What Medicare Options Are Right for You?

When you work, some of the money you earn automatically comes out of your paycheck and helps fund Medicare, a national public health insurance program.

If you or your spouse worked enough time while paying Medicare taxes, you will qualify for Medicare:

  • When you turn 65
  • When you’ve been getting Social Security Disability Insurance (SSDI) benefits for two years, or
  • If you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or end-stage kidney disease (ESRD).

If you get Childhood Disability Benefits (CDB) benefits for two years based on a parent’s work record, you will also qualify for Medicare.

Medicare coverage includes:

  • Part A, which helps pay for medical care you get while you’re in a hospital
  • Part B, which helps pay for medical care you get outside of a hospital, like when you go to the doctor’s office; and
  • Part D, which helps pay for prescription drugs.

If you’ve been getting SSDI or CDB for two years, Medicare Parts A and B will start automatically. Otherwise, you may need to sign up, depending on your situation. No matter how you qualify, you need to sign up separately for a Part D plan.

Most people don’t have to pay a premium for Part A, but they do have to pay monthly premiums for Parts B and D. For this reason, nobody is required to get them.

Answer the questions on this page to see which parts of Original Medicare make sense for you and whether you might qualify for programs that can help you pay your monthly premiums, copayments, co-insurance, and deductibles. If you need more information about Medicare, call the Alaska Medicare Information Office at 1-800-478-6065 or 1-800-770-8973 (TTY).

Note: In Alaska, there are no Medicare Advantage (Part C) plans. All Medicare coverage is through Original Medicare. If you are 65 or older, you can choose to get private Medicare Supplement Insurance (Medigap), which covers some expenses that Parts A and B do not cover. Learn more about Medicare Supplement Insurance or find a policy in your area.

Do You Qualify to Get Medicare and Other Coverage at the Same Time?

If you qualify to get Medicare at the same time as you have employer-sponsored coverage, Medicaid, or Working Disabled Medicaid Buy-In coverage, having those other benefits may impact your Medicare decisions:

  • If you also qualify for Medicaid or the Working Disabled Medicaid Buy-In, they may help pay for some medical expenses that Parts B and D would not pay for. They may also help pay your monthly Medicare premiums and other Medicare expenses like deductibles and coinsurance.
  • If you also qualify for employer-sponsored coverage, you may wish to decline Part B and Part D coverage, so that you don’t have to pay their premiums. However, your private coverage must meet certain standards, or else you may have to pay monthly penalties if you choose to sign up for Parts B and D later.

You may have other options as well, such as retirement benefits, Veterans (VA) benefits, or military (TRICARE) benefits. Learn more about how Medicare interacts with other types of coverage.

Can You Get Help Paying for Medicare Parts A and B?

While Medicare offers good coverage, it is not as low-cost as Medicaid. Depending on the care you need, you may have to pay large copayments, co-insurance, or deductibles. And, for Part B, you may have to pay a monthly premium (usually $109.00 per month).

If you have both Medicare and Medicaid coverage, Medicaid may help pay for your Part B and Part D expenses.

If you only have Medicare and don't have Medicaid, a Medicare Savings Program (MSP) might help pay for your Medicare expenses. There are four MSPs that help people with low income and low resources:

  • The Qualified Medicare Beneficiary (QMB) program helps people with countable income that’s 100% of the Federal Poverty Guidelines (FPG) or less ($1,255 per month or less if you live alone). QMB helps pay for your Part B premium and reduces copayments and deductibles.
  • The Specified Low-Income Beneficiary (SLMB) program helps people with countable income that’s more than 100% of FPG, but at or below 120% of FPG ($1,506 per month or less if you live alone). SLMB helps pay for the Part B premium, but does not help with anything else.
  • The SLMB Plus program helps people with countable income that’s more than 120% of FPG, but at or below 135% of FPG ($1,694 per month or less if you live alone). SLMB Plus helps pay for the Part B premium, but does not help with anything else.
  • The Qualified Disabled and Working Individual (QDWI) program helps people who have lost their SSDI benefits because they earn more than the Substantial Gainful Activity (SGA) level ($1,170 per month), but have countable income that’s 200% of FPG or less ($2,510 per month or less if you live alone). It lets you stay on Medicare Part A even though you don’t get SSDI anymore and it will pay for the Part A premium that would otherwise apply.

Note: For MSPs, your income is counted using SSI’s countable income calculation, which means less than half of your earned income is counted. That means you might qualify even if you think your income is over the limits.

Your Countable Income:

The resource limit for QMB, SLMB, and SLMB Plus is $8,780 if you live alone and $13,930 if you live with someone else. For QDWI, it’s $4,000 if you live alone and $6,000 if you live with another person.

Apply for an MSP by filling out the combined application for services and turning it in at your local Division of Public Assistance (DPA) office.

If you need help with your application, call the Alaska Medicare Information Office at 1-800-478-6065 or 1-800-770-8973 (TTY).

Can You Get Help Paying for Medicare Part D?

Part D helps you pay for your medications, but there are some expenses for you, such as the monthly premium, a deductible, copayments, co-insurance, and the donut hole.

If you cannot afford these costs, you may qualify for the Low Income Subsidy (LIS), which is also called “Extra Help.” The Low Income Subsidy has two levels:

  • The full subsidy is for people who also get Medicaid coverage or who are in a Medicare Savings Program. You may also qualify if your countable income is less than $20,331 per year and your resources are less than $8,890 if you are single (the limits are higher for larger households).
    • With the full subsidy, you will not have to pay a Part D premium or deductible, there will be no donut hole, and there may be lower copayments.
  • The partial subsidy is for people who can’t get the full subsidy, but have less than $22,590 in annual countable income and less than $13,820 in resources, if you are single (the limits are higher for larger households).
    • With the partial subsidy, you will pay 0%, 25%, 50%, or 75% of the Part D premium, depending on your income, and will only have to pay a $82 deductible before you get help paying for drugs. You will have to pay co-insurance and copayments for your medications, but they will be lower than they would be without the partial subsidy.

If you get Medicaid or Supplemental Security Income (SSI) benefits, you automatically qualify for the LIS and do not need to apply.

Note: Not all of your income and resources are counted when you apply for the Low Income Subsidy. You can apply even if you don’t think you will qualify.

You can apply for the Low Income Subsidy online, at your local Social Security office, or by calling the Medicare Information Office at 1-800-478-6065.

Changing your Part D plan

One way to save money is by finding a better Part D plan for the medications you take. You usually can only change your Part D plan during open enrollment, which is from October 15 - December 7. Any changes you make start on January 1 of the following year. Use the Medicare Plan Finder to find the right Part D plan for you.