am married and my husband makes between 75-100K per year, depending, and our home is in his name, so there is a lot I don’t know yet about how this will play out. Obviously, I want to figure out how to discharge the debt, I need to understand how to deal best with taxes, and it would be amazing to have my children qualify for some amount of this so we can afford their school and such, but for this particular issue, do you know how insurance is dealt with if we are fully covered under the county insurance for LIFE thanks to my husbands job for the past 30 years? Would I still be forced to pay Medicare expenses? I am 38, and the disability is the result of an accident, but the report sent to me also says they will review my case in 36 months because they believe my condition will improve….the dated the start of the disability as Nov 2014. 2 years before I actually applied, too. So, is this considered permanent disability, or something else? It’s all very confusing. I am sure I have a thousand more questions to ask, but if you know any of the answers to these, I would appreciate your feedback! Thank you!

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    1. Congrats on your approval.

      A three year medical review is very standard.

      Social security doesn’t have a designation “permanent disability”

      I can’t answer your medicare question. You could try asking the ship program https://www.shiptacenter.org

      If your doctor is willing to complete the form, you’d be eligible to discharge the federal loans, and some readers have success with the private ones too.

      hope this helps ❤

      Liked by 1 person

  2. Hi,
    I have a compassionate allowance diagnosis and received my approval letter as well as notice that I am automatically enrolled in Medicare which would start 11/1/18. I of course have been out of work for 2 years, (not married etc), in a lot of debt due to COBRA and copays while they tried to figure out what I have (rare neurodegenerative brain disease), and currently on Medicaid because of no income.
    My disability payments put me over the financial cap for Louisiana Medicaid ($750/mo); though I haven’t received a monthly payment yet, I’m assuming I need to notify my Medicaid provider.

    My question is what do I do between now and 11/1/18? I CANNOT be without insurance (currently have speech and physical therapy visits)

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  3. Hi,
    I have a compassionate allowance diagnosis and received my approval letter as well as notice that I am automatically enrolled in Medicare which would start 11/1/18. I of course have been out of work for 2 years, (not married etc), in a lot of debt due to COBRA and copays while they tried to figure out what I have (rare neurodegenerative brain disease), and currently on Medicaid because of no income.
    My disability payments put me over the financial cap for Louisiana Medicaid ($750/mo); though I haven’t received a monthly payment yet, I’m assuming I need to notify my Medicaid provider.

    My question is what do I do between now and 11/1/18? I CANNOT be without insurance (currently have speech and physical therapy visits)

    Like

  4. 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

    Like

    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

    2. Hi! I’m a Medicare Insurance Agent. I hear this so often. I’m so sorry for your hardship. If you’re on Medicare, you can call the social security office and tell them that you would like to apply for “extra help” and also known as “LIS,” if approved, that will help to cover prescription premiums and deductibles and it helps you apply for a Medicare Savings Program, even if you aren’t eligible for Medicaid. They sometimes cover the Part B premium, copays and deductibles depending on the level you’re approved for. Depending on the level granted, you might qualify for a Dual Special Needs Plan, also known as a D-SNP. This is a Medicare Advantage Plan (MAPD) that usually has no monthly premium and low copays, deductibles and co-insurance if any. Most of these plans have built in Dental, Vision and Hearing benefits along with many other benefits like Over The Counter Benefits that will buy your vitamins, Tylenol, first aid products, ect at a pharmacy, a Transportation benefit that can give you rides to your appointments or to the pharmacy, a Fitness Membership, Meal delivery at home for a certain amount of time if you’re discharged after a hospital inpatient or nursing home stay, a Lifeline Assistance benefit, Chiropractor visits and so many more. There are so many and I run into many people who don’t know what is available to them. I would definitely try this out! Best of luck to you. Feel free to reach out if you have any questions or I can do anything to help!

      Like

  5. 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

    2. After your 24 months of disability, you’re usually automatically placed on Medicare. If you’re private insurance is not connected to your Medicare, you are able to keep it. Your Medicare will be your primary insurance and your private insurance will be your secondary. My husband and I are Medicare Insurance Agents and I hope this gave you a little more information. There is so much to know with policies and so many just don’t know their options and even more don’t even know what their plans actually provide! Best of luck!

      Like

  6. 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?

    Like

    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

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