Income limits for getting Medicare Part B premium help and extra help for drug costs have been increased for 2012. The federal poverty level is now set at $930.83 per month, so a person living on less than this amount qualifies for various assistance programs.  Additionally, people who live on up to 35% more than this amount can also qualify for some help through the Medicare Savings Program and the Low Income Subsidy for Part D.

MEDICARE SAVINGS PROGRAM income limits for getting help in 2012.  Add $20 to each amount below.

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) and limited resources.  For this group, the 2012 level is $930.83/month ($11,170/year) for an individual; $1,260.83/month ($15,130/year) for a couple.

Specified Low-Income Medicare Beneficiaries (SLMBs):  States must pay the Medicare Part B premium for Medicare beneficiaries with incomes between 100% FPL and 120% FPL and limited resources. The limit for this group is $1,117 /month ($13,404/year) for an individual; $1,513/month ($18,156/year) for a couple.

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 and limited resources.  The limit for this group is $1,256.63/month ($15,079.50/year) for an individual; $1,702.13/month ($20,425.50/year) for a couple.

EXTRA HELP FOR PART D:  Add $20 disregard to each amount.

Full Subsidy:  Medicare Part D provides a full drug subsidy with low co-payments to Medicare beneficiaries with incomes up to 135% FPL and limited resources.  For those individuals, the 2012 eligibility limit is $1,256.63/month ($15,079.50/year) for an individual; $1,702.13/month ($20,425.50/year) for a couple.

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 limited (but higher than allowed for full subsidy) resources.  The income limit for this group is $1,396.25/month ($16,755/year) for an individual; $1,891.25/month ($22,695/year) for a couple.

There is some confusion about how the recent increase in people’s Social Security benefits affects their QMB, SLMB, or QI status, and some people may have received letters in January telling them they now make too much money to get help. I talked to the AHCCCS Client Advocate’s office and was told people could lose their assistance until the income levels are officially raised on April 1. But I have talked to others outside the AHCCCS system who say people should not lose their help.  If anyone knows of people who have been dropped from QMB, SLMB, or QI-1, please contact me.

Arizona is one of just eight states that do not ask people about their assets, such as money in the bank or in retirement accounts, when reviewing an application for the Medicare Savings Program. Arizona only looks at a person’s income.

Call or email me if you have questions about getting help.

The income limit information was provided by The Center for Medicare Advocacy.

In Maricopa County, 44% of Medicare beneficiaries are enrolled in Medicare Advantage plans.  There are 21 Medicare Advantage plans available in Maricopa county that include Part D drug coverage. The plans listed below have the largest number of enrollees or are growing their numbers.  The plans listed below are all HMO network plans.

Pacificare is the big kahuna in Maricopa County and is run by UnitedHealthcare. The plan is better known as AARP Medicare Complete, and this plan has been around for a very long time.

Cigna‘s plan gets 4.5 stars out of 5 on the Medicare.gov rating system.  If Cigna can get 5 to stars, it will be allowed to enroll new members throughout the year rather than just during the Open Enrollment Period of October 15th – December 7th.

Banner Medisun also gets 4.5 out of 5 stars from the Medicare.gov rating system.

Health Net is holding onto its enrollment numbers, despite having a monthly premium.

Humana is growing at a good pace.  Humana also has several PPO plans, which are not listed above.

SCAN, which grew rapidly over the previous three years, did not increase its enrollment numbers in 2011.

CareMore is in its second year in Phoenix and is growing rapidly – but lags far behind the other players.

Medicare Advantage enrollment data can be found at http://www.cms.gov/MCRAdvPartDEnrolData/

In Tucson and Pima County, competition is fierce among the four major players in the Medicare Advantage market. Medicare Advantage is popular among Pima County seniors, with 45% being enrolled in these private plans.

CMS (Centers for Medicare & Medicaid Services) released the latest numbers on Medicare Advantage enrollment, and here’s what it looks like in Pima County. I have not listed every plan, just the ones with the biggest enrollment.  I have not listed PPO plans, which have fairly small enrollment numbers. All of the plans below are HMO plans with a network of providers, though two of these plans have some local out-of-network options.

CareMore is only in its third year in Tucson, but its enrollment is growing fast, mostly by getting people to change from other Advantage plans. I can’t go into details here, lest someone think I’m promoting these plans.  I’m just reporting the numbers.

Health Net had over 19,000 member three years ago.  Then they became the first Tucson HMO to charge a premium, which led thousands of their members to move to other plans with $0 premium.

SCAN was supposed to be a new competitor in the Tucson market in 2012, but they seem to have put the brakes on building their provider network here. They say they made a decision to concentrate on their operations in Phoenix where they have 12,688 members and a large network of providers.

AARP Medicare Complete plans are actually UnitedHealthcare plans.  The AARP Medicare Complete is the old Pacificare plan and has been  around for a long time.  The AARP Medicare Complete Plus plan is known to providers as the “United plan” and has a different contract.

The enrollment numbers come from CMS and can be found at https://www.cms.gov/MCRAdvPartDEnrolData/MCESR/list.asp#TopOfPage.