When “The Rent” is Just Too Darned High

Are your drug costs or Part A or B premiums getting a bit much for you? If you can meet certain income limits, there is help for this. (This is not an exhaustive list!)

Medicare Savings Program

Your State government may help pay your Medicare Part A and/or B premiums and may also pay the deductions, coinsurance, and copayments if you can answer Yes to these three questions:

  • Do you have or are you eligible for Part A?
  • Is your income for 2023 at or below the income limits listed below for Extra Help?
  • Are you in California and have less than $130,000 in assets (for a single-person family)?
2023 Medi-Cal Eligibility

Levels of Medicare Savings Program Eligibility

“Dually-eligible beneficiaries” are beneficiaries enrolled in Medicare and Medicaid. The term includes beneficiaries enrolled in Medicare Part A and/or Part B and getting full Medicaid benefits and/or assistance with Medicare premiums or cost sharing through the Medicare Savings Program (MSP):

  • Qualified Medicare Beneficiary (QMB) Program: Helps pay Part A, Part B, or both Program premiums, deductibles, coinsurance, and copayments
  • Specified Low-Income Medicare Beneficiary (SLMB) Program: Helps pay Part B premiums
  • Qualifying Individual (QI) Program: Helps pay Part B premiums but is limited to a first-come, first-served basis
  • Qualified Disabled Working Individual (QDWI) Program: Pays Part A premiums for certain disabled and working beneficiaries under 65 not getting Medicaid and who meet certain income and resource limits set by their State.

Medicare pays covered dually-eligible beneficiaries’ medical services first, because Medicaid is generally the payer of last resort. Medicaid may cover medical costs Medicare may not cover or partially covers (such as nursing home care, personal care, and home- and community-based services).

California’s Medicaid (Medi-Cal) Eligibility by Income

How to Apply for the Medicare Savings Program in California

Call Medi-Cal at (800) 541-5555. Have your Social Security number and your income tax information ready. That’s it!

Medicare Part D Extra Help, or the Low-Income Subsidy (LIS) Program

The Low-Income Subsidy is a Federal program to help people with limited income and resources pay Medicare prescription drug program costs, like drug premiums, deductibles, and coinsurance. In 2023 drug costs are no more than $4.15 for each generic drug and $10.35 for each brand-name covered drug. Another name for this program is “Medicare Part D Extra Help,” so it’s the same program, just an extra name. (Some people are automatically enrolled in the Part D Extra Help/LIS program while others must apply themselves.)

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $5,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.

The application for Extra Help does not enroll you in a Medicare Prescription Drug Plan. You do not need to be enrolled in a Medicare Prescription Drug Plan to file for Extra Help. However, the Extra Help assistance does not start until you’re enrolled with an approved Medicare prescription drug provider.

Levels of Part D Assistance

This is a quick look without all the “Q” acronyms:

The Federal Poverty Level is $12,880 for individuals and $17,420 for couples – higher in Alaska and Hawaii

Medicare Part D Extra Help Eligibility

You may qualify for the low-income subsidy available under Medicare Part D if:

  • Your annual income and assets are below the eligibility thresholds. The Medicare Extra Help program eligibility limits may change from year to year. For the most up-to-date levels, visit Medicare.gov.;
  • Your annual income is higher than the eligibility limit, but you support other family members who also live in the same household;
  • Limits are slightly higher if you live in Hawaii or Alaska.

Ways to Apply for Medicare Part D Extra Help

  • Click here to apply for Extra Help with Medicare Prescription Drug Cost Plans
  • If you prefer not to enroll online, you can download the form here.
  • No printer? Then call Social Security at (800) 772-1213 (TTY (800) 325-0778) and ask them to mail you an application or just apply over the phone. They’re available Monday through Friday from 7 a.m. to 7 p.m.
  • Apply in person at a Social Security office (call to make sure they’re open at (800) 633-4227 for your local office)

After you submit your application, Social Security will review it and send you a notification in the mail if you are eligible. If you qualify for Extra Help and are not yet enrolled in a Medicare Part D Prescription Drug Plan, you can enroll in a plan at that time. Give me a call, I’ll help you to find your best plan!

Which Assets Count Against Eligibility?

Assets that count toward against include:

  • Cash and bank accounts, including checking, savings, and certificates of deposit
  • Real estate outside of your primary residence
  • Stocks and bonds, including U.S. savings bonds
  • Mutual funds and IRAs

When calculating eligibility for the low-income subsidy, Medicare does not count resources such as your home (or primary residence); insurance policies; or a car. Many people qualify for Medicare Extra Help savings and do not know it. The best way to find out if you qualify is to go ahead and apply.

Like any income-based government program, they must make sure you qualify every so often, so expect them to periodically make sure you haven’t won the lottery or otherwise don’t need the subsidy!

But What if I Still Don’t Qualify for Extra Help?

Other options for lowering your prescription drug coverage costs:

  • In California, if you have Original Medicare and do NOT have a drug plan, click this link for the Prescription Drug Discount Program for Medicare Recipients Click here to see the overview brochure
  • Other states may have programs that can help pay your prescription drug costs. Contact your Medicaid office or State Health Insurance Assistance Program (SHIP) for more information. Visit Medicare.gov/contacts for your Medicaid office’s phone number, and visit shiptacenter.org for your SHIP’s phone number.
  • Compare Prescription Drug Plans or Medicare Advantage – Prescription Drug plans for the following year; I can help with this by researching which plans will give the best coverage for your list of medications. If you have a chronic illness, like heart disease or diabetes, there are plans designed to help with the cost of medications – like selected insulins at zero copay in California. BONUS: You can enroll any time of the year into a Chronic Special Needs Plan (C-SNP).
  • If you had Extra Help before but no longer qualify for Extra Help during the year, you have a one-time Special Enrollment Period to switch plans. Remember, you can re-apply for Extra Help at any time if your income and resources change.
  • If you have a kind of rare or very expensive medication, check out NeedyMeds. There may be a Patient Assistance Program to help with your specific drug.
  • Want to streamline the search for a Patient Assistance Program? Use the Medicine Assistance Tool to see if there’s a program for you. Another one to check out is the RxAssist Patient Assist Program Center.
  • The Patient Advocate Foundation helps uninsured and under-insured patients find external programs and organizations that may help with drug costs.
  • Copay relief may be available at the Patient Advocate Foundation Co-Pay Relief, see if you qualify.
  • Investor Mark Cuban from “Shark Tank” has started a new venture to help with the cost of drugs. It doesn’t cover all drugs, but it may save you money with some very expensive ones. Check out costplusdrugs.com to see if it can help you.
  • Have you seen those TV commercials for GoodRx? It works! Look up your medication here and see what price you pay. If you pay for your Tier 1 and Tier 2 drugs directly out of pocket, the total costs of these drugs does not go toward your TrOOP. This means you would potentially enter later on in the year than earlier.
  • SingleCare.com also offers a similar drug-savings program to GoodRx. (Their webpage is a little wonkier than the GoodRx, but it pays to compare rates!)
  • Request 90-day supplies of your medications; many Medicare Advantage plans give a discount for a 90-day supply by mail order, and some offer 100 pills for the same cost as 90.
  • Online pharmacies in Canada, India, and Mexico are other sources for lower cost prescription medicine for Americans. But let the buyer beware, just sayin’.

One More Way to Lower Your Part B Premium (also in select other states):

There are Medicare Advantage plans with Part B rebates or “give backs.” For example, plans in California will rebate up to $$$ to your monthly Social Security check through a Part B giveback. If you’re basically healthy and have a little “just in case” cash, this is a VERY popular option! Contact me for more information.

Required Disclaimer:  “We do not offer every plan available in your area.  Currently we represent 0 to 28 organizations that offer 0 to 28 or more products in your area.  Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.”  So there.

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