There are two ways for seniors to get help with their Medicare premium and Part D drug costs. Medicare beneficiaries with monthly income below $1,246 (individual) or $1,675 (couple) can apply to the state of Arizona for help.  Seniors with slightly higher income can go to Social Security for help with their Part D premium and drug costs. The “Limited Income Subsidy” is for people whose monthly income is less than $1,381 (individual) or $1,859 (couple).

Apply through the state of Arizona:
A person on Medicare fills out an AHCCCS form (Arizona Health Care Cost Containment System, pronounced “access”) and provides proof of income or where it comes from. (AHCCCS is Medicaid in Arizona.) This proof can be the annual letter from Social Security that shows how much a person receives and how much is being taken out for the Part B premium and any other charges, such as a Part D premium to an insurance company. Sometimes bank statements may need to be provided.

For people in other states, you can find info on where to get this help by googling “medicare savings program (your state name)”.

Here’s the help: Once approved for the Medicare Cost Sharing program, the state will pay the person’s part B monthly premium, which is $96.40, $110.50, or $115.40 (for those who are new to Medicare this year). Social Security will waive the Part D premium, up to about $25.00 per month. Then Social Security provides a subsidy to help with prescription costs, so the person will pay only $6.30 for a one-month supply of even the most expensive brand name drugs. Generics would cost $2.50 for a one-month supply.

Another important benefit is that people getting this help do not have a “doughnut hole” in their drug plan. This is the gap in Part D plans during which the plan stops paying for drugs and the person must pay 100% of the cost – until $4,550 has been spent. In 2011, people in the doughnut hole get a 50% discount on their brand drug costs.

Asset limits: When processing an application for help, AHCCCS has no asset limit (bank accounts, stocks, bonds, life insurance), but only considers income (Social Security check, pension, annuity payments, alimony). With no asset limit, it is best to apply through the state of Arizona (AHCCCS) for this help.  Social Security does consider assets when it processes an application for help.

Apply through Social Security:
Some people qualify for help with their drug costs, but not the state’s help with their Medicare Part B premium. People who have monthly income of less than $1,381 (for a single person) or $1,859 (for a couple) can get help with their Part D premium and their prescription costs. This help is received through an application to Social Security. Go to ssa.gov and see the link in the left hand column “Get extra help with Medicare prescription drug costs”. The application is pretty simple and Social Security will process it in about two weeks.

No penalty: Some people who qualify for help with their drug costs have never enrolled in Part D. Once approved for help, a person can enroll in a Part D plan and will not be penalized for a late enrollment.

I’ve heard that over 25% of seniors who qualify for help are unaware of these assistance programs. Having $96 more to spend each month is a big help. But the drug cost help can be the difference between choosing to take needed prescriptions and having money to buy food. So spread the word.

Forms can be found on-line at: http://www.azahcccs.gov

Or email me at medicareblog@gmail.com

Many seniors are struggling with health care costs and co-pays for their prescription drugs.  Many do not realize they can get help. I have met quite a few people whose Social Security check is less than $1,200 per month who did not realize they qualify for some really important help from the state of Arizona and Social Security.

An individual with a monthly income of $1,238 or less can get help from a program called  “Medicare Cost Sharing”. The monthly income limit for a couple is about $1,659. This program is for seniors and people under 65 who are on Social Security Disability and Medicare.

Here’s how it works: A person on Medicare fills out an AHCCCS form and provides proof of income or where it comes from.  (AHCCCS is Medicaid in Arizona.) This proof can be the annual letter from Social Security that shows how much a person receives and how much is being taken out for the Part B premium and any other charges, such as a Part D premium to an insurance company.  Sometimes bank statements may need to be provided.

For someone turning 65 soon, an AHCCCS application should be submitted about one month before Medicare will begin.

Here’s the help: Once approved for the Medicare Cost Sharing program, the state will pay the person’s part B premium, which is $96.40 per month (or $110.50 if you are new to Medicare this year). The state will also pay the Part D premium, up to about $20.00 per month. Then Social Security provides a subsidy to help with prescription costs, so the person will pay only $6.30 for a one-month supply of even the most expensive brand name drugs. Generics would cost $2 per month.

Another important benefit is that people getting this help do not have a “doughnut hole” in their drug plan. This is the gap in Part D plans during which the plan stops paying for drugs and the person must pay 100% of the cost – until $4,050 has been spent.

Some people qualify for help with their drug costs, but not the state’s help with their Medicare Part B premium.  People who have monthly income of  less than $1,354 (for a single person) or $1,821 (for a couple) can get help with their Part D premium and their prescription costs.  This help is received through an application to Social Security.

I’ve heard that over 25% of seniors who qualify for help are unaware of these assistance programs. Having $96 more to spend each month is a big help. But the drug cost help can be the difference between choosing to take needed prescriptions and having money to buy food.  So spread the word.

FYI:  AHCCCS stands for Arizona Health Care Cost Containment System and is pronounced “access”.

Forms can be found on-line at: http://www.azahcccs.gov

Pima Council on Aging can also help: 694-0418.

Or email me at medicareblog@gmail.com