Can people with low incomes qualify for a Medicare subsidy?

In this week’s column, Phil Moeller, the author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs and co-author of the updated edition of How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security, answers a question about Medicare subsidies.

My mother has nothing deducted from her Social Security check. Do people with low incomes qualify for a Medicare subsidy?

Question: I am sending a question on behalf of of my mother. I’m concerned that she doesn’t have health coverage even though she thinks she does.

She turned 65 this past April and enrolled in Medicare with a supplemental plan through UnitedHealthcare. Apparently, there’s a maximum out-of-pocket of $4,000 a year and she pays copays to go to the doctor, have procedures like back injections, and other fairly routine care. Prescriptions are cheap, too.

She tells me she is having nothing taken out of her Social Security check, nor is she paying any other monthly premium. I was under the assumption that everyone in the U.S. of Medicare age must pay for Medicare. She’s been to the doctor several times since April and has had two back injections with no surprise bills or lack of coverage. And she definitely has a Medicare card, too.

For my own peace of mind, does being low income qualify her for a paid subsidy? She doesn’t work and has had income under the poverty level for at least the past two years.

Thank you for your assistance in advance! 
Christine

Answer: Normally, Part B of Medicare costs most people $135.50 a month, so if Christine’s mother is not having anything taken out of her Social Security to cover that premium, she most likely is correct that her mother is receiving low-income subsidies from Medicare.

There are four Medicare Savings Programs available to people whose incomes are low enough to also qualify for Medicaid. It very much sounds like your mother is one of the persons who are “dually eligible” for both Medicare and Medicaid. Specific terms of the programs depend on the state Medicaid rules where she lives. 

In addition, Medicare’s Extra Help program helps pay prescription drug costs for people whose incomes are low enough to qualify. 

Christine’s note says her mother has a supplemental health insurance plan. While some people may refer to Medicare Advantage plans this way, most references to supplemental plans are referencing Medigap supplemental insurance plans. In this case, her mother likely has a Medicare Advantage plan. These managed care plans are frequently used to provide insurance to dually eligible beneficiaries.

While it can be daunting to call an insurance company, I’d suggest Christine’s mother do just that, so she can confirm details of her mother’s coverage. If Christine wanted to make the call, her mother would have to authorize her to discuss her private medical records and care with United Healthcare.

Christine is asking all the right questions and, on behalf of aging parents everywhere, she deserves a lot of credit for paying attention to her mom’s health care needs. My children express no interest in such matters, although they are males and, from what I read, thus somehow disadvantaged in the parental caregiving department.