Understood Care
Getting the care you need should not depend on your budget. If you are managing a new diagnosis, living with a chronic condition, or caring for a loved one, there are proven ways to reduce bills, lower prescription costs, and access free or low cost services. This guide shows you where to start, which programs to ask about, and how to get one on one help.
Financial help usually falls into a few categories
If you have Medicare and limited income and resources, Medicare Savings Programs can pay some or all of your Part A and Part B costs. That can include premiums, deductibles, and coinsurance depending on the category. Ask your state Medicaid office about QMB, SLMB, and QI and apply even if you think you are just over the limit since rules change each year.
Extra Help lowers your prescription costs if you have Medicare drug coverage. It reduces premiums and deductibles and sets low fixed copays for covered medicines. You apply through Social Security and can qualify based on income and resources.
For many people with Medicare, certain vaccines are covered at no cost and many insulins are capped at a predictable monthly amount in participating plans. Check your plan details and ask your pharmacist how these rules apply to you.
Some states run prescription assistance programs that work alongside Part D. These programs may help with premiums, deductibles, or copays and can coordinate benefits so you pay less at the pharmacy counter. Availability and rules vary by state.
Comparing Part D or Medicare Advantage drug coverage each year can significantly lower costs, especially if your medicines changed. Ask your clinician or pharmacist if a generic or a clinically appropriate alternative is available. Use the official Medicare plan comparison tool during open enrollment or when eligible for a special enrollment period at https://www.medicare.gov/plan-compare. An Understood Care advocate can review your medication list, run side by side plan comparisons, check pharmacy networks and prior authorization rules, and help you enroll with reminders for future reviews.
Medicaid can cover full health benefits with little or no cost for people who meet income and other rules. Children who do not qualify for Medicaid may qualify for the Children’s Health Insurance Program. Contact your state Medicaid office to check eligibility and apply.
If you are enrolled in Medicaid, ask about non emergency medical transportation for rides to covered appointments when you have no other way to get there. States must follow federal guidance for this benefit.
If you are not eligible for Medicare or full Medicaid, you may qualify for Marketplace savings that lower monthly premiums and reduce deductibles and copays. You can check potential savings on HealthCare dot gov and learn how the premium tax credit works.
Nonprofit hospitals are required to have a written financial assistance policy and to make reasonable efforts to screen patients for eligibility before using aggressive collections. If you receive a hospital bill you cannot afford, ask for the financial assistance application and a plain language summary.
Federally supported community health centers provide primary care and many offer dental and behavioral health services. Fees are discounted based on family size and income. You can search for a nearby site and ask about the sliding fee program.
Understood Care advocates can help you identify programs, gather documents, complete applications, and follow up on decisions so you receive every discount you qualify for. To get started, call (646) 904-4027 or sign up at https://app.understoodcare.com.
If you qualify for VA health care, copays can be reduced or waived based on priority group, service connection, and financial hardship. The VA also offers travel reimbursement for eligible trips to covered appointments. Ask your VA facility about your options.
Programs of All Inclusive Care for the Elderly can coordinate medical and long term services so you can remain in the community. Costs depend on your eligibility for Medicare and Medicaid.
Understood Care advocates can help you check eligibility, gather paperwork, apply for VA travel reimbursement, and coordinate enrollment and services with PACE teams.
If you join certain approved clinical research studies, Medicare may cover routine items and services such as office visits and tests, while the study sponsor may cover the experimental item or service. Always ask how costs will be handled before you enroll. Medicare
Learn more:
Lower costs of medication https://understoodcare.com/care-types/lower-costs-of-medication
Analyze medical bills https://understoodcare.com/care-types/analyze-bills
If a claim is denied, read the notice carefully. You can appeal and include supporting letters from your clinician. If you have Medicare and need help understanding the notice or filing an appeal, your local SHIP offers free counseling. Nonprofit hospitals must screen you for financial assistance before taking extraordinary collection actions. An Understood Care advocate can be by your side throughout your entire healthcare journey, help review the denial, gather letters, complete forms, coordinate with SHIP, and track deadlines so your appeal is strong and on time. For support, call (646) 904-4027 or sign up at https://app.understoodcare.com/
You do not have to manage this alone. A trained advocate can help you evaluate savings programs, prepare applications, compare plans, organize paperwork, and talk with billing offices so you can focus on your health.
This content is for education only and does not replace professional medical advice. If you have new weakness, severe pain, fever with confusion, chest pain, or trouble breathing, call emergency services.
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