Financial Help

Introduction

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.

What kinds of financial help exist

Financial help usually falls into a few categories

• Programs that lower premiums and out of pocket costs
• Free or discounted care from hospitals and clinics based on income
• Prescription drug savings and payment options
• Travel and transportation help for medical care
• Counseling services that help you apply and appeal

Help with Medicare costs

Medicare Savings Programs

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 for Part D

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.

Drug cost changes that can help right now

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.

Help with prescriptions

State programs and other coordination

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.

Plan comparisons and generics

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 and Marketplace savings

Medicaid and CHIP

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.

Transportation for Medicaid members

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.

Marketplace premium tax credits and cost sharing reductions

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.

Hospital and clinic financial assistance

Nonprofit hospital financial assistance policies

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.

Community health centers and sliding fee discounts

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.
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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.

Benefits for veterans and specific communities

VA care and travel reimbursement

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.

PACE for people who qualify for nursing home level care

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.

Coverage you may not realize you have

Clinical research study costs

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

Practical steps to lower bills and get help

1. Request an itemized bill and check for errors such as duplicate charges or services you did not receive
2. Before a scheduled service, ask the billing office for a cost estimate and whether financial assistance or payment plans are available. Nonprofit hospitals must share this information upon request
3. Call your state’s SHIP for free counseling about Medicare costs, plan choices, and appeals. Find your local SHIP at https://www.shiphelp.org
4. If you take several medicines, bring your full list to your clinician or pharmacist and ask about lower cost alternatives or a medication review. Plan comparisons can also reveal lower cost options
5. If transportation is a barrier, ask your plan or clinic about ride options. Medicaid members can request non emergency medical transportation through state programs. Learn about Marketplace options at https://www.healthcare.gov

How Understood Care advocates help with medication costs and billing

1. Review your medication list and prices, check for generics and clinically appropriate alternatives, and coordinate prior authorizations, tiering exceptions, and pharmacy network options
2. Compare Medicare Part D and Medicare Advantage plans based on your current medicines and preferred pharmacies, then help you enroll and set reminders for future reviews
3. Find manufacturer assistance, copay cards, charitable foundations, and mail order options, and help complete applications
4. Analyze medical bills and explanations of benefits, spot coding or billing errors, request corrections, and set up payment plans or charity care when eligible
5. Track deadlines for appeals and communicate with clinics, health plans, and pharmacies on your behalf
   

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

When you are denied or billed more than expected

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/

How an advocate can help

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.

FAQ

• What is this guide about and who is it for?
  This guide is for people who are worried about medical costs, prescription prices, and paying for care. It explains common types of financial help, how Medicare, Medicaid, the Marketplace, hospitals, and drug programs can lower what you pay, and how to get one on one help from an advocate so you are not figuring this out alone.
• What kinds of financial help are available for healthcare?
  Financial help usually falls into a few groups: programs that lower premiums and out of pocket costs, hospital and clinic financial assistance based on income, prescription drug savings, help with travel and transportation for medical care, and counseling services that guide you through applications and appeals.
• How can Medicare Savings Programs help with my costs?
  If you have Medicare and limited income and resources, Medicare Savings Programs can pay some or all of your Part A and Part B premiums, deductibles, and coinsurance. These programs have names like QMB, SLMB, and QI. You apply through your state Medicaid office, and it is worth applying even if you think you are just over the limits because rules change.
• What is Extra Help for Medicare Part D?
  Extra Help is a federal program that lowers prescription drug costs for people with Medicare Part D. It can reduce premiums and deductibles and sets low, fixed copays for covered medicines. You apply through Social Security based on income and resources. If approved, your out of pocket drug costs drop substantially.
• Are there recent drug cost protections I should know about?
  Many people with Medicare now pay nothing for certain recommended vaccines and have monthly caps on many covered insulins in participating plans. These changes can make predictable budgeting easier. Your plan documents and your pharmacist can explain how these protections apply to your specific coverage.
• Can states help with prescription costs beyond Part D?
  Some states run their own prescription assistance programs that work alongside Medicare drug coverage. These programs may help with premiums, deductibles, or copays and sometimes coordinate benefits so you pay less at the counter. Eligibility and rules vary, so it is important to check your state’s options.
• How can plan comparisons and generics lower my medication costs?
  Comparing Part D or Medicare Advantage drug coverage each year can reveal plans that cover your current medicines at lower cost. Asking your clinician or pharmacist about generics or clinically appropriate alternatives can also help. Using the official Medicare plan comparison tool and reviewing results with an advocate can make these choices clearer and easier.
• What can Medicaid and CHIP offer?
  Medicaid can provide full health coverage with little or no cost if you meet income and other eligibility rules. Children may qualify for the Children’s Health Insurance Program even if they do not qualify for Medicaid. Your state Medicaid office can explain benefits, help you apply, and connect you to transportation benefits for medical appointments.
• How do Marketplace plans help people who are not on Medicare?
  If you are not eligible for Medicare or full Medicaid, you may get savings through the Health Insurance Marketplace. Premium tax credits can lower monthly premiums, and cost sharing reductions can lower deductibles and copays if you qualify. You can check potential savings and compare plans through HealthCare.gov.
• What is hospital financial assistance and who can use it?
  Nonprofit hospitals must have a written financial assistance policy and must try to see if you are eligible before using aggressive collections. If you receive a bill you cannot afford, you can ask for a financial assistance application and a plain language summary. If approved, part or all of your bill may be reduced or forgiven based on your income and family size.
• How do community health centers help with costs?
  Federally supported community health centers offer primary care and often dental and behavioral health services. They use a sliding fee scale based on family size and income, so visits may be much more affordable. You can ask a local center about their discount program and what services are included.
• What benefits might veterans have access to?
  If you qualify for VA health care, your copays may be reduced or waived based on your priority group, service connection, and financial situation. The VA can also reimburse certain travel costs for eligible trips to covered appointments. It is important to ask your VA facility about both medical and travel benefits.
• What is PACE and who is it for?
  Programs of All Inclusive Care for the Elderly (PACE) help people who qualify for nursing home level care remain in the community. They coordinate medical care and long term services like day programs and home support. Costs depend on whether you have Medicare, Medicaid, or both. An advocate can help you check if there is a PACE program in your area and whether you qualify.
• Are there situations where clinical research studies affect my coverage?
  If you join certain approved clinical research studies, Medicare may cover routine items and services such as office visits and standard tests, while the study sponsor may cover the experimental drug or device. Before enrolling, always ask who pays for what so you are not surprised by bills.
• What practical steps can I take right now to lower bills?
  You can request an itemized bill, check for errors, and ask the billing office for a cost estimate before scheduled services. You can ask about payment plans and financial assistance. Calling your state’s SHIP program can help you understand Medicare costs and plan options. Bringing a full medication list to your clinician or pharmacist and asking about lower cost alternatives can also reduce monthly spending.
• How do Understood Care advocates help with medication costs and billing?
  Advocates can review your medications, look for generics and clinically appropriate alternatives, and coordinate prior authorizations and tiering exceptions. They can compare Part D and Medicare Advantage plans based on your actual medicine list, help you enroll, and set reminders to review plans later. They also analyze medical bills for errors, request corrections, set up payment plans or charity care when available, and help you apply for manufacturer assistance, copay cards, or charitable foundations.
• What should I do if a claim is denied or I am billed more than expected?
  If you receive a denial, read the notice carefully and note the reason and deadlines. You have the right to appeal and can include supporting letters from your clinician. SHIP counselors offer free help for Medicare appeals. Nonprofit hospitals must check for financial assistance eligibility before using harsh collection actions. An advocate can help you understand the notice, gather paperwork, complete appeal forms, coordinate with SHIP, and track deadlines so your appeal is as strong and timely as possible.
• How can an advocate make this process easier for me?
  A trained advocate can help you identify savings programs, organize documents, complete applications, compare plans, and talk with billing offices and insurers on your behalf. They help you turn a confusing mix of letters and bills into a clear plan, so you can focus more on your health and less on paperwork and phone calls.

References

• Medicare Savings Programs overviewhttps://www.medicare.gov/basics/costs/help‍
• Extra Help for Medicare Part D overview
  https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/5-ways-to-lower-your-drug-costs‍
• Social Security Extra Help application
  https://www.ssa.gov/medicare/part-d-extra-help‍
• Insulin savings in Medicare
  https://www.medicare.gov/coverage/insulin
• ‍Vaccines covered under Medicare drug coverage
  https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/5-ways-to-lower-your-drug-costs
• ‍CMS Prescription Drug Assistance Programs and SPAP coordination
  https://www.cms.gov/medicare/coordination-benefits-recovery/prescription-drug-assistance-programs‍
• Compare Medicare plans
  https://www.medicare.gov/plan-compare‍
• Medicaid eligibility policy
  https://www.medicaid.gov/medicaid/eligibility-policy‍
• Find your state Medicaid office
  https://www.medicaid.gov/eligibility‍
• Children’s Health Insurance Program
  https://www.medicaid.gov/chip‍
• Medicaid non emergency medical transportation policy guidance
  https://www.medicaid.gov/medicaid/benefits/nonemergency-medical-transportation-nemt-policy-guidance‍
• HealthCare dot gov savings information
  https://www.healthcare.gov/more-savings‍
• Cost sharing reductions
  https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs‍
• IRS requirements for nonprofit hospital financial assistance policies
  https://www.irs.gov/charities-non-profits/financial-assistance-policy-and-emergency-medical-care-policy-section-501r4‍
• IRS billing and collections rules for nonprofit hospitals
  https://www.irs.gov/charities-non-profits/billing-and-collections-section-501r6
• Find a community health center
  https://findahealthcenter.hrsa.gov
• Health Center Program sliding fee discount information
  https://bphc.hrsa.gov/compliance/scope/sliding-fee-discount-program
• VA copay and cost information
  https://www.va.gov/health-care/copay-rates
• VA Beneficiary Travel
  https://www.va.gov/health-care/get-reimbursed-for-travel-pay/
• Medicare PACE overview
  https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/program-of-all-inclusive-care-for-the-elderly-pace‍
• Medicare coverage for clinical research studies
  https://www.medicare.gov/coverage/clinical-research-studies
• Free counseling and local help
  State Health Insurance Assistance Program home
  https://www.shiphelp.org‍
• Administration for Community Living SHIP program page
  https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship‍
• Eldercare Locator for local aging services
  https://eldercare.acl.gov/Public/Index.aspx
• Related Understood Care resources
  Care Coordination
  https://understoodcare.com/care-types/care-coordination‍
• Lower Costs of Medication
  https://understoodcare.com/care-types/lower-costs-of-medication
  Appointments
  https://understoodcare.com/care-types/appointments
• Medicare Savings Programs overview
  https://www.medicare.gov/basics/costs/help‍
• Extra Help for Medicare Part D overview
  https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/5-ways-to-lower-your-drug-costs‍
• Social Security Extra Help application
  https://www.ssa.gov/medicare/part-d-extra-help‍
• Insulin savings in Medicare
  https://www.medicare.gov/coverage/insulin‍
• Vaccines covered under Medicare drug coverage
  https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/5-ways-to-lower-your-drug-costs‍
• CMS Prescription Drug Assistance Programs and SPAP coordination
  https://www.cms.gov/medicare/coordination-benefits-recovery/prescription-drug-assistance-programs‍
• Compare Medicare plans
  https://www.medicare.gov/plan-compare‍
• Medicaid eligibility policy
  https://www.medicaid.gov/medicaid/eligibility-policy‍
• Find your state Medicaid office
  https://www.medicaid.gov/eligibility‍
• Children’s Health Insurance Program
  https://www.medicaid.gov/chip‍
• Medicaid non emergency medical transportation policy guidance
  https://www.medicaid.gov/medicaid/benefits/nonemergency-medical-transportation-nemt-policy-guidance‍
• HealthCare dot gov savings information
  https://www.healthcare.gov/more-savings‍
• Cost sharing reductions
  https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs‍
• IRS requirements for nonprofit hospital financial assistance policies
  https://www.irs.gov/charities-non-profits/financial-assistance-policy-and-emergency-medical-care-policy-section-501r4‍
• IRS billing and collections rules for nonprofit hospitals
  https://www.irs.gov/charities-non-profits/billing-and-collections-section-501r6‍
• Find a community health center
  https://findahealthcenter.hrsa.gov‍
• Health Center Program sliding fee discount information
  https://bphc.hrsa.gov/compliance/scope/sliding-fee-discount-program‍
• VA copay and cost information
  https://www.va.gov/health-care/copay-rates‍
• VA Beneficiary Travel
  https://www.va.gov/health-care/get-reimbursed-for-travel-pay/‍
• Medicare PACE overview
  https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/program-of-all-inclusive-care-for-the-elderly-pace‍
• Medicare coverage for clinical research studies
  https://www.medicare.gov/coverage/clinical-research-studies‍
• Free counseling and local help
  State Health Insurance Assistance Program home
  https://www.shiphelp.org‍
• Administration for Community Living SHIP program page
  https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship‍
• Eldercare Locator for local aging services
  https://eldercare.acl.gov/Public/Index.aspx‍
• Related Understood Care resources
  Care Coordination
  https://understoodcare.com/care-types/care-coordination‍
• Lower Costs of Medication
  https://understoodcare.com/care-types/lower-costs-of-medication‍
• Appointments
  https://understoodcare.com/care-types/appointments

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.