|
Help Paying Medicare Costs
Do you Qualify for Extra Help with your Prescription Drug Coverage?
You may qualify for Extra Help, also called the low-income subsidy (LIS), from Medicare to pay prescription drug costs if your yearly income and resources are below the following limits in 2011:
- Single Person: income less than $16,245 and resources less than $12,640
- Married Person living with spouse and no other dependents: Income less than $21,855 and resources less than $25,260
You may also qualify even if you have a higher income (like if you still work or if you live in Alaska or Hawaii, or have dependents living with you).
Resources include money in a checking or savings account, stocks, and bonds.
Resources DO NOT include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person), or life insurance policies.
TIP: To see if you qualify and/or to apply for Extra Help, click here.
If you qualify for Extra Help and join a Medicare prescription drug plan, you will get the following:
- Help paying your Medicare drug plan's monthly premium, any yearly deductible, coinsurance, and copayments
- No coverage gap
- No late enrollment penalty
You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:
- You have full Medicaid coverage
- You get help from your state Medicaid program paying your Medicare Part B premiums (in a Medicare Savings Program described below), or
- You get Supplemental Security Income (SSI) benefits.
You will receive a purple letter from Medicare if you automatically qualify for Extra Help. You do not need to apply for extra help if you receive this letter. Keep this letter for your records. The following applies if you automatically qualify for Extra Help:
- If you are not already in a Medicare Part D plan, you must join one. If you don't join a Part D plan, Medicare may enroll you in one. If so, they will send you a yellow or green letter letting you know when your coverage begins.
- Different plans cover different drugs. Check to see if the plan you are enrolled in covers the drugs you use and if you can go the the pharmacies you want. Compare with other plans in your area.
- You can change your Part D plan anytime. Your new plan will be effective the first day of the next month.
- If you have Medicaid and live in certain institutions (like a nursing home), you pay nothing for your covered prescription drugs.
Caution: If you have employer or union coverage and you join a Medicare Part D plan, you may lose your employer or union drug coverage, and possibly your health coverage even if you qualify for Extra Help. Your dependents may also lose their coverage. Call your employer's benefits administrator for more information before you join. If you receive a yellow or green letter from Medicare stating they enrolled you in a Part D plan and you do not want that coverage, call 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048 and tell them you want to "opt out" of the Part D prescription drug plan due to employer or union coverage. You will not be charged a late enrollment penalty to join a Part D plan later provided your employer or union drug coverage is creditable coverage (at least as good as Medicare's Part D coverage).
Medicare Savings Programs (Help paying your Medicare costs)
States have programs that pay Medicare premiums and, in some cases, may also pay Part A and Part B deductibles, coinsurance, and copayments.
Although the rules may vary from state to state, in general, you must meet the following requirements (for 2011) in order to be eligible for the Medicare Savings Program:
- You must be entitled to and enrolled in Medicare Part A
- Single Person - Monthly income less than $1,246 and resources less than $6,680
- Married and Living Together - Monthly income (combined) less than $1,675 and resources less than $10,020
Resources include money in a checking or savings account, stocks, and bonds. Resources DO NOT include your home, car, burial plot, burial expenses up to your state's limit, furniture, or other household items.
TIP: To download the Medicare Savings Program application, click here. These amounts may change each year.
There are four Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI)
- Qualified Disabiled & Working Individuals (QDWI)
If you qualify for any of the above programs, you automatically qualify for Extra Help paying for the cost of Medicare prescription drug costs.
What does the QMB program cover?
The QMB program covers the cost of Medicare premiums, deductibles and coinsurance that Medicare beneficiaries usually pay. It means that your state covers these Medicare costs for you, and you have to pay only for anything that Medicare normally does not cover, such as routine dental care and eyeglasses. QMB does not supplement your Medicare coverage but instead ensures that you will not be precluded from coverage because you cannot afford to pay the costs associated with Medicare.
Tip: Some states require you to pay a small co-payment when you see a doctor.
What does the SLMB program cover?
If your income is too high to qualify for QMB but is not more than 20 percent above the federal income poverty level, you may receive Specified Low-Income Medicare Beneficiary (SLMB) coverage, which pays for your Medicare Part B monthly premium only. You will, however, pay for Medicare deductibles, coinsurance, and any care not covered by Medicare. The eligibility requirements are the same as those under the QMB program except that your income cannot exceed the national poverty level by more than 20 percent.
What does the QI program cover?
If your income is too high for help under SLMB, you may qualify under the Qualifying Individual (QI) program. This program has two qualifying levels. Under the first, if your income is more than 20 percent but no more than 35 percent above the national poverty level, your state may pay your Medicare Part B premium. Under the second level, if your income exceeds the 35 percent limit but is less than 75 percent of the national poverty level, the state may pay part of your Medicare Part B premium.
Caution: The QI program must be applied for each year because assistance is provided from a limited pool of funds on a first-come, first-served basis. Individuals who received the benefit in the last month of the previous year will be given priority.
What does the QDWI program cover?
If you are a Qualified Disabled and Working Individual, you may qualify for help paying for your Part A premiums if you do not qualify for premium-free Part A. The income limits are generally $3,715 per month for an individual and $4,989 per month for a married couple. Resources are limited to $4,000 for an individual and $6,000 for a married couple.
Applying for the programs
If you have Medicare Part A and think you qualify for assistance, you must apply for Medicaid at a state, county, or local medical assistance office. If you aren't receiving Medicare Part A but you believe you qualify, contact the Social Security Administration. Call (800) 772-1213, TTY users should call 1-800-325-0778 or look in your telephone directory for the number of your local office.
Programs for People Who Live in the U.S. Territories
There are programs in Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa to help people with limited income and resources pay their Medicare costs. Programs vary in these areas. Call your local Medical Assistance (Medicaid) office to find out more about their rules, or call 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048 and say "Medicaid" for more information.
Citation: cms.gov, ssa.gov |
Medicare Program 
