Seniors on Medicare can get help paying medical bills from hospital financial assistance programs, Medicare Savings Programs, Medicaid, Extra Help for prescription drugs, and interest-free payment plans with providers. The first step is to make sure the bill is right: compare it with your Medicare Summary Notice or plan statement, because errors and unpaid insurance claims can make a bill higher than it should be. Then apply for every program that fits, starting with the ones that can lower the bill itself.
Where should I start?
Start with the bill in front of you. Before asking for help, confirm you actually owe the amount:
- Has Medicare paid? Look for the claim on your Medicare Summary Notice (MSN) or your plan's Explanation of Benefits (EOB).
- Has your Medigap or other coverage paid? Some bills go out before secondary insurance pays.
- Is the amount at or below "maximum you may be billed"? That's on your MSN.
- Are there duplicates or services you didn't get?
If something is off, call the billing office and ask for a corrected bill. See common medical billing errors seniors should check for.
Script:
"Before I pay this bill, can you confirm that Medicare and my [Medigap/other plan] were billed and have paid? Please send me an itemized bill and hold the account while I review it."
What help is there for hospital bills?
Nonprofit hospitals must have a written financial assistance policy under Internal Revenue Service (IRS) rules. Depending on income, you might get free or reduced-cost care. IRS rules also require nonprofit hospitals to make reasonable efforts to see if you qualify before taking certain collection actions.
If you have Medicare, ask whether you can apply. See hospital financial assistance (charity care) for seniors on Medicare.
Script:
"I'd like to apply for financial assistance for my bill. Can you send me your financial assistance policy and application, and tell me what documents you need? Please hold the account while my application is reviewed."
Doctors' offices and for-profit providers may have their own hardship policies. It's worth asking.
Can Medicare programs lower what I pay?
Medicare Savings Programs (MSPs). Run by state Medicaid offices, these help with Medicare costs. Medicare.gov says the QMB program helps pay Part A and Part B premiums, deductibles, coinsurance, and copayments, and that Medicare providers aren't allowed to bill QMB members for those amounts. Other programs, the Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programs, help pay Part B premiums. See Medicare Savings Programs.
Medicaid. People who qualify for both Medicare and Medicaid are "dually eligible." Medicare.gov says Medicare pays first, and Medicaid may cover costs after that. See dual eligibility.
Extra Help. This Medicare program helps people with limited income and resources pay for Part D drug costs. See Extra Help for prescription drug costs.
The Medicare Prescription Payment Plan. It spreads Part D drug costs across the year in monthly payments. See the Part D out-of-pocket cap and the Medicare Prescription Payment Plan.
Apply even if you aren't sure you qualify. States set their own limits.
What if I still owe a balance?
Ask for a discount. Some providers may lower a balance for people on a fixed income or for paying in full. Policies vary and it isn't guaranteed, but you can ask. See how to negotiate a medical bill.
Set up an interest-free payment plan. Some providers may offer plans directly. The Consumer Financial Protection Bureau (CFPB) warns that medical credit cards and some financing plans can carry high interest, especially after a deferred-interest promotion ends. See medical bill payment plans.
Script:
"I can pay $[amount] a month. Can we set up an interest-free plan directly with your office? Please confirm in writing that there's no interest or fees and that the account won't go to collections while I'm making payments."