| 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:
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. If you qualify for Extra Help and join a Medicare prescription drug plan, you will get the following:
You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:
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:
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) 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:
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.
There are four Medicare Savings Programs:
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.
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. 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 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) and say "Medicaid" for more information. |
