Financial Assistance for Medical Costs


If you have Part D and you need help paying for Medicare prescription drug plan costs, such as premiums, deductibles, copayments, and coinsurance, because of limited income and resources, you may be eligible for Medicare’s Extra Help program. If you qualify for Extra Help, you will receive assistance paying your Part D expenses, will have less costs if you enter the coverage gap in your Part D plan, will not be required to pay a late enrollment penalty if you enroll in Medicare after your Initial Enrollment Period, and will be able to switch plans at any time of the year. Qualification requirements for Extra Help may change each year, and are based upon yearly income and resource limits. You automatically qualify for Extra Help if you have Medicare and either have full Medicaid coverage, get help from Medicaid for paying your Part B Premiums with the Medicare Savings Program, or you get Supplemental Security Income (SSI). If you did not qualify automatically and did not receive notice of your qualification in the mail, you can apply for Extra Help anytime by visiting www.socialsecurity.gov/i1020, calling Social Security at 1-800-772-1213, or visiting www.medicare.gov/contacts to find the location of your state’s Medicaid office.

If you need help paying for other Medicare health care costs, you may be eligible for a variety of other assistance programs. There are several different state-run programs such as the Qualified Medicare Beneficiary (QMB) Program, the Specified Low-Income Medicare Beneficiary (SLMB) Program, the Qualifying Individual (QI) Program, and the Qualified Disabled and Working Individuals (QDWI) Program.

In addition, Medicaid is a joint federal and state program that covers most medical costs that Original Medicare, Medicare Part D, and Medicare Advantage Plans do not cover. Medicaid programs may have different names in different states, may have different eligibility requirements, and may include different coverage. Many states have recently expanded their Medicaid programs, so people who were not previously eligible may now be able to obtain Medicaid.

Other forms of medical care financial assistance include State Pharmacy Assistance Programs (SPAPs), Pharmaceutical Assistance Programs, and Programs of All-inclusive Care for the Elderly (PACE).

All of the programs listed above vary state-to-state and year-by-year, so you should call or visit your state’s Medicaid office, visit www.medicare.gov/contacts, or call 1-800-MEDICARE to receive specific and updated information.

What if I already have health insurance when I turn 65?

Many employers offer group health plan coverage to current employees or retirees. You may also have health plan coverage through the employer of your spouse or domestic partner.

If you have Medicare and you are offered coverage under a group health plan, you can choose to accept or reject the plan.  If you have a private plan, whether it be through employment or your spouse, when you qualify for Medicare, the decision to sign up for Medicare or delay Medicare is an important one that will have long term effects on your coverage. 

Many private plans change the structure of benefits for enrollees at age 65 to account for Medicare.  If you chose to not sign up for Medicare at 65 because you have a private plan, you may have gaps in your coverage.  If you plan on working past 65, call your health plan and discuss the effects of Medicare eligibility on your coverage and benefits.

If you have Medicare and other health coverage, each type of coverage is called “payer.” When there’s more than one payer, “coordination of benefits” rules who pays first. The “primary payer” pays what it owes on your bills first, and then your provider sends the rest to the “secondary payer” to pay.

Medicare will either be the first or second payer depending on a variety of factors.  The payment arrangement between your private or employer plan and Medicare will determine which plan is the first payer. You should check your insurance policy for the rules about which plan will pay first.

You can also call the Benefits Coordination & Recovery Center (BCRC) toll-free at 1-855-798-2627.  This chart provides an over view of the general rules for first and second payers when you have Medicare and another health care plan.

Military Families

If you are an active-duty service member or the spouse or dependent child of an active-duty service member and you have TRICARE insurance, you must enroll in Medicare Part A when you are first eligible in order to keep your TRICARE coverage. You must be signed up for both Part A and Part B before the active-duty service member retires in order to keep TRICARE and avoid a break in health coverage. TRICARE, which changes to TRICARE for Life (TFL) when the active-duty service member retires, is coverage that is supplementary to Medicare. This means that when you obtain a Medicare-covered service, Medicare pays first, and then TRICARE pays the applicable Medicare deductible and coinsurance amounts for you. For any service that TRICARE covers and that Medicare does not cover, TRICARE will be the primary insurance. If neither Medicare nor TRICARE covers a service, you will be responsible for the necessary payment. Click here to learn more about health care options for veterans.