Getting Help Paying for Medicare in Missouri

There are many state, federal, and joint programs available to Medicare beneficiaries that can assist if medical costs are too high. Some help with Medicare Part A and Part B premiums, others help with deductibles, copayments, coinsurance, and there is even help paying for prescription drug costs. 

To calculate your income and resources for these programs you should count any cash in checking or savings, along with stocks and bonds. Don’t count your home, car, furniture, or other personal items. There are some other exceptions, so be sure to ask us about what should be included. The qualifying income limits for each program are changing year to year, so we suggest applying even if you’re a little over the limits.

Medicare Savings Programs

If you’re eligible for Part A, you could get assistance from state programs to help with Medicare Part A and Part B costs. These programs could cover premiums, copays, coinsurance, and deductibles so it’s important that you at least apply if you have lower income or resources than listed in the chart below.

Qualified Medicare Beneficiary Program (QMB)

If you are part of this program, you’ll receive a QMB card which you should show to anyone you get services from. You won’t have to pay any premiums for Part A or Part B. You shouldn’t be charged for copays, coinsurance, or deductibles. You’ll receive a deep discount for prescription drugs.

Specified Low-Income Medicare Beneficiary Program (SLMB)

The SLMB Program pays for Part B premiums only.

Qualified Individual Program (QI)

The QI Program also pays Part B premiums, and participants are given coverage in the order applications are received. Past participants are given priority. You won’t be eligible if you qualify for Medicaid.

Qualified Disabled and Working Individuals Program (QDWI)

The QDWI Program is for people who don’t qualify for premium-free Part A because they went back to work after having Part A, or they are disabled and working. You also can’t be receiving state medical help.

Medicare Savings Program Income/Resource Limits for Missouri (Monthly)

Income Limit
Single
Income Limit
Married
Resource Limit
Single
Resource Limit
Married
Pays For
Qualified Medicare Beneficiary Program (QMB)$1,084$1,457$7,860$11,800Part A premiums
Part B premiums
Deductibles, coinsurance, and copayments
Specified Low-Income Medicare Beneficiary Program (SLMB)$1,296$1,744$7,860$11,800Part B premiums only
Qualified Individual Program (QI)$1,456$1,960$7,860$11,800Part B premiums only
Qualified Disabled and Working Individuals Program (QDWI)$4,339$5,833$4,000$6,000Part A premiums only

Medicare has a program called Extra Help that you automatically qualify for if you are a part of one of these programs. More details are below.

“Extra Help” for Prescription Costs

The Extra Help Program helps people in certain income brackets afford their medications. It pays for participants’ Part D premiums, copays, deductibles, and drug costs in whole or in part. Participants pay $3.60 for generic drugs and $8.95 for brand name drugs.

Your Extra Help benefits will continue year after year unless your income changes. If this happens, Medicare will send you a notice and you should apply again. Your copayments could change too, but Medicare will let you know before the end of the year.

You can apply for Extra Help alone, but if you think you qualify for it, you probably qualify for other programs too, so you should apply to those first. Other programs like Medicare Savings Programs, Medicaid, or Supplemental Security Income will automatically qualify you for Extra Help.

Extra Help Income/Resource Limits in Missouri (Yearly)

Income Limit
Single
Income Limit
Married
Resource Limit
Single
Resource Limit
Married
Pays For
Extra Help$19,140$25,860$14,610$29,160Part D premiums
Part D deductibles, coinsurance, and copayments

Medicaid

Medicaid is a government program for people with lower income. It kicks in to cover leftover expenses after Medicare or any private plans have paid. It also covers some services that Medicare doesn’t- like a nursing home. MOHealthNet in Missouri also has programs that help with daily activities so people can continue to live at home with assistance.

To see if you qualify for Medicaid, look at the chart below.

2020 Medicaid Income/Resource Limits in Missouri (Monthly)

Income Limit
Single
Income Limit
Married
Resource Limit
Single
Resource Limit
Married
Pays For
Regular Medicaid for Aged, Blind, and Disabled$904$1,222$4,000$8,000Most costs not covered by Medicare or other insurance

In addition to Regular Medicaid, Missouri also offers Medicaid for Home and Community based care, as well as Nursing Homes. Income levels for these programs are different, so be sure to check with us for specifics.

If you qualify for Medicaid, you automatically qualify for the Extra Help program above. See our full article on Special Needs Programs for those with disabilities.

Qualifying for Medicaid with Spend Down

If your income is higher than the chart allows, but your medical costs are very high, you could qualify for Medicaid through Spend Down. In Missouri this means that each month after your medical costs bring your income into the allowable levels, then Medicaid kicks in to help with the remainder of costs. This works for income, but not assets.

Pharmaceutical Assistance Program

Some drug companies offer their customers direct help in paying for their prescription costs. Ask us if your drug is part of one of these programs. Each one requires a separate application and may need to be submitted monthly to receive assistance..

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If you need help paying for Medicare, the good news is that there are many programs in place so you can get the healthcare you need. If you don’t meet the income guidelines in the charts above, but you’re still struggling to pay, give us a call. We know each situation is different and we know about programs that can help you qualify. We’re here to help!

Adam helps seniors and Medicare- eligible people find the right insurance plan
I specialize in Medicare and Medicaid dual enrollment in Springfield, Missouri

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