Dear Savvy Senior: Are there any programs that you know of that help seniors with their Medicare expenses? I’m 67 and live primarily on my Social Security, and am having a hard time paying my Medicare premiums, deductibles, co-pays and prescription drug costs. — Need Some Help
Dear Need: There are several financial assistance programs that can help Medicare beneficiaries who are having a tough time paying their out-of-pocket health care costs. Here’s what’s offered, along with the eligibility requirements and how to apply.
Let’s start with a program that helps lower-income Medicare beneficiaries pay premiums and out-of-pocket costs for Medicare Parts A and B. It’s called the Medicare Savings Program , and it has several benefit levels for people with different financial resources. At its most generous the program will pay your Part B premium and pretty much all your Medicare deductibles and coinsurance. At its least generous the program will pay just your Part B premium.
To qualify, the minimum standard set by Medicare is an income under 135 percent of the federal poverty level, which at the moment works out to around $1,313 a month for individuals. Everything counts toward income, including payouts from 401(k) plans, pensions, Social Security and help from family members. Medicare also allows states to impose an asset test, which can be as little as $7,080 per individual, not counting your house or car but counting retirement savings and bank accounts.
But some states have made their programs a lot more generous, with much higher income limits and in some cases no asset tests at all. And the program may be called something else in your state. To find out if you qualify or to apply, contact your local Medicaid office — call 800-633-4227 for contact information.
For help with your Medicare prescription drug plan costs, there is another completely separate program called Extra Help. To get it, you’ll need to apply through your local Social Security office.
Depending on how low your income is, the program will pay all or part of your Part D prescription drug plan premium and deductible, a hefty chunk of your copay, and totally eliminate the doughnut hole coverage gap. In 2013, individuals with an income below $1,436 a month, and assets less than $13,300 can qualify for Extra Help.
If you’re eligible to be in a Medicare Savings Program, you will automatically qualify for Extra Help. But because the requirements are slightly different, even if you don’t qualify for a Medicare Savings Program for Part B you might be able to get Extra Help for Part D. For more information or to apply, call Social Security at 800-772-1213 or visit socialsecurity.gov/prescriptionhelp.
To help you find out if you’re eligible for these programs, use the National Council on Aging web-based tool at benefitscheckup.org. You’ll need to fill out an online questionnaire that asks things like your date of birth, ZIP code, expenses, income, assets and a few other things. Once completed you’ll get a report detailing which programs you may qualify for, along with downloadable application forms and, in the case of Extra Help, allow you to complete your entire application online. The program even knows the Medicare Savings Program eligibility rules in your state.
Or, if you don’t have Internet access, contact your State Health Insurance Assistance Program, which provides free one-on-one Medicare counseling in person or over the phone. To locate your local program, call the eldercare locator at 800-677-1116.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior.org. Jim Miller is a regular contributor to “Today” on NBC and the author of “The Savvy Senior” book.