Low-income Medicare beneficiaries get help with their Medicare Part B premium and their prescription drug costs. Income levels that qualify for help have been raised for 2013.
Anyone on Medicare with monthly income below $1,313 (individual) or $1,765 (married couple) can get help through the Medicare Savings Program, which is funded by the federal government, but administered through state Medicaid offices. In Tucson, the ALTCS office (Arizona Long Term Care System) handles applications for this help.
Medicare beneficiaries who qualify for this help will get their Medicare Part B premium paid by the state. That means they will have $104.90 more in their Social Security check each month. Then the state will send info to Social Security and get them signed up for help with their Part D and drug costs. This is called the Low Income Subsidy (LIS).
LIS and PRESCRIPTION HELP:
A person who qualifies for LIS pays $2.65 for generic drugs and $6.60 for brand drugs. This is a really good deal, since most Part D plans have a $40 co-pay for brand drugs. Some Part D drug plans require an $8, or even $15 co-pay for generics. So the LIS program can save people a lot of money on their prescriptions.
Medicare beneficiaries with monthly income below $978 (individual) and $1,313 (couple) get more help. In addition to having their Part B premium paid by the state, they get help with their medical bills. The deductibles and/or co-pays that are part of Medicare and Medicare Advantage are paid by the state, so these folks should not have any out-of-pocket costs when they get medical care. These folks are called Qualified Medicare Beneficiaries (QMB).
In Arizona, QMBs are assigned an HMO health plan and they must use doctors in the plan’s network in order to get their medical co-pays covered by AHCCCS (Arizona medicaid). Then they have Original Medicare, or a Medicare Advantage plan to pay the major portion of their medical bills. But if they are enrolled in Medicare Advantage, they must make sure their doctors are in both their AHCCCS plan network and their Medicare Advantage plan network.
SPECIAL NEED PLANS:
There are Medicare Advantage plans available for QMBs that can avoid the confusion about coordinating two networks. All AHCCCS plans now have related Medicare Advantage plans that are owned by the same company – and have the same provider networks. Additionally, these Advantage plans offer QMBs benefits that are not covered by Medicare, such as $1,000 of dental services per year; eyeglasses every two years; and money for hearing aids.
NOTE: I’ve included the $20 disregard for the income limit figures provided here. The actual limits are $20 less, but Medicare will “disregard” $20″ per month – but only one $20 disregard is allowed for a couple.
ARIZONA AND ASSETS:
The state of Arizona, when considering an application for the Medicare Savings Program, does not care about a person’s assets. Arizona only looks at income, so a person can have money in the bank, IRAs, or a substantial life insurance policy and still qualify for this help.
Because Arizona does not ask about a person’s assets, it is best to apply for the Medicare Savings Program and LIS through the state. If a person applies for help through Social Security, asset limits are considered – and they are very low: $13,300 for an individual and $26,580 for a couple.
I recently helped a client apply for the LIS through SSA.gov. The online application for “Extra Help” was short and simple. In about two weeks she received a letter saying she qualified for LIS (help with her drugs costs). The letter also said the state of Arizona had been informed that she might qualify for the Medicare Savings Program – but she had to apply for that help.
The state sent this lady the application form and I helped her fill it out. Now she must wait 30 to 45 days for the state to process it. In the meantime, her Medicare has started and she is paying the Part B premium.
So I learned something from this experience: We should have started the whole process through the state.