Government Assistance & Resources

Despite all the health insurance coverage available, participants are still left with premiums and/or cost shares to pay. There are a variety of government programs that help participants in need with these expenses. Some even help with living expenses.

Medicaid & Extra Help

Medicaid is a program that helps people with limited income and resources pay medical expenses. It’s jointly sponsored by the federal and state governments. It helps people with income too low (lower than the FPL) to qualify for ACA subsidies. For Medicare beneficiaries, it also offers benefits not normally covered by Medicare, such as nursing home care and personal/custodial care services. Contact your state Medicaid office to apply. There is no restrictive enrollment periods, you can apply at anytime.

Medicaid also works with Medicare. For people who are duel eligible (eligible for both Medicare and Medicaid), Medicaid pays Medicare part A premium, part B premium, and/or cost shares depending on which category of the Medicare Savings Program (MSP) the beneficiary is in (QMB, SLMB, QI, and QDWI). Beneficiaries falling into QMB, SLMB, and QI categories, automatically get full Extra Help (which pays your prescription drugs’ premium, deductible, and cost shares). If you are getting SSI (Supplemental Security Income, you also automatically qualify. Beneficiaries not in the 3 MSP categories can still apply here for Extra Help with the Social Security Administration (SSA), and can still be eligible for some help.

Many states have a SPAP (State Pharmaceutical Assistance Program) that might be able to help you with prescription drug costs if you are not qualified for Extra Help. To find out if your state has a SPAP that can help, check out this resource link. You can also find out if your drug manufacturer offers help. You can contact your state Medicaid office or State Health Insurance Assistance Program (SHIP) for more information.

Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage for children up to age 19. It is a joint federal and state program that provides health coverage to uninsured children in families with incomes too high to qualify for Medicaid, but too low to afford private coverage. Eligible income is between 170% and 400% FPL, depending on your state. States might have different name for their Medicaid and CHIP programs. You can look it up for your state here. For example, in Georgia, the CHIP program is called PeachCare for Kids.

Supplemental Security Income (SSI)

SSI is a monthly payment the SSA send to people with limited income and resources, including people of age 65 and older, or people under 65 with disabilities. The money is intended for basic needs, such as food, clothing, and shelter. The amount depends on your existing income.

Other Programs

Other than healthcare and medication needs, you can also find help with food & nutrition (e.g., Supplemental Nutrition Assistance Program/SNAP, emergency food assistance program, etc.), housing & utilities (e.g., HUD and Section 8 Housing Program, low-income home energy assistance, reverse mortgage counseling, etc), transportation (e.g., regional transit services reduced fare cards, transportation programs for getting to doctor’s appointment, etc.), to name a few.

Author: pan

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