| Tue, Sep 06, 2011 @ 09:00 AM

Medicare Assistance Can Help Those with Lower Incomes

Posted by Medicare Made Clear

There are programs that can help those with lower incomes pay some costs Medicare doesn’t cover.There are a variety of Medicare assistance programs available for people with limited incomes, resources or assets. Medicaid, the Medicare Savings Program, the Program for All-Inclusive Care for the Elderly (PACE), Pharmaceutical Assistance Programs and the Extra Help program are available in most states. It’s a good idea to apply early if you think you might need help to make sure you have ample time to complete the application process.

Help paying for your medical and prescription drug expenses

  • Medicaid is a joint federal/state program that helps pay for costs not covered by Medicare and provides some benefits that Medicare doesn’t cover. These may include prescription drugs, eye care and long-term care.
  • Medicare Savings Programs (MSPs) provide subsidies for your Original Medicare Part A and B deductibles. There are four types of MSPs: Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, Qualified Individual and Qualified Disabled and Working Individuals. Check with Medicare.gov for your state eligibility requirements.
  • Program for All-Inclusive Care for the Elderly (PACE) helps individuals over 55 who qualify for nursing home care (but can live safely in the community with help) get the assistance they need to continue living in their home. This program is available in most states.
  • Pharmaceutical Assistance Programs (PAPs) are operated by pharmaceutical companies and help pay Medicare Part D members’ prescriptions for some or all of the drugs that the pharmaceutical company manufactures. Some states have State Pharmaceutical Assistance Programs (SPAPs) that help Medicare Part D members by paying for their monthly drug plan premium.
  • Extra Help (also known as Low-Income Subsidy or LIS) is a program that helps pay the costs of Medicare Part D prescription drug coverage. In 2011, most qualifying members have 95% of their costs covered and pay no more than $2.50 for each generic or $6.30 for each brand-name covered drug. Depending on income, some individuals may qualify to pay only a portion of their Medicare Part D drug plan premium and deductible.

Who qualifies for Extra Help (LIS)?

You automatically qualify if:

  • you have Medicaid, or
  • your state Medicaid program helps pay your Part B premiums (in an MSP) or
  • you receive Supplemental Security Income Benefits.

Income and resource limits determine eligibility for the Extra Help (LIS) program. While each state sets its own income eligibility limits, which vary by state, you may qualify if you have up to $16,335 in annual income per single person ($22,065 per married couple) and your resources are below $12,640 per single person ($25,260 per married couple).

These Medicare assistance programs are mostly offered only within the 50 U.S. states. There are other programs for people in the U.S. Territories. To find out if you qualify for assistance from Medicare, go to www.socialsecurity.gov, call 1-800-772-1213 or apply through your State Medical Assistance (Medicaid) office. The handbook Medicare & You has information on the programs that offer financial help for those with limited resources.

For more information contact the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact Medicare Made Clear to learn more 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, 7 days a week.


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Y0066_110608_163041 File & Use 07182011