How to Escape Medicare Fees

Art: 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 roughly $130 per month to pay premiums.

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

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Secret Tips from Readers

Finding a way to get or stay on Medicaid (while also on Medicare) is often a good option. If you have Medicaid, you may not have to worry about choosing plans, buying supplemental insurance, or anything else, since many forms of Medicaid will pay for everything automatically.

Sadly, many of our readers readers report that after they got approved for disability, they were turned down for Medicaid or told by Medicaid that they were not eligible at all, or only eligible for a form of medicaid that was expensive, or a form of medicaid that didn’t cover their medical bills.

Happily, many of our readers also report that this turned out not to be true! There may be more Medicaid programs you can apply for that no one tells you about.

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“I Don’t Believe I Can Get Medicaid”

Maybe it will help to see a sample of how many different Medicaid programs one state can have. Here’s a few examples of different Medicaid programs and income limits from a sample state. Income Limits for a Single Person:

• Medicaid Spend Down: $590/month
• Aged Blind Disabled Medicaid: $780/month
• Medicare Savings Program/QMB: $1,060/month
• Medicare Savings Program/SLMB: $1,400/month
• Medicaid Waiver/Long Term Care: $2,300/month
• Medicaid Buy In: $4,600/month
• MAGI Medicaid: Disabled people can’t apply
• Medicaid for families: Disabled people can’t apply

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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 arts or crafts from bed and selling on Etsy. Some states require ten hours per week, and other states require one hour per month. 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. 

Pro Tip: Some states exclude premiums. Medicare part A and B premiums won’t be excluded, but the amount you pay for any other insurance premiums is deducted from your “countable income.” If you’re close to a limit, sometimes picking up a little insurance with a premium gets you under. Sometimes people purchase a small amount of dental or vision insurance for this reason.

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

• 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
• Many excellent programs that provide cheap or free medications: How To Be Broke & Medicated

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

• Assistance with premiums and co-payments: Patient Services
• Co-payments for important medical treatments: The HealthWell Foundation
• Free Medical Care programs: When You Can’t Afford to Go to the Doctor
• 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

Option #15 – Save Money Other Ways

• Discounts and free services for people with disabilities: How to Be Poor in America
• Affordable housing is the number one biggest way our readers report achieving financially stable while on disability: Section 8 Guide for the Disabled and Plucky

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 2019. If you found this page helpful, please share it with others by pressing one of these magic little buttons: