If you have limited income and resources then you need to read this. Medicare Savings Programs can help you pay for your premiums, deductibles, copayments and coinsurance.
Learn the benefits of Extra Help & Medicare Savings Programs and how to apply on your own. Remember, when you submit the application for Extra Help, request that the information be sent to your state too.
Three Things To KNow Before Getting Started
- If you are eligible for Extra Help you are eligible for a Special Enrollment Period.
- If you are eligible for Extra Help you are not subject to the Late Enrollment Penalty.
- Submitting an application for Extra Help starts the application process for an MSP.
Closing Gaps In Care
“Closing a gap in care” is a common phrase we use and I’m guessing no one has ever explained this to you. Closing a gap in care often referred to as medication adherence.
That’s a fancy way of saying that you take a prescription drug and do not follow the doctors’ orders. There are other gaps in care and we’ll get to those in a minute. Those are referred to as the Social Determinants of Health.
How Are You Going To Get Help?
- Licensed Agent Assistance
- Social Government Referral Programs
- Call Your Local Medicaid Office
What Is Extra Help?
Low Income Subsidy (LIS) and Extra Help are used interchangeably. Extra Help (LIS) is a federal subsidy program that helps Medicare-eligible consumers save money on their prescription drug costs.
Note that Extra Help is a federal program and not a state program. We’ll get to state programs in a moment but it’s important to note that Extra Help only subsidizes costs associated with Part D.
Extra Help is run by the Social Security Administration. SSA determines eligibility and benefit levels for Extra Help and processes the application.
Medicare beneficiaries can qualify for Extra Help paying for their monthly premiums, annual deductibles, and co-payments related to Medicare prescription drug coverage.
ssa.gov/benefits/medicare/prescriptionhelp.html
Levels Of Extra Help
There are 4 levels that someone can qualify for based on their income and resources. Resources are bank accounts, stocks, bonds, and other resources that can be readily converted to cash within 20 days or less.
There is a percentage associated with each level of Extra Help and it determines how much of the plan premium will be paid for and the amount of money a prescription copayment might cost.
Extra Help Program Benefits
Eligible consumers may have a zero monthly plan premium or receive a reduction determined by Social Security. The Coverage Gap does not apply to a consumer who receives Extra Help.
The Extra Help benefit is estimated to have an annual value of $5,100. As mentioned before, the Part D Late Enrollment Penalty (LEP) does not apply to a consumer who is eligible for Extra Help.
Late Enrollment Penalty (LEP)
A person enrolled in a Medicare plan may owe a late enrollment penalty if they go without creditable prescription drug coverage for any continuous period of 63 days or more.
Extra Help may reduce or eliminate the penalty and remains in effect while a consumer is eligible for Extra Help and remains enrolled in a Part D plan.
What Are Medicare Savings Programs?
Medicaid and Medicare Savings Programs are used interchangeably. Medicare Savings Programs are state programs that help consumers save money on premiums, deductibles, copayments and coinsurance.
Note that MSP’s are provided by your state and with the help of federal funds. MSP’s subsidize only the costs associated with Part A & Part B, not Part D.
Individuals that qualify for a Medicare Savings Program automatically qualify for Extra Help but a consumer with Extra Help does not necessarily qualify for a Medicare Savings Program.
You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions.
medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs
Levels Of Medicare Savings Programs
There are 7 levels that someone can qualify for based on their income and resources. If you have Medicare and Medicare then you need to know which premiums are paid for by the state.
| Eligibility Level | Pays For Part A Premium | Pays For Part B Premium | Pays For Part D Premium | Medicare Deductibles, Copays, Coinsurance | Have Health Benefits Through Medicaid |
|---|---|---|---|---|---|
| FBDE | No | Varies By State | May Be Covered By Extra Help | Varies By State | Yes |
| QMB Plus | Yes | Yes | May Be Covered By Extra Help | Yes | Yes |
| SLMB Plus | No | Yes | May Be Covered By Extra Help | Varies By State | Yes |
| QMB Only | Yes | Yes | May Be Covered By Extra Help | Yes | No |
| QI | No | Yes | May Be Covered By Extra Help | No | No |
| QDWI | Yes | No | May Be Covered By Extra Help | No | No |
| SLMB Only | No | Yes | May Be Covered By Extra Help | No | No |
Medicare Savings Programs Benefits
If you are eligible for an MSP then you may enroll in a Dual Special Needs Plan (DSNP). Dual-eligible consumers are those with both Medicare and Medicaid.
Dual Special Needs Plan provides consumer with benefits that are in addition to what’s covered by Original Medicare and may include dental, transportation and over-the-counter benefits.
Late Enrollment Penalty
If you didn’t enroll in Part A when you were first eligible your monthly premium may go up 10% for twice the number of years you were without and could have had it.
If you didn’t enroll in Part B when you were first eligible your monthly premium may go up 10% for each 12-month period you could have had Part B and but didn’t sign up.
If you are eligible for a Medicare Savings Program you are not subject to a Late Enrollment Penalty for Medicare Part A and/or Medicare Part B.
How To Qualify For Medicare Savings Programs
Qualifying is simply making less income and having less resources than the limits listed below. Alaska and Hawaii have higher limits so these number apply to all other states.
1. Qualified Medicare Beneficiary (QMB): You may qualify for the QMB program if you have income of less than 100% of the Federal Poverty Level (FPL) and resources under $8,400 if single and $12,600 if married.
| Medicare Savings Program | Individual Monthly Income Limits | Individual Resource Limits | Married Couple Monthly Income Limit | Married Couple Resource Limit |
|---|---|---|---|---|
| Qualified Medicare Beneficiary (QMB) Program | $1,153 | $8,400 | $1,546 | $12,600 |
2. Specified Low-Income Beneficiary (SLMB): You may qualify for the SLMB program if you have income between 100 and 120% of the Federal Poverty Level (FPL) and resources under $8,400 if single and $12,600 if married.
| Medicare Savings Program | Individual Monthly Income Limits | Individual Resource Limits | Married Couple Monthly Income Limit | Married Couple Resource Limit |
|---|---|---|---|---|
| Specified Low-Income Medicare Beneficiary (SLMB) Program | $1,379 | $8,400 | $1,851 | $12,600 |
3. Qualifying Individual (QI): You may qualify for the QI program if you have income of at least 120% and not more than 135% of the Federal Poverty Level (FPL) and resources that do not exceed three times the limit for SSI eligibility.
| Medicare Savings Program | Individual Monthly Income Limits | Individual Resource Limits | Married Couple Monthly Income Limit | Married Couple Resource Limit |
|---|---|---|---|---|
| Qualifying Individual (QI) Program | $1,549 | $8,400 | $2,080 | $12,600 |
4. Qualified Disabled and Working Individuals (QDWI): You may qualify for the QDWI program if you have income of $4,615 if single and $6,189 if married and resources of $4,000 if single and $6,000 if married.
| Medicare Savings Program | Individual Monthly Income Limits | Individual Resource Limits | Married Couple Monthly Income Limit | Married Couple Resource Limit |
|---|---|---|---|---|
| Qualified Disabled & Working Individuals (QDWI) Program | $4,615 | $4,000 | $6189 | $6,000 |
Some states like Hawaii and Alaska may choose to increase the federal guideline amounts or remove the resource all together. It is important to reference each states eligibility rules.
Ask Yourself 3 Questions Before Applying
- Do I have or am I eligible for Medicare Part A?
- Is my income for the year at or below the limits listed above?
- Are my resources at or below the limits listed above?
If you answer “Yes” to all 3 questions call us or your State Medicaid Program to see if you may qualify and ask about how to complete an application.