Health care costs in the United States are spiraling out of control. Even with Medicare many are struggling to pay the ever-increasing costs of inpatient and outpatient services. When you add in the high prescription drug prices, it gets even harder! This article will briefly examine some options that can help you optimize your health care. Think of it as a primer that can guide your research and point you in the right direction in terms of acquiring further information.
As you probably know, Medicare doesn’t cover 100% of your health care costs. For one thing, the federal government’s health care program is fairly strict about only providing assistance with health care that it deems “medically necessary.” Even if your care, supplies, and consultations meet Medicare’s “medically necessary” criteria, the government typically pays 80% of the service or supply costs. That leaves you picking up the tab for the remaining 20%.
Assistance with medical premiums
If you meet Medicare’s low income standards, you may qualify for a Medicare Savings Program (MSP). These programs are also known as Medicare Premium Payment Programs or Medicare Buy-in Programs. They are divided into three main categories that have different income eligibility limits. The first MSP is called the Qualified Medicare Beneficiary program; it pays for Part A and Part B premiums, co-pays, and deductibles. The second MSP is called the Specified Low Income Medicare Beneficiary program. This one pays for Medicare’s Part B premium. The third MSP is called the Qualifying Individual Program, which also pays for Medicare’s Part B premium. You may also be eligible for a less common MSP called the Qualified Disabled Working Individual program. Contact Medicare directly at 1-800-633-4227 to see if you qualify for these MSPs.
Another option that may help you with your healthcare costs is veteran benefits. The Department of Veterans Affairs provides qualified individuals with healthcare and prescription drug discounts.
You may also want to use low-cost health centers and clinics in your local area. Medicare-approved services generally cost less at these state-run clinics. You can call your State Health Insurance Assistance Program by finding the appropriate phone number at the SHIP website.
Assistance with prescriptions
You should also consider Medicare supplemental insurance, sometimes called Medigap, if you have Original Medicare Part A and Part B but are struggling with high out-of-pocket costs. Medigap policies are offered through third-party health insurance companies as well as some employers.
If you’re having trouble paying the high cost of prescription drugs, the federal government offers a program called Extra Help that may assist you with costs for Medicare’s Part (prescription drug) plan. You may qualify for Extra help if
- your monthly income is below $1505 (or $2022 for couples)
- your assets including financial accounts and real estate are below $13640 ($27250 for couples)
If you’re enrolled in Medicaid, a Medicare Savings Program, or you receive Supplemental Security Income, you are automatically in the Extra Help program. If not, you can apply at your local Medicaid office or by contacting the Social Security Administration.
Finally, you may receive prescription drug cost assistance from State Pharmaceutical Assistance Programs (SPAPs). These organizations are managed by your state of residence, and most of them have income level restrictions. You can find contact information for SPAPs at the official Medicare website. It’s worth noting that not all states feature SPAP programs. If you state is not listed in the search function under the prior link, you should seek out the other alternatives mentioned above.