- Every state has a State Health Insurance Assistance Program (SHIP) or State Health Insurance Benefits Advisors (SHIBA) to help you learn more about Medicare plans and how to enroll in them.
- The Social Security Administration (SSA) can help you apply online, in person, or over the phone.
- Federal and state programs can help you pay for Medicare costs.
Figuring out how to enroll in Medicare, how to choose the best plan for you, and how to pay for your premiums can be daunting, despite the vast array of resources available.
Here’s a brief guide to help you navigate the process, whether you want to better understand plans and benefits, enroll in Medicare, or get help paying for Medicare costs.
(And to help you define the many official acronyms and terms you’ll encounter along the way, you may want to keep this Medicare glossary handy.)
Some aspects of Medicare are remarkably consistent, which makes them easier to understand. Other parts change every year — and missing deadlines or underestimating costs can lead to unwanted expenses. If you have questions about Medicare, here are some reliable resources to consult:
SHIP/SHIBA
The State Health Insurance Assistance Program (SHIP) and State Health Insurance Benefits Advisors (SHIBA) are nonprofit networks staffed by trained, unbiased volunteers who can guide you through your Medicare options. SHIP and SHIBA counselors and classes can help you find out:
- which services various Medicare plans cover
- what the plan options are in your area
- how and when to enroll in Medicare
- how you can get help covering costs
- what your rights are under Medicare
To find out more about your local SHIP office, visit the national website or call 877-839-2675. You can also find a list of state-by-state SHIP/SHIBA contacts, including phone numbers, on this Medicare site.
Social Security Administration
The Social Security Administration (SSA) manages the Medicare online application process. Most people will be able to complete the application in about 10 minutes. You likely won’t need to have any additional documentation on hand when you apply.
If you’re not a fan of online applications, you can also apply by phone. Call 800-772-1213 between 7 a.m. and 7 p.m. from Monday through Friday. If you’re a deaf person or someone with hearing issues, you can use the TTY service at 800-325-0778.
Because many SSA field offices remain closed due to COVID-19 restrictions, applying in person may be difficult right now. But you can still contact your local field office for assistance using this Social Security office locator.
SHIP’s COVID-19 Virtual ClassesBecause many SHIP counseling sites have suspended in-person meetings, some states are offering help through virtual Medicare classes. To find classes with information that applies to your area, visit the SHIP website and click on the “SHIP locator.” Many classes are available in Spanish and in English.
You can enroll in Medicare regardless of your income level. Most people don’t pay anything for Medicare Part A (hospital) coverage. For Part B (medical) coverage, most people pay a premium of $144.60 in 2020.
Who do I contact if I’m paying higher premiums?
If your individual income is higher than $87,000, you might pay an income-related monthly adjustment amount (IRMAA). If you’ve received an IRMAA notice and you think it’s based on the wrong income figures or you’ve had a big change in your life since your income was calculated, you can appeal the decision.
Contact the SSA office in your area by using this field office locator or by calling the national SSA toll-free at 800-772-1213. You will need to complete this form to report a life-changing event.
Where can I get help if my income is lower?
If your income is limited, you might qualify for assistance paying your premiums and deductibles. These are some programs that can help you with Medicare costs.
Medicaid
If you’re a Medicare beneficiary with limited income or resources, you may be eligible for Medicaid. Medicaid is a program operated by both the federal government and state governments. It pays for some benefits that Medicare doesn’t offer.
You can be enrolled in both Medicare and Medicaid at the same time, regardless of whether you have original Medicare (Part A and Part B) or a Medicare Advantage (Part C) plan.
Qualified Medicare Beneficiary (QMB) program
The QMB program is one of four assistance programs created by the Department of Health and Human Services (HHS). Even though HHS started these programs, they are now operated by state governments.
This program helps people who meet income limits pay for:
- Part A premiums
- Part B premiums
- deductibles
- coinsurance
- copayments
If you’re in the QMB program, your doctor and healthcare providers are allowed to bill you only a limited amount for prescription medications ($3.90 in 2020). They are not allowed to bill you for services and other items covered by Medicare.
The 2020 monthly income limits for the QMB program are:
- Individual: $1,084
- Married: $1,457
The 2020 resource limits for the QMB program are:
- Individual: $7,860
- Married: $11,800
For help applying for the QMB program, visit this Medicare site and select your state from the menu.
What counts as a “resource”?These programs define a resource as money you have in your checking or savings account, stocks, bonds, and real estate (other than your home). “Resource” does not include the house you live in, your car, your furniture, or your personal belongings.
Specified Low-income Medicare Beneficiary (SLMB) program
This state program can help you get funds to pay your Part B premiums. To qualify, you have to be enrolled in Medicare and meet certain income limits.
The 2020 monthly income limits for the SLMB program are:
- Individual: $1,296
- Married: $1,744
The 2020 resource limits for the SLMB program are:
- Individual: $7,860
- Married: $11,800
To apply for the SLMB program, visit this Medicare site and select your state from the menu.
Qualifying Individual (QI) program
The QI program is administered by your state. It helps Medicare beneficiaries with limited income pay their Part B premiums. To apply for the program, visit this Medicare site and select your state from the menu.
The 2020 monthly income limits for the QI program are:
- Individual: $1,456
- Married: $1,960
The 2020 resource limits for the QI program are:
- Individual: $7,860
- Married: $11,800
Qualified Disabled Working Individuals (QDWI) program
This program helps you pay for any Part A premium you owe. To apply for the program, visit this Medicare site and select your state from the menu.
The 2020 monthly income limits for the QDWI program are:
- Individual: $4,339
- Married: $5,833
The 2020 resource limits for the QDWI program are:
- Individual: $4,000
- Married: $6,000
Extra Help
If you qualify for the QMB, SLMB, or QI programs, you will automatically qualify for the Extra Help program too. This program helps you pay for Medicare prescription drug coverage.
Extra Help automatically renews each year unless your income or resources change. Notices are mailed in September (on gray paper) if there’s been a change in your income or resources and you need to reapply. Notices are mailed in October (on orange paper) if your copayments are changing.
You will not need to complete an application if you have Medicare and you also receive Supplemental Security Income (SSI) or if you have both Medicare and Medicaid. In these situations, you will get Extra Help automatically.
Otherwise, if you meet the income limits, you can apply for Extra Help here. If you want help filling out the application, you can call Social Security at 800-772-1213 (TTY: 800-325-0778).
If you’d like more information on Extra Help in Spanish, you may want to watch this video.
What if I need more help than these programs provide?
PACE program
If you are ages 55 or over and you need nursing home care, you may be eligible for the Programs of All-Inclusive Care for the Elderly (PACE) program, which will let you receive a wide range of services similar to those you’d get in a skilled nursing facility. These services, though, are offered to you through home- and community-based healthcare providers, and they cost less.
If you have Medicaid, PACE won’t cost you anything. If you have Medicare, you will pay a monthly premium for your care and prescriptions. If you don’t have either Medicare or Medicaid, you can still pay privately to participate in the program.
To see if you live in one of the 31 states offering PACE plans, visit this Medicare website.
NCOA benefits checkup
The National Council on Aging (NCOA) offers a benefits checkup to help you find local assistance with everything from Medicare costs to transportation and housing.
You’ll just need to answer a few questions to narrow down your location and the type of help you’re looking for, and the NCOA will connect you to a list of programs that can help you. The NCOA database contains more than 2,500 programs that help people across the nation.
If you need to talk to someone about your rights under Medicare, or if you want to report a problem with a healthcare provider, here are some options to consider.
Medicare Rights Center
The Medicare Rights Center is a national nonprofit organization that offers counseling, education, and advocacy to Medicare beneficiaries. You can speak to an advocate by calling 800-333-4114 or visiting its website.
Senior Medicare Patrol (SMP)
If you think there’s been an error in your Medicare billing or you suspect Medicare fraud, you can reach out to the SMP. SMP is a national resource center funded by grants from the Administration for Community Living, which is part of HHS.
SMP is a good place to go for current information on Medicare-related scams. The national helpline is 877-808-2468. Counselors staffing the helpline will be able to put you in touch with your state SMP office.
- Getting assistance with Medicare can help ensure that you find the right plan, enroll on time, and save as much money on Medicare costs as possible.
- Working with experts in your state’s SHIP and SHIBA programs is a good way to answer questions you might have before, during, and after the enrollment process.
- Finding out more about state and federal Medicare savings programs can help you keep costs down, and knowing who to call if you spot a problem can keep you from becoming a victim of fraud or abuse.