If a person is turning 65 and living on their Social Security benefits, they might qualify for help with the Medicare Part B premium ($99.90 per month) and their drug costs.  If a person applies for this help through the state of Arizona, there is no limit on how much a person can have in savings to qualify. If a person applies through Social Security, assets such as savings cannot exceed $13,070 for an individual or $26,120 for a couple.

The Arizona Health Care Cost Containment System (AHCCCS – pronounced “access”) administers the Medicare Savings Program in our state.  An application for the Medicare Savings Program can be submitted up to 45 days before a person’s Medicare coverage will begin.  To provide proof of income, a person can attach the annual award letter they receive from Social Security in December of each year.  If a person is not collecting Social Security as they are turning 65, providing proof of income becomes more complicated and they might be better off going through Social Security. Social Security will check their tax records.

When the state of Arizona approves a person for the Medicare Savings Program, AHCCCS will notify Social Security that the individual also qualifies for the low income subsidy for drug coverage.

Here are the levels for getting help in 2012:

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.

Add $20 disregard to each income level.  But a couple only gets to add $20 once.

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.

Medicare will undoubtedly be a big issue in the upcoming election, and proposals from both Republicans and Democrats include cutting benefits or pushing more costs onto seniors and disabled people.  The Center for Medicare Advocacy has a list of suggestions for strengthening Medicare, and I agree with all of them.

The following suggestions are from the Center for Medicare Advocacy:

Put a Drug Benefit in Traditional Medicare

Offering a drug benefit in traditional Medicare and allowing the Medicare program to negotiate drug prices would give beneficiaries a choice they do not now have.  These changes would also result in enormous cost-savings for Medicare, taxpayers and beneficiaries. A drug benefit in traditional Medicare would provide an alternative to profit-driven and administratively inefficient private plans.

I often ask the questions: Why is Part D so complicated? Why are there over 1,100 Part D plans across the country – all run by insurance companies?  Does this save Medicare money, since Medicare is actually paying the prescription bills?

Let People Between Age 55 and 65 Buy-In to Medicare

Lowering the age of eligibility to enroll this healthier population  in the Medicare program would add revenue from  people who will likely need less care and fewer services than older and disabled enrollees.

My comment: Right on! Insurance companies don’t want people over 55, so why not let them enroll in Medicare? 

Include Dental, Vision, and Hearing Coverage in Medicare

People who rely on Medicare identify the need for basic dental and vision coverage (which Medicare does not currently provide) as critical to their well-being and highly desirable. Most people with Medicare, however, go without basic dental and vision care.  Basic dental and vision care not only improve the quality of life for people, they also promote overall health and save taxpayer money by preventing later, more serious issues that result from untreated routine issues.

Improve Assistance to Low-Income Medicare Beneficiaries

Assistance for poor people who have Medicare should be more generous.  Only people with incomes up to about $12,000 get full financial assistance to pay for their Medicare benefits.  For other poor people with Medicare, only partial assistance is available (for people with incomes just under $17,000.)

My comment: Another right on!  I see too many people living on $1,200 – $1,500 per month who cannot afford to spend $5,000 (or more) per year on medical bills if they get sick. And $45 co-pays to see a specialist is a lot of money for these folks, meaning they may not get the care they need.

Add Care Coordination to Traditional Medicare

Many people who use Medicare are older, sicker, and have complex health needs. In general, people with complex health needs have multiple chronic and acute care conditions.  This group represents about 25% of the Medicare population and accounts for about 80% of Medicare spending. Coordinating the healthcare needs of this population is essential, yet traditional Medicare does not pay for care coordination as a benefit in its own right.

My comment:  This is what Medicare Advantage plans are supposed to be, but mostly they just pay the bills rather than coordinate care.  Medicare Advantage plans should be delivering coordinated care – or savings for Medicare – if they are to continue.

The big news from Washington is the vote to approve the payroll tax extension through the end of 2012.  Also included in the bill is a provision to avoid  a 27% cut in pay for doctors serving Medicare patients.

And within the bill, HR 3630 is sec. 2211:  Extension of the Qualifying Individual (QI) program.

In late-December, the state of Arizona sent letters to about 12,500 people telling them they would lose the help they get paying for their Medicare Part B premium.  This would mean having $99.90 taken out of their monthly Social Security check – and thus about $100 less to live on each month.  In January these folks got a letter saying they would get help, but only through the end of February.  I wonder if the state will send another letter telling these folks about the extension of the QI program through the end of 2012?

The QI program is a fixed-amount block grant to states to administer through their Medicaid programs. In Arizona we know Medicaid as AHCCCS (pronounced “access”) which stands for the Arizona Health Care Cost Containment System.

The Center for Medicare Advocacy says the QI program has been extended year-to-year ever since its initial authorization expired in 2002. With this  funding record, I wonder why AHCCCS felt it necessary to scare so many low-income seniors and disabled Arizonans with letters saying the federal government would not continue the QI program?

Through the QI program, states have a limited amount of money from which they must pay, on a first come, first serve basis, the Medicare Part B premium for Medicare beneficiaries with incomes between 120% and 135% of the federal poverty level.  In 2012, 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.

Add $20 to these figures due to a rule that sets aside $20 of a person’s income. And the state of Arizona does not consider a person’s assets, like money in the bank or IRAs, when a person applies for this help. Arizona (AHCCCS) just wants to know a person’s income.

Contact me for more information about getting help through AHCCCS and the QI program, SLMB, and QMB.

There are other levels for getting this help and more, and I wrote about them last week: Extra Help for Medicare and Part D costs.