Extra Help for Low-Income Beneficiaries
The new Medicare drug benefit has several levels of help for people with Medicare who have limited resources. In addition, many states are providing added help to residents—including, in some cases, residents who don't qualify for Medicare's low-income assistance.
Most of the documents outlined below provide general information and are geared toward advocates, consumers, or legislators. More Details includes more in-depth information on the regulations that govern operations of the low-income benefit and specifics on what states can do to provide added help.
From Families USA: Background Pieces on the Low-Income Subsidy and Who Might Qualify
Whether a low-income Medicare beneficiary qualifies for added help from the program—and how much extra help he or she might receive—will depend on several factors, including:
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- whether he or she qualifies for one of the three Medicare Savings Programs (which are actually administered by state Medicaid programs)
- whether he or she lives in a long-term care facility;
- his or her income; and,
- his or her assets.
The pieces listed below are designed to help people sort through the various levels of help for low-income beneficiaries. If there's any question about whether a beneficiary can qualify for help, he or she should go ahead and apply—applying is free, and the savings can be substantial.
The Medicare Drug Benefit: How Much Will You Pay?: Tables detail the basic benefit as well as the low-income benefit for those who are and aren't enrolled in Medicaid. (updated November 2010)
Extra Help for Your Drug Costs: Do You Qualify?: This piece helps low-income beneficiaries determine whether they will be able to receive extra help with drug costs under the new law whether they are or are not also enrolled in Medicaid (updated March 2007).
Will You Be Eligible for Low-Income Assistance in 2007? A Decision Tree Chart: A flow chart that can help beneficiaries sort out the confusing eligibility requirements for different levels of low-income assistance. (updated March 2007)
What States Can Do to Help People with Limited Resources
The new Medicare law left significant gaps or holes in the prescription drug benefit it created. For example, most beneficiaries will still have considerable out-of-pocket costs, including monthly premiums, an annual deductible, copayments, and a large gap in coverage—known as the doughnut hole—where they will have to pay all of their drug expenses on their own. What's more, the new drug benefit will not cover several classes of drugs that beneficiaries may need.
States can provide extra help by filling in these gaps or by helping to ensure a smooth transition for those who are moving from Medicaid drug coverage to coverage under Medicare Part D. Our series titled Gearing Up: States Face the New Medicare Law is designed to help state advocates and policy makers get up to speed on the new drug benefit and how it will affect state Medicaid and Pharmacy Assistance Programs.
Gearing Up: States Face the New Medicare Law—Is Your State Ready for 2006? This report examines what the new Medicare Part D prescription drug benefit means for state Medicaid programs. (September 2004)
Gearing Up: The Holes in Part D - Gaps in the New Medicare Drug Benefit, Part 1 of 2 (July 2005)
Gearing Up: Filling the Holes in Part D - The Essential Role of State Pharmacy Assistance Programs, Part 2 of 2 (July 2005)
Getting Help
If you want to discuss whether you or someone you are helping might qualify for added help, contact your local State Health Insurance Assistance Program. Click here for information on how to contact the program nearest you where counselors can provide individualized help.
You can also call Medicare at 1-800-MEDICARE or visit Medicare's Web site at http://www.medicare.gov/.
Low-income Medicare beneficiaries can apply for Extra Help with their Medicare Part D costs (also known as the Low-Income Subsidy) through their state's Medicaid offices or through the Social Security Administration's Web site.
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