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What if I cannot afford Medicare?

Several programs can help you pay different Medicare costs. Your income and resources must be low enough to use these programs. Resources are things you own, like savings accounts, jewelry, a boat, stock, etc.

Medicare Savings Program

MassHealth Senior Buy-In and MassHealth Buy-In help low income elders and younger Medicare beneficiaries get Medicare benefits.

If you get MassHealth, it will pay your Part B premium and your Medicare prescription drug coverage, Medicare Part D. You may also be able to get help paying out-of-pocket co-payments to doctors and hospitals.

If you have a Part A premium, MassHealth may help pay your premium also.

For 2017, if you are single, your “countable income” must be less than $1,377/month and the things you own must be worth less than $7,390.

For couples, your “countable income” must be less than $1,847/month and the things you own must be worth less than $11,090. You can also have up to $1,500 per person in a burial account, but the money set aside for burial must be in a separate bank account.

Call the MassHealth Enrollment Center for an application: 1-888-665-9993.

“Extra Help” or the Low-Income Subsidy Program

The Social Security Administration offers the Extra Help program to help pay for some Medicare Part D costs. Extra Help can help pay premiums, deductibles, coinsurance, and copayments.

In 2017, your "countable income" must be less than $18,090/year (for an individual) or $24,360/year (for a couple with no other dependents). Your resources must be less than $13,820 (for an individual) or $27,600 (for a couple with no other dependents).

Some people get Extra Help automatically. If you can get Extra Help automatically, Medicare will write to you. If you do not get a letter from Medicare about Extra Help, you can apply online or call the Social Security Administration at 1-800-772-1213.

Prescription Advantage

Prescription Advantage is a prescription drug insurance plan for any Massachusetts resident who is 65 or older.

Younger people who have a disability who meet income and employment limits may also be able to get Prescription Advantage.

Prescription Advantage may help pay all or part of the Medicare prescription drug plan’s drug co-payments.

Prescription Advantage will also provide an “out-of-pocket spending limit”. Once you have spent enough of your own money to reach this limit, Prescription Advantage will cover drug co-payments for the rest of the plan year.

As of April 1, 2017, if you are 65 or older, your countable income must be less than $5,025/month (for an individual) or $6,676/month (for a couple).  If you are under age 65 and disabled, your countable income must be less than $1,889 (for an individual) or $2,544 (for a couple).

To apply, contact Prescription Advantage Customer Service at 1-800-243-4636 (option 2).

Medigap

Some private insurance companies sell Medigap policies. Medigap policies are another kind of health insurance. These policies help you pay for expenses like coinsurance. You have to pay a monthly Medigap premium in addition to your monthly Part B premium.

Medigap policies must follow strict Federal and state laws and regulations about benefits, coverage, and when you can apply. The best time to buy a Medigap policy is during the 6-month period that begins when you are 65 and first enroll in Part B. After that 6-month period, your option to buy a Medigap policy may be limited.

To find out more about eligibility and enrollment in Medigap policies, see Medicare's Medigap Policy Search or download their pdf file Choosing a Medigap Policy. You can also call 1-800-Medicare.

Produced by Greater Boston Legal Services, Massachusetts Legal Assistance Corporation, Community Legal Aid, and Massachusetts Law Reform Institute
Last Updated March 2017

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