Guest guest Posted October 24, 2008 Report Share Posted October 24, 2008 Financial help for people with limited income and resources QualificationsCounting income and assetsSubsidized benefits (chart)How to applyAutomatic eligibilityState Pharmaceutical Assistance Programs Find out if you qualify for Medicare’s low-income subsidies or “extra helpâ€. Subsidies can pay for some or all of your plan’s monthly premiums and the annual deductible (if there is one), as well as some or all of your drugcopayments or coinsurance. Qualifications Depending on your income and resources, you could receive an average of $3,6001 per year to help pay prescription drug plan expenses.2 If you qualify, you may join one of the 2009 AARP MedicareRx Plans without paying a late-enrollment penalty. Some individuals are automatically eligible and do not need to apply. Qualifications for low-income subsidies To qualify for extra help, you must meet at least one condition in each column: Medicare Part A or B U.S. residency Income and assets You are entitled to Medicare Part A(Hospital Insurance). ORYou are enrolled inMedicare Part B (Medical Insurance). You live in one of the 50 states or theDistrict of Columbia.2 You are single andhave income of lessthan $15,600 and resources of less than $11,990.3ORYou are married and have income of less than $21,000 and resources of less than $23,970.3 Note: These amounts are for 2008 and can change each year.1 SSA.gov Web site, http://www.ssa.gov/prescriptionhelp 2 Programs may vary if you live in the United States Territories (Puerto Rico, U.S. Virgin Islands, Guam, American Samoa and Northern na Islands). 3 If you have more or less than these amounts, you still may qualify for extra help. The resource limits include $1,500 per person for burial expenses. See Counting income and assets to see what is and is not included. back to top Counting income and assets In some cases, Medicare will consider your assets as well as your income to determine if you are eligible for extra help. Assets counted include: Cash (including checking and savings accounts). Certificates of deposit. Retirement accounts (like IRAs or 401(k)s). Stocks, bonds and mutual funds. Promissory notes. Property that can be converted to cash within 20 days. Mortgages. Life insurance policies. Assets not counted include: Your primary home. Your primary car. Burial plots or agreements. Funds set aside for burial expenses (up to $1,500). back to top Subsidized benefits If you qualify for extra help, your premiums and deductibles could be reduced or eliminated. You could also pay lower copayments for prescriptions, depending on your income and assets. Medicare Drug Benefit Subsidies for People with Limited Income and Resources1 Low-IncomeSubsidy Level Monthly Premium AnnualDeductible Copayments/Coinsurance Medicaid and Single:Income at or less than $10,400Couple:Income at or less than $14,000 $02 $0 $1.10 generic $3.20 brand-name No copays after $4,350 out-of-pocket for drugs Medicaid and Single:Income above $10,400 Couple:Income above $14,000 $02 $0 $2.40 generic $6.00 brand-name No copays after $4,350 out-of-pocket for drugs Medicaid and Institutionalized ornursing facility $02 $0 No copays Single:Income less than $14,040 and assets less than $7,790 Couple:Income less than $18,900 and assets less than $12,440 $02 $0 $2.40 generic $6.00 brand-name No copays after $4,350 out-of-pocket for drugs Single:Income less than $14,040 and assets more than $7,790 but less than $11,990 Couple:Income less than $18,900 and assets more than $12,440 but less than $23,970 $02 Up to $60 After the deductible is met, assigned copay or 15% of drug costs3, whichever is lower; after $4,350 out-of-pocket for drugs $2.40 generic $6.00 brand-name Single:Income less than $15,600 and assets less than $11,990 Couple:Income less than$21,000 and assets less than $23,970 Discounted Premium (sliding scale based on income) Up to $60 After the deductible is met, assigned copay or 15% of drug costs3, whichever is lower; after $4,350 out-of-pocket for drugs $2.40 generic $6.00 brand-name 1 NOTE: These income amounts and resource limits are for 2008 and can change each year. Income levels may vary in Alaska and Hawaii. Contact the Social Security Administration for more information.2 If you choose a plan which has a premium at or under the CMS established benchmark, your plan premium will be $0. If you choose a plan which has a premium above the CMS established benchmark, your premium will be the difference between the benchmark and the plan’s premium. See the 2008 benchmarks below. Please note that benchmarks are subject to change annually. CMS benchmarks by state State Subsidy Region AK 36.42 34 AL 28.29 12 AR 27.69 19 AZ 15.92 28 CA 19.80 32 CO 24.59 27 CT 29.17 2 DC 30.78 5 DE 30.78 5 FL 19.16 11 GA 30.04 10 HI 24.32 33 IA 30.61 25 ID 33.53 31 IL 30.26 17 IN 33.50 15 KS 30.62 24 KY 33.50 15 LA 24.62 21 MA 29.17 2 MD 30.78 5 ME 30.64 1 MI 30.49 13 MN 30.61 25 MO 26.71 18 MS 31.35 20 MT 30.61 25 NC 33.43 8 ND 30.61 25 NE 30.61 25 NH 30.64 1 NJ 31.23 4 NM 19.28 26 NV 16.64 29 NY 24.18 3 OH 26.82 14 OK 28.04 23 OR 30.19 30 PA 26.59 6 RI 29.17 2 SC 31.12 9 SD 30.61 25 TN 28.29 12 TX 25.01 22 UT 33.53 31 VA 31.03 7 VT 29.17 2 WA 30.19 30 WI 31.03 16 WV 26.59 6 WY 30.61 25 3 For the first $60 in drug costs, assigned copay or 100% of drugs costs, whichever is lower. Subsidies for United States Territories (Puerto Rico, U.S. Virgin Islands, Guam, American Samoa and Northern na Islands) that have low income assistance available may be different than those stated in the chart above. To find out more, and to apply for extra help, call toll-free: 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7days a week). TTY users, call: 1-877-486-2048. Or, you can call your State Medicaid Office, or the Social Security Administration toll-free at : 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users, call : 1-800-325-0778. There is no penalty to apply for extra help. If you applied last year and didn’t qualify, you can re-apply to see if you qualify this year. If you do not qualify, you are still eligible for Medicare Part D coverage, but not for extra help. back to top How to apply for financial help Processing and approval of your application could take up to eight weeks, so apply early. This is an application for extra help only. Submitting this application will not enroll you in a Medicare Part D prescription drug plan. Choose a drug plan provider Whether or not you qualify for extra help, you must enroll with a plan provider to get prescription drug coverage. Learn more about the AARP MedicareRx Plans provided by UnitedHealthcare. Get an application The Application for Help with Medicare Prescription Drug Plan Costs is available from the Social Security Administration.You may have already received a copy in the mail. To get a copy, call toll-free: 1-800-772-1213, 7 a.m. - 7 p.m., Monday - Friday.TTY users, call: 1-877-325-0778. Submit an application You can mail a hard copy of your completed application or fill out and submit an online application.Mail completed paper forms to: Social Security AdministrationWilkes-Barre Data Operations CenterP.O. Box 1020Wilkes-Barre, PA 18767-9910 Did you qualify? After the application is received, by mail or online,it will take up to eight weeks to find out if you have qualified for extra help. back to top Automatic Eligibility Nearly half of those who get Medicare and Medicaid benefits are in fair or poor health. And, one-third have significant limitations in activities of daily living.4 If you get Medicare and Medicaid or fall into one of these other high-need categories, you are automatically eligible for financial help and do not need to apply. Do you receive both Medicare and Medicaid? Do you receive both Supplemental Security Income (SSI) benefits and have Medicare? Are your Medicare premiums paid by your state? Note: Many Medicare beneficiaries who have limited incomes are not aware that they qualify for extra help.These people must apply for this help in order to receive it. 4 The Henry Kaiser Family Foundation, Medicare Low-Income Assistance Under the Medicare Drug Benefit, September 2005. back to top State Pharmaceutical Assistance Programs State Pharmaceutical Assistance Programs (SPAP) are state-funded, prescription drug assistance programs. SPAPs are only available in some states. Contact your SPAP directly about qualification criteria and benefits. If you are enrolled in a SPAP or have other secondary prescription drug coverage, you may still be eligible for Federal help. Return to Eligibility information. back to top Regards, Vergelpowerusa.orgPlay online games for FREE at Games.com! All of your favorites, no registration required and great graphics – check it out! Quote Link to comment Share on other sites More sharing options...
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