Medicare Premium Bills and Dually Eligible Individuals – Justice in Aging

Medicare offers essential health care coverage for people with disabilities and older adults. Medicare can also be expensive, with premium bills reaching hundreds of dollars each month. Most individuals enrolled in both Medicaid and Medicare (“dually eligible individuals”) should have premiums covered by Medicaid. This issue brief describes the different types of Medicare premium bills, explains premium assistance options, and addresses issues that may arise.

Types of Medicare Premium Bills

Medicare Part A covers inpatient hospital care, skilled nursing facility care, home health care, and hospice. For most Medicare enrollees, Medicare Part A is premium-free. A small number of Medicare enrollees (about 1%) are charged a premium for Medicare Part A.^[1] The Medicare.gov website lists Part A premium amounts. Part A premiums are typically deducted from Social Security checks. Sometimes Part A premiums are billed directly by Medicare. An individual can check the status of their Medicare premium payment on their online Medicare.gov account.

Medicare Part B covers outpatient care including doctor’s visits, as well as durable medical equipment like wheelchairs or walkers. Most Medicare enrollees are charged a premium for Part B. The Medicare.gov website lists Part B premium amounts. Part B premiums are typically deducted from Social Security checks. Sometimes Part B premiums are billed directly by Medicare. An individual can check the status of their Medicare premium payment on their online Medicare.gov account.

Medicare Part C is Medicare managed care, otherwise known as Medicare Advantage. Medicare Advantage is an alternative to Original Medicare. Medicare Advantage plans must cover Part A and Part B services for enrollees. Most Medicare Advantage plans do not have an additional premium, but some do.^[2] Part C premium amounts are listed on Medicare Plan Finder. Part C premiums are typically billed directly to the enrollee; individuals can request that it be deducted from their Social Security check.^[3] Part C premiums are in addition to any Part A or B premiums an individual may owe.

Note that some Medicare Advantage plans offer a Part B premium reduction known as a “give back benefit”. These reductions are often very small (e.g., 50 cents off the $202.90 Part B premium). Information about the amount of Part B premiums covered in a give back benefit is available in Medicare Plan Finder.

Medicare Part D covers outpatient prescription medications, which are not typically covered by Medicare Part A or B. Part D operates differently depending on whether a person is on Original Medicare or enrolled in Medicare Advantage.

• Part D in Original Medicare: Part D prescription drug coverage is available to Original Medicare enrollees through standalone Prescription Drug Plans (PDPs). Premium amounts for PDPs are available on Medicare Plan Finder. Part D premiums are typically billed directly to the individual by the PDP; individuals can also request that Part D premiums be deducted from their Social Security check.
• Part D in Medicare Advantage: Most Part C Medicare Advantage plans incorporate Part D coverage into one plan (Called a Medicare Advantage plan with Part D coverage, or MA-PD). In that case, the premium amount for Part C, including the amount for Part D prescription drug coverage, is shown on Medicare Plan Finder.^[4] The Part C and D combined premium is typically billed directly to the enrollee by the Medicare Advantage plan; individuals can also request the premium amount be deducted from their Social Security check.

Assistance Available to Cover Medicare Premiums

Help is available for Medicare premiums, as outlined below.

Medicare Savings Programs. Medicare Savings Programs (MSPs) are a set of Medicaid programs that help cover out-of-pocket Medicare costs. There are four MSPs (QMB, SLMB, QI, and QDWI). While there is a minimum federal eligibility level for each, states can set higher asset and income eligibility levels for QMB, SLMB, and QI. States also have different names for their MSPs.[5] MSPs are available both to people on Original Medicare and Medicare Advantage. The State Health Insurance Assistance Program (SHIP) can provide assistance with the Medicare Savings Programs applications.

• QMB is the most generous MSP. When a person is enrolled in QMB, their Medicare Part A (if someone does not have free Part A) and Part B premiums are covered. An individual can be on full Medicaid and QMB at the same time.
• SLMB and QI both cover Part B premiums. A person can be enrolled in both SLMB and full Medicaid at the same time. A person cannot be on QI and the full Medicaid at the same time.
• QDWI covers Part A premiums. QDWI is a very small program for certain people whose Social Security Disability Insurance has ended.

Full Medicaid. Full Medicaid refers to coverage for Medicaid services. Depending on the state and type of Medicaid, a person may have their Part B premiums covered by full Medicaid.^[6]

LIS (also known as “Extra Help”). LIS pays for Part D premiums (with LIS covering the full premium for benchmark plans). Individuals who are on Medicaid or an MSP should be auto-enrolled into LIS. Individuals can also apply for LIS at the Social Security Administration (LIS has slightly higher eligibility limits than most Medicaid programs). For more information about LIS coverage for premiums, see Justice in Aging’s How to Access Free Part D Plans for Low Income Subsidy Enrollees.

When a State Requires a Person to Apply to Medicare. In addition to the premium assistance programs mentioned above, if the individual’s state Medicaid program required them to apply for Medicare as a condition for Medicaid eligibility, then, according to CMS policy, the state should pay for the individual’s premiums and cost-sharing.^[7] Fourteen states appear to have policies that require Medicare-eligible individuals to apply to Medicare as a condition of Medicaid eligibility.^[8]

Premiums Improperly Charged

In some circumstances, a person may be enrolled in assistance but still charged a premium that should be covered.

When it is a Part A or B premium bill, advocates should start with the client’s state Medicaid agency. Note that it can often take several weeks for applications to process and premium assistance to begin. If the state Medicaid agency is delayed in responding, consider escalating with the Medicaid constituent services department via counselors at the Aging and Disability Resource Centers (ADRCs) or state SHIP. SHIPs and ADRCs may have contacts at the state Medicaid agency that they can ask for more information or to escalate. These cases can also be escalated to the Social Security Administration and the Centers for Medicare and Medicaid Services (1-800 MEDICARE and the Medicare Ombudsman). Constituent services staff for Members of Congress can offer assistance if other channels fail.

When an individual enrolled in LIS receives a Part D premium bill, it may be due to the individual enrolling in a plan that is charging above the benchmark premium. See Justice in Aging’s How to Access Free Part D Plans for Low Income Subsidy Enrollees. In some cases, however, plans may not have updated information about the individual’s LIS status. Enrollees and or advocates should first contact the plan to check LIS status and ask for the plan to update its system.^[9] If the plan continues erroneously charging a premium amount, advocates should consider escalating to 1-800 Medicare to file a customer service-related complaint.

Additional Information About Premium Assistance

Late Enrollment Penalties. An individual receiving Medicare premium assistance through full Medicaid, Medicare Savings Program, or LIS should not be charged late enrollment penalties.^[10]

Retroactive Coverage. Full Medicaid, SLMB, QI, and LIS can all apply retroactively for a number of months before application.^[11] While QMB does not apply retroactively before the QMB application date, there are a couple of scenarios where a person may get QMB applied back to a certain date:

• When the state is delayed in processing the QMB application, it may be applied back to the time of QMB application or determination.^[12]
• When a state should have screened a person for QMB (e.g., when a person on Medicaid is turning 65, or when a person is on SSI-based Medicaid), QMB eligibility may be applied back to the time of when screening should have taken place.^[13]

Past-Due Medicare Premiums. If a person faces a past-due Medicare premium, they have several options, including requesting an installment plan, requesting a waiver for extreme hardship, and challenging the amount billed. For more information, see Justice in Aging’s Payment Options for People who Owe Past-Due Premiums.

Examples

A Social Security Check Is Less Than Expected

Manuel is concerned about his Social Security check. He thought he was going to get $1,500 per month in Social Security retirement, but the check he received is only $1,296. He requested more information, and the Social Security Administration sent him a letter with this language:

This means SSA is deducting the 2026 Medicare Part B premium of $202.90 / month from his Social Security check. Manuel’s advocate screens him for Medicare Savings Programs, and was able to help him enroll in assistance.

A Large Medicare Premium Bill Arrives

Sophia is alarmed to receive a large Medicare Premium Bill from Medicare for over $1,000. The bill has the following language:

Summary of Charges

This means that Sophia owes the Social Security Administration back premiums for one month of coverage in June, and an upcoming payment for Medicare coverage in July. Sophia has some work quarters, which means her Part A premium is $311 (instead of the full $565), but she does not have enough work quarters for Premium-free part A.

Sophia’s advocate screens her for Medicare Savings Program eligibility. Sophia’s advocate also reviews options for Sophia to waive her past-due Medicare premium or address it with a payment plan. See the Justice in Aging resources Payment Options for Individuals Who Owe Past-Due Medicare Premiums. For more information on Medicare premium bills, see CMS’ Medicare Premium Bill.

Conclusion

Though most dually eligible individuals should receive help with premium costs, there are many opportunities for things to go wrong. Justice in Aging is interested in hearing about situations where individuals are receiving incorrect or improper premium or cost-sharing bills; please let us know by emailing info@justiceinaging.org.

Endnotes

1. Individuals who must pay a premium to access Medicare Part A do not have sufficient work history themselves or through a spouse. ↑

2. About one third of Medicare Advantage plans have a premium. KFF, Medicare Advantage 2025 Spotlight: A First Look at Plan Premiums and Benefits (November 2024). ↑

3. An individual can have their Part C premium deducted from their Social Security check, by asking their Part C plan. ↑

4. To view the latest Part D plan premium cost and breakdown for Medicare Advantage plans, see the CMS CY2026 plan landscape file. ↑

5. Some states have robust QMB programs, and/or do not have SLMB or QI programs. For more information on MSP eligibility by state, see KFF, Eligibility for QMB, and KFF, Eligibility for SLMB, and KFF, Eligibility for QI ↑

6. All states cover Part B premiums for full Medicaid enrollees, if the person belongs to a cash assistance group or deemed cash assistance group, even if the person is not enrolled in a Medicare Savings Program. The following 28 states cover Part B premiums for all full-benefit state plan Medicaid enrollees, even if the person is not enrolled in a Medicare Savings Program: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, District of Columbia, Florida, Georgia, Hawaii, Indiana, Iowa, Kansas, Maryland, Michigan, Mississippi, Nevada, New Jersey, New Mexico, North Carolina, Ohio, Oregon, South Carolina, Utah, Virginia, Washington, and Wyoming. For more information, see Chapter 1 of the Medicare Manual State Payment of Medicare Premiums. ↑

7. Section 1.9 of Chapter 1 of the Manual State Payment of Medicare Premiums (“…under CMS policy, states cannot require Medicaid applicants and beneficiaries to apply for Medicare as a condition of eligibility unless the state pays any Medicare cost-sharing or premiums the individual incurs.”). ↑

8. The following states appear to have a policy in place requiring Medicare-eligible individuals to enroll in Medicare as a condition of Medicaid eligibility: Alaska, California, Colorado, Idaho, Florida, Maryland, Massachusetts, Michigan, Mississippi, New York, Utah, Virginia, Washington State, and West Virginia. ↑

9. For Medicare Advantage enrollees, they should contact the Medicare Advantage plan. For Original Medicare enrollees, they should contact the standalone Prescription Drug Plan. ↑

10. Chapter 1 of the CMS Medicare Manual State Payment of Medicare Premiums (See Section 1.15 for more information about late enrollment penalties after a person leaves a Medicare Savings Program). For the effect of LIS on Part D late enrollment penalties, see NCOA, What Is the Penalty for Enrolling Late in Medicare Part D? ↑

11. Until January 2027, retroactive coverage for SLMB, QI, and Medicaid is for three months. Retroactive coverage is in place unless the state has received a waiver from retroactive coverage. Starting in January 2027, the retroactive period for SLMB, QI, and non-expansion full Medicaid will be two months (unless the state received a waiver from retroactive coverage, in which case it will be fewer months). See Justice in Aging, How H.R. 1 Impacts People Dually Eligible for Medicare and Medicaid For information on LIS retroactive coverage see Medicare Rights Center, Part D when you have Medicare and Extra Help. ↑

12. For more information on QMB effective dates, see section 1.6.2.5 of Chapter 1 of the CMS Medicare Manual State Payment of Medicare Premiums. ↑

13. For more information on QMB auto-enrollment of SSI-based Medicaid enrollees, see Section 1.6.2.6 of Chapter 1 of the Medicare Manual State Payment of Medicare Premiums. For more information on required screening of individuals who become eligible for Medicare, see Section 1.4.4 of Chapter 1 of the Medicare Manual State Payment of Medicare Premiums. ↑