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.
- You have to be poor to qualify: How Poor Do I Have to Be?
- To apply, call Social Security and request an SSI Interview.
- If you are not eligible for SSI because you have too much savings or too many resources, If You Are Over the SSI Resource Limit
- If you are not eligible for SSI because your spouse has too much income, you probably can’t change this. But do check back if you have more children or get divorced or live separately.
- If you are not eligible for SSI because you have too much income from gifts, inheritance or other sources look here: I Have Too Much Income
- Also check out: Ten Common Reasons SSI Might be Denied or Stopped
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:
- Cheaper prescriptions: See if you are eligible for Medicare Extra Help.
- If you have too much money for Medicare Extra Help, try: Medicare state pharmaceutical assistance
- Purchasing Medicare supplemental insurance. See SHIP program above.
- One popular form of supplemental insurance that assists with Medicare costs: Medicare Advantage plan.
- 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.”
- Cheap or free medications: How To Be Broke & Medicated
- Assistance with premiums and co-payments: Patient Services
- Co-payments for important medical treatments: The HealthWell Foundation
- Dental care: When You Can’t Afford to Go to the Dentist
- Lab tests: How to Get Free or Cheap Lab Tests
- Got big medical bills? How to Deal with Debt & Disability
What Do You Think?
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Updated May 2018. If you found this page helpful, please share it with others by pressing one of these magic little buttons: