MEDICARE & LIMITED INCOME:
Every day I get a call or two from folks who are suffering the double whammy: They don’t understand how Medicare and Medicaid work together, and they are living on amounts that would make most of us drop our jaws: $500 - $1500 a month. They are entitled to medical and financial support through these programs. There are actually three, the Extra Help program through Social Security is the third. It provides deep discounts on medications, waives penalties, and coinsurances and more.
Extra Help Program (Low Income Subsidy) No sense reinventing the wheel so here is some information copied directly for you: “For 2025, the annual income limits are less than $23,475 for an individual and less than $31,725 for a married couple, while the resource limits are less than $17,600 for an individual and less than $35,130 for a married couple. Resources like your home and car do not count, but savings, stocks, and bonds do.
Important details about eligibility
What counts as resources: Savings accounts, stocks, bonds, and other assets. Your primary home, one car, and personal belongings are not counted.
What counts as income: Most cash payments count, but some don’t, such as Supplemental Nutrition Assistance Program (SNAP) benefits or housing assistance.
Automatic qualification: You may automatically qualify for Extra Help if you are enrolled in both Medicare and Medicaid, receive Supplemental Security Income (SSI), or qualify for a Medicare Savings Program.
Higher limits: Financial limits may be higher if you live in Alaska or Hawaii, or if you support other family members who live with you.
How to apply: If you do not automatically qualify, you can apply through the Social Security Administration.
Benefits: If you qualify, you can receive help with Part D premiums, deductibles, and copayments. “
Even if you’re not sure you qualify, APPLY. You might be surprised. You can call Social Security at 800-772-1213 or go online (that is the fastest way) at www.ssa.gov/medicare/ part-d-extra-help and apply.
Medicaid - so much more than you think
There are levels of support in Medicaid - and here they are: Full Benefit Dual Eligible (FBDE) Qualified Medicare Beneficiary (QMB, QMB+) Specified low-Income Medicare Beneficiaries (SLMB, SLMB+) Qualifying Individual (QI) Qualified Disabled & Working Individuals (QDWI) Every program level has income limits but there are some calculations based on the federal poverty level so it’s hard to do this yourself. I can help you fill out an application if you’re struggling with it, but I am not qualified to tell you much more - and I don’t work for the State.
Here is some official language:
“Medicaid levels are determined by specific income and household size thresholds that vary by state and eligibility group (e.g., children, pregnant women, adults). For example, in expanded states, individuals with incomes below 133% of the Federal Poverty Level (FPL) may qualify, while other eligibility pathways exist for specific groups like the elderly or disabled. Eligibility charts are often structured by household size, with limits increasing for larger families.
General eligibility
Federal Poverty Level (FPL): Many eligibility rules are based on the FPL, which is a figure published annually by the government.
State-specific rules: Because states set their own specific rules, it’s crucial to check your state’s health department website for exact figures.
Household size: Income limits increase for larger families, so the number of people in a household is a key factor in determining eligibility.
Different pathways: You may qualify for different pro- grams based on age, family status, pregnancy, disability, or other factors, such as the Children’s Health Insurance Program (CHIP).
Example income levels (Texas)
Children’s Medicaid: Monthly income limits for children are based on a percentage of the FPL, which varies by household size.
Medicaid for the Elderly and People with Disabilities: Income limits can be much lower for these groups, such as a single person with a monthly income below $943.
Institutional/Nursing Home Medicaid: In Texas, this requires a higher income limit than regular Medicaid, at $2,829 per month for a single individual. “
My advice is always to apply for everything. What is the worst that can happen? You get turned down? At least then you will know but if you don’t apply you never will. Some programs go as high as 200% of the federal poverty level so don’t be shy... go apply.
The Health & Human Services office is around the far side of the Factory Connection store in Atlanta and can provide you with an application. They will ask for your Social Security Benefits Letter and a bank statement, as well as identification, when you turn it in. If you have assets over $2000 in the bank it gets a bit more complicated.
Medicare & Medicaid Combined: Dual Eligibility For those with both programs there are Medicare advantage plans that provide everything from zero copays to a sliding scale of copays based on your level of Medicaid. They can give a person as much as $360 a month in spending money on a pre-paid card for over the counter, groceries, rent, utilities, and more - depending on the plan, the carrier, and more. For those making so little to survive on, these plans can be lifesavers. Many have transportation benefits, expanded benefits for dental, vision, and hearing up to as much as $5000 or even more. But plans vary by county, by state, and even by situation. Someone who is QI will not get the same plan as an FBDE level Medicaid recipient. But Medicare and Medicaid alone won’t give you these benefits - and many people think they do.
Bear in mind that spending benefits will be limited to those with chronic conditions in 2026. Even if you have benefits on your plan now those are being reduced generally on all plans, sometimes by a lot. And if you have been getting groceries in 2025, but have no chronic condition, you will be limited to over-the-counter spending only in 2026. Still, having anything extra to spend on non-food items will give you more to spend out of your income on food items.
There are so many variables when it comes to these programs it is always best to consult an agent who knows the ropes and can advise you. As always, I’m here for you to assist, answer questions and give you directions, and I hope you will give me a call or text and do just that.
May the Lord bless you until we meet, and long after that.
- Amy
Amelia (Amy) Gunstanson is a Navy Veteran with 30 years’ experience in life and health insurance, the last six years in Medicare specifically. She is the Principal Agent/ owner of Medicare Thrive in Atlanta, TX, serving Cass and surrounding areas. She is federally certified, licensed in 20 states and appointed/certified with many major carriers including Kemper Life, Humana, United Healthcare, Physicians Mutual, Christus, Aetna, Cigna Blue Cross and more. You can call or text questions or requests for appointments to 430-999-2271 or on the web at www.medicarethrive. com.