Hundreds of Seniors Eligible for Help with Medicare Costs
Hundreds of Seniors Eligible for Help with Medicare Costs
Eileen Doherty
According to the Kaiser Family Foundation, 70,000 Coloradoans are eligible for help with the high costs of prescription drugs and the Medicare Part B premium. Together these costs represent an average of $125/month that Medicare beneficiaries are needlessly paying. So why are older Coloradoans not getting the help they need?
Research suggests that most individuals who pay these costs do not know they are eligible. As with most government programs, the eligibility criteria are complex and the application procedures can be overwhelming. However, since these savings can represent as much as a $1500 per year savings or more depending on income and resources, as well as medical and prescription drug costs, Medicare beneficiaries should seek out help in accessing these services.
There are three Medicare Savings Programs for which individuals may be eligible depending on income and resources. The first program is called Qualified Medicare Benefit or QMB. To be eligible for QMB, an individual’s monthly income from all sources such as Social Security, pensions, stocks, and interest must be less than $927 ($1245 for couples) and the resources must be less than $8180 ($13,120 for couples). Exempt resources include the home, a car, term life insurance policies, and irrevocable burial policies.
Individuals who are eligible to receive QMB will have their monthly Medicare Part B premium paid, the Medicare Part A deductible if they need to go to the hospital, the Part B deductible if they need physician or other services, and the 20% co-payment for Part B physician and other services.
Individuals on QMB also receive the Low Income Subsidy or Extra Help to assist in paying for prescription drugs, meaning the cost of drugs (if it is on the formulary) varies between $1.10 for generics and $3.30 for name brands.
The second Medicare Savings Program is Special Low Income Benefit Program or SLIMB for individuals who have a higher income. To be eligible for SLIMB, the individual must have a monthly income of less than $1109 ($1491 for a couple) from all sources. Resource limits are $8180 for individuals and $13,020 for couples with the same exemptions as for the QMB program. Individuals on SLIMB receive assistance with prescription drug coverage and pay $1.10 for generics and $3.30 for name brands.
The third Medicare Savings Program is Qualified Medicare Benefit Program or QI-1 is similar to the SLIMB program however, the income guidelines are higher. Individuals must have less than $1246 from all sources ($1675 for a couple) with the same resource requirements and exemptions as the other two programs. QI-1 pays for the Medicare Part B premium representing similar savings to the SLIMB program. Most individuals who are eligible for QI-1 are also eligible for prescription drug coverage and pay between $1.10 for generics and $6.30 for name brands.
Depending on income some individuals who qualify for QI-1, as well as individuals whose monthly income is less than $1361 (couples $1838) may also be eligible for prescription drug assistance. The same resource limits and exemptions apply as in the other programs. Individuals may be charged a $63 deductible. Most people will pay $2.50 per prescription for generics and $6.30 for name brands. Individuals will pay a 15% co-insurance of the $4,398 for the out-of-pocket threshold prescription drug costs or $660. After the individual pays $660 co-insurance plus the $63 deductible, the individual will be eligible for Medicare catastrophic drug coverage. At that time, the individual will pay $2.50 for generics and $6.30 for name brands.
To apply for the Medicare Savings Program individuals will need to request a Medicaid application and submit it to the county Department of Human Services in which they currently reside. The form may be completed online at https://peak.state.co.us/selfservice/ or downloaded at http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1251567068887.
To apply for the prescription drug benefit the individual may call the Social Security Administration at 1-800-772-1213, enroll on line at www.ssa.gov or call 303-333-3482.
For assistance with enrollment or to obtain forms, call 303-333-3482. Our counselors are available to help with enrollment.
Eileen Doherty, M.S. is the Executive Director of Senior Answers and Services and the Colorado Gerontological Society. She has more than 35 years of experience in gerontology in administration, research, training and education, and clinical practice. She can be reached at 303-333-3482 or at doherty001@att.net.
