I recently wrote about getting help with the Medicare Part B premium and drug costs. These programs are called the Medicare Savings Program (MSP) and the Low Income Subsidy (LIS).   Medicare beneficiaries with income below $1,313 per month  (individual) or $1,765 (married couple) can apply for help through their state Medicaid office.  But people with slightly higher income than this can apply for help with their drug costs through SSA.gov, and I did not include this in my last post.

A Medicare beneficiary with monthly income above $1,313, but less than $1,436 can go to SSA.gov and apply for “Extra help” for their Part D drug costs. A married couple living on more than $1,745 per month, but less than $1,939 can also get help with their Part D premium and their drug costs.

People in these income brackets will get the following benefits depending on where they fall in the income range:

Sliding scale reductions of their Part D monthly premium

$65 annual deductible in their Part D plan (rather than $325 in some plans)

15% co-insurance for their drugs (rather than $40 or $90 co-pays that are built into most Part D plans)

***Social Security does have asset limits, which are $13,300 for an individual and $26,580 for a married couple.

In my last post I recommended that people go through their state Medicaid office to get help, but people in this  income bracket cannot go through their state. They can only go through Social Security.

Last year I was talking to a client who told me she could not afford an expensive pain medication her doctor had prescribed. I asked her what her monthly income was and we determined she would not qualify for help through the state of Arizona – but I suggested she try using the Extra Help application on SSA.gov.

She called me two weeks later to say she had received a letter from Social Security telling her she qualified for LIS.  She was thrilled that she would be able to take the expensive medication that really helped her.

Before working with this client, I was not aware of this highest income bracket that qualifies for help through Social Security. That’s because this income bracket is not on the state form (AHCCCS for Arizona) that is used to apply for the Medicare Savings Program.

Here is a link to the AHCCCS form to apply for the Medicare Savings Program. http://www.azahcccs.gov/applicants/Downloads/ApplicationForms/de-103.pdf

Here we go again. I got an email today from Chris who wrote:

I just received a letter from Arizona AHCCCS stating that the Medicare Savings Program has not been funded by the U.S. Congress and beginning Jan. 1, 2013, Part B premiums will no longer be paid under the QMB Medicare Savings Program.

This letter also states:  “While you will be responsible for your Part B premiums beginning January 2013, the premiums will not be deducted from your Social Security Payments for a few months…”.

The same letter went out to 12,500 people in Arizona last year around this time, but our esteemed-and-well-paid-representatives in Washington came to a year-end agreement to pass a bill that included funding for multiple programs. Funding for the Medicare Part B premium assistance was included in that bill and nobody lost their help.

Last year’s letter (December 2011) went like this:

You receive help paying your Medicare Part B premium through the Qualified Individual-1 (QI-1) program. Although AHCCCS determines eligibility for this program, it is funded 100% by the Federal government.

Your QI-1 benefits will end December 31, 2011 because Congress has not authorized any additional funding for the program.

You will be responsible for paying your Medicare Part B premiums beginning January 1, 2012

Just after that “happy holidays!” letter went out to people living on less than $1,246 per month,  Congress passed a bill on December 23rd, 2011 to fund various programs, including the Medicare Saving Program. I wrote about this last year.

Now here we are on December 27th, 2012 and nothing has been passed to extend funding for 2013. Yikes! Hopefully our  esteemed-and-well-paid-representatives in Washington will get back from yet-another-vacation and pass a damn bill!

In the meantime, I would say, “Don’t panic, things will get worked out”.  I hope that is accurate advice.

I just got an email from my bank, Chase. It looks very fishy to me, so I will not be clicking the link and providing my account information.  The email can be found at the end of this post. A person should never respond to a request like this which asks for important personal and financial information.

However, I have heard from clients who have been contacted by their Medicare Advantage plans offering to help them get a subsidy for their drug costs.  Several of my clients have said, “Thanks but no thanks” because they do not give out information over the phone. And yet, these were legitimate offers of help from Social Service Coordinators, a company that contracts with Medicare Advantage plans to reach out and help members qualify for and maintain help through the Medicare Savings Program and the Low Income Subsidy.

Another outreach effort by Medicare Advantage plans

Just this week a client told me her Medicare Advantage plan called to ask if a nurse could visit her to do an in-home checkup. My client thought this was very odd because she sees her primary care doctor regularly and has no particular issues. But as it turns out, Medicare Advantage plans are doing face-to-face meetings with people enrolled in their plans to do surveys of their health conditions. This information is provided to Medicare as part of the plan’s risk analysis. And this risk analysis helps the Advantage plan get more accurate payment from Medicare.

Here is the strange email I received from my bank.  Do you think it’s a scam?