Understanding Part D Extra Help # 10508

Western Poverty Law Center 
Guide to coverage for Low Income Californian's 

getting-keeping-coverage

What if I can’t afford the Part B – Doctor Visit Premium of $134/month?

Check out Medi-Cal – (Our Website for MAGI based qualification under 65 ♦ MediCal Resources.org) If you would be on Medi-Medi – Cal MediConnect – Cal Duals (our website)

Learn more on categories of dual eligibles whose out of pocket costs are paid by Medi-Cal

Learn More about Medicare Savings Programs (MSP’s) ⇒ CA Health Advocates

4 programs that can help pay Medical Expenses Publication # 11445

Publication 10126 Getting Help with Medicare Costs

See also Medicare & You – Link in side panel

Medicare Savings Program

Copied from Los Angeles Medi Cal website


The Medicare Savings Programs help pay for Medicare premiums for Seniors and Persons with Disabilities. What services are offered? The government pays part or all of your Medicare premium based on your income. Who can be covered? Medicare beneficiaries entitled to receive Part A Medicare. How much does it cost? Nothing. Is there an income limit? Yes, up to 135% of the Federal Poverty Level (FPL).  To qualify for the program, the family’s monthly income must be at or below the income limit specified for the family size.  See the Monthly Income chart for details.

Monthly Income Limit
Family Size Monthly Income must be at or below 135% of FPL 
1 $1,366
2 $1,852
3 $2,338
4 $2,824
5 $3,310
6 $3,796
7 $4,282
8 $4,768
9 $5,254
10 $5,740

  Is there a property limit? Yes, depending on the family size.  See the Property Limits Chart for details.

Property Limits
Family Size Limits
1 $7,560
2 $11,340

  Is citizenship or legal residency required? Yes.

How do I apply?

Apply by mail.  To apply, download and complete the application MC 14A, then mail the application to any local Department of Public Social Services Medi-Cal office.  View the map for a Medi-Cal Office near you Apply in person.  For your convenience, you may apply at any local Department of Public Social Services Medi-Cal office.  View the map for a Medi-Cal Office near you.   Los Angeles Medi Cal  *

Can’t one apply ONLINE?  

Los Angeles ONLINE Enrollment with links to other counties

Medicare offers several Medicare Savings Programs (MSPs) that assist people with low income and assets: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI) and Qualified Disabled Working Individual (QDWI). California also offers the 250% California Working Disabled (CWD) program. You must meet certain income and asset limits to qualify for these programs, which are administered by Medi-Cal (the California health program known as Medicaid in other states). This section provides information on eligibility and how to apply. Topics on this page:

  1. Qualified Medicare Beneficiary (QMB)
  2. Specified Low-Income Medicare Beneficiary (SLMB)
  3. Qualified Individual (QI)
  4. Qualified Disabled Working Individual (QDWI)
  5. 250% California Working Disabled (CWD)
  6. How to Apply

See also:

 Qualified Medicare Beneficiary (QMB)

The Qualified Medicare Beneficiary (QMB) program helps pay for the following Medicare costs:

  • Medicare Part A premium. Note: Some people are required to pay a premium for Medicare Part A because they do not have enough Social Security credits. Most people do not pay a premium for Medicare Part A because they or their spouse earned enough credits by working 40 or more quarters (approx. 10 years of working full-time, four quarters per year). People who worked 30-39 quarters may buy Part A coverage and pay a monthly premium of $232 in 2018. People who worked fewer than 30 quarters may also buy Part A coverage and pay a higher monthly premium of $422 in 2018.
  • Medicare Part B premium ($134.00 per month in 2018)
  • Deductibles for both Part A ($1,340 per benefit period in 2018) and Part B ($183 annually in 2018)
  • Coinsurance under both Part A and Part B. For example, under Part A, QMB pays the $335 per day for hospital days 61-90, and the $670 per day for the 60 hospital lifetime reserve days in 2018. Under Part B, QMB pays the remaining 20% coinsurance after Medicare pays 80% of the covered outpatient medical services such as physician visits, as long as you see doctors and other providers who accept Medi-Cal. Note: This is because Medi-Cal administers the MSPs and will only pay providers who accept Medi-Cal.  Copied from CA Health Care Advocates

ca health advocates.org/qualification-at-a-glance  

Medicare & You – see link in side panel

Resources & Related Pages

What if you no longer qualify for Extra Help Publication # 11215

Medi Helper.com They can help you qualify… they do charge a fee based on the complexity of the case.

2 page assessment form

Medi-Cal Estate Recovery

  Medi Medi – Medi-Cal & Medicare, Together Medicaid (Medi-Cal) Getting Started Publication # 11409  

Medicare Part A Hospital & B Doctor Visits Eligibility & Premium Calculator  

Related Pages

Medicare and You 2020 #10050  
Everything you want to know 

Different Parts of Medicare - Video

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Topics

How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS
Definitions


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