Help with Medicare Costs

I am meeting today with a couple who are having trouble paying their drug co-pays. It sounds like they qualify for help with their Medicare costs and their drug costs – but they had never heard about programs that help people on Medicare with low income.

There are two separate programs to help with Medicare costs and drug costs: 1) The Medicare Savings Program is administered by the states.  2) Extra Help for Part D is run through Social Security.

The income limits provided below apply to most states, but not all. Hawaii and Connecticut have much higher income limits for getting help.

Eight states do not consider assets when their residents apply for the Medicare Savings Program, which is administered through state Medicaid offices. Those eight states are:  Arizona, Alabama, Connecticut, Delaware, Maine, Mississippi, New York, Vermont.

MEDICARE SAVINGS PROGRAM  in 2015

1. Qualified Medicare Beneficiaries (QMBs)

States must pay all Medicare cost-sharing for Medicare beneficiaries with incomes up to 100% of the federal poverty level (FPL) (+ $20) and resources below $7,280 ($10,930 if married).  A beneficiary must have income below $1,001/month for an individual; $1,348/month for a couple.

2. Specified Low-Income Medicare Beneficiaries (SLMBs)

States must pay the Medicare Part B premium for Medicare beneficiaries with incomes between 100% and 120% FPL (+$20) and resources below $7,280 ($10,930 if married). The income limit for this group is $1,197 /month for an individual; $1,613/month for a couple.

3. Qualified Individual (QI)

States have a limited amount of money from which they must pay, on a first come, first served basis, the Medicare Part B premium for Medicare beneficiaries with incomes between 120% FPL and 135% FPL (+$20) and resources below $7,280 ($10,930 if married).  The income limit for this group is $1,345/month for an individual; $1,813/month for a couple.

EXTRA HELP FOR PART D in 2015

Full Subsidy:  People who qualify for the help described above will also qualify for a full subsidy for Medicare Part D.  They do not pay a Part D premium and they pay only $6.60 (or less) for any brand name drug and $2.65 (or less) for generics.

This is a huge savings over “regular” Part D co-pays for brand drugs, which range from $35 to $45 for a one-month supply.   For example, a person taking insulin, with a regular co-pay of $45, would pay only $6.60.  On most Part D plans, “non-preferred brand” drugs have a co-pay of $75 to $95, but that is reduced to $6.60 if a person gets Extra Help.

People who get Extra Help do not have a donut hole/coverage gap in their drug plan.

Partial Subsidy: Medicare Part D provides a partial subsidy of premium, deductible and co-insurance to Medicare beneficiaries with incomes up to 150% FPL and resources below $13,640 ($27, 250 if married). The income limit for this group is $1,471/month for an individual; $1,991/month for a couple.  They will have a reduced Part D premium and 15% co-insurance for their drugs (or the co-pay on their plan if it is less than 15%).

People who think they qualify for the partial subsidy can only apply through SSA.gov.  Those who qualify for the Medicare Savings Program and Extra Help can apply through their state Medicaid office (or website) or through SSA.gov.

People in Arizona can use an online application at www.healthearizonaplus.gov

First you set up a user name and password and then you ask for help with Medicare costs.  It takes about 20 minutes to complete the application.  If your only income is from Social Security, the program will access your Social Security information and tell you if you qualify.  ARIZONA DOES NOT ASK IF YOU HAVE SAVINGS OR OTHER ASSETS.

Confirmation will be received by mail within about one week.  It’s amazingly fast if you apply on line.  Otherwise, it can can 45 days to process a paper application.