Wednesday, June 15, 2022

How Do I Qualify For Medicare Low Income Subsidy

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The Low-Income Subsidy Program is a federal health care program. Its administered by the Social Security Administration for Medicare consumers with limited income. The program helps Medicare beneficiaries with Medicare Part D costs. Fortunately for you, many people do not realize that they qualify for it. They assume that they make too much money to qualify for help or dont see themselves as needing help. Therefore, this is a golden opportunity. Youll help beneficiaries save money, and youll probably gain a sales lead as well!

What To Know About Medicare Extra Help:

  • The Medicare Extra Help Program, also called the Part D Low-Income Subsidy, helps Medicare beneficiaries with low income and resources pay for the cost of their prescription drugs and prescription drug coverage.
  • To qualify for Extra Help, you must be on Medicare and living in the U.S. with income and financial resources below a certain annual threshold.
  • Many people may qualify for Extra Help without realizing it.
  • You can apply for the Medicare Extra Help Program through the Social Security Administration online, over the phone or in-person, when restrictions allow.

The Medicare Extra Help Program, also called the Part D Low-Income Subsidy, helps Medicare beneficiaries with low income and resources pay for the cost of their prescription drugs and prescription drug coverage. This benefit is worth an estimated $5,000 per year, according to the Social Security Administration.

Many people may qualify for Extra Help without realizing it. To qualify for Extra Help, you must be on Medicare Part A and/or Part B and living in the U.S. with income and financial resources below a certain annual threshold. Here we explain what the Extra Help Program is, who qualifies and how to apply if you do.

What Is The Medicare Part D Extra Help Program

The Medicare Extra Help program is for people who need financial assistance with their Medicare Part D coverage. Prescription drug coverage is available through either a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan . Both types of plans are available through Medicare-approved private insurance companies.

If youre eligible for the Medicare Extra Help program, the level of assistance you get depends on your income and financial resources. The program caps the costs you pay for covered generics and brand-name medications. In 2021, enrollees who receive Extra Help wont pay more than $3.70 for each generic medication and $9.20 for each brand-name medication. In addition, depending on your income and assets, you may get help with Medicare Part D premiums and deductibles.

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Having Trouble Paying Your Prescription Drugs

If you qualify for Extra Help and join a Medicare drug plan, you’ll:

  • Get help paying your Medicare drug plan’s costs.
  • Have no late enrollment penalty.

You automatically qualify for Extra Help if you have Medicare and meet any of these conditions:

  • You have full Medicaid coverage.
  • You get help from your state Medicaid program paying your Part B premiums .
  • You get Supplemental Security Income benefits.

Drug costs in 2019 for people who qualify for Extra Help will be no more than $3.40 for each generic drug and $8.50 for each brand-name drug.

Find Your Level Of Extra Help

Don

Extra Help is a program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. If you get Extra Help but youre not sure if you’re paying the right amount, call your drug plan. Your plan may ask you to give information to help them check the level of Extra Help you should get.

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Other Proof You Have Medicaid

  • A copy of your Medicaid card .
  • A copy of a state document that shows you have Medicaid.
  • A print-out from a state electronic enrollment file that shows you have Medicaid.
  • A screen print from your state’s Medicaid systems that shows you have Medicaid.
  • Any other document from your state that shows you have Medicaid.

How Do I Qualify For Medicare Low

To be eligible you must have Medicare and a lower income. Assets must be below a certain amount as well. Some people may find theyre ineligible for Medicaid, yet still eligible for Low-Income Subsidy.

If eligible for any of the below programs, you qualify for a Low-Income Subsidy:

  • Qualified Medicare Beneficiary
  • Specified Low-Income Medicare Beneficiary
  • Qualifying Individual

Otherwise, income and resource limits apply. If your income and resources are above the limits, but you think you may still qualify for a LIS, you should still apply.

Income limits are $19,140 for an individual and $25,860 for a married couple. There are levels of assistance you can receive from a LIS, depending on your need. You could qualify for partial assistance based on your assets. See the chart below for limits.

$29,520

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What Is A Low

The Low-Income Subsidy in Medicare helps people with Medicare pay for medications and lowers the cost of Medicare Part D prescription drug coverage. With the low-income subsidy, you get assistance paying for your Medicare Part D monthly premium, deductible, copayments, and coinsurance. According to the Social Security Administration , this subsidy is estimated to be worth about $5,000 a year.

The amount of the subsidy you receive will depend on resource limitations set by the Social Security Act as well as your income compared to the federal poverty level .

How To Apply For Medicare Extra Help

Low Income Subsidy – Extra Help with Prescription Coverage

To apply for the Medicare low-income subsidy, simply fill out an Application for Extra Help with Medicare Prescription Drug Plan Costs form with Social Security. You can apply and submit this form by:

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.

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.

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Eligibility For Extra Help/lis For 2021

You are automatically enrolled in a drug plan with the Extra Help/Low-Income Subsidy program for 2021 if you qualify for Medi-Cal or a certain type of Medicare Savings Program . The chart below explains what you will pay for your Part D coverage depending on the Medi-Cal and/or Medicare Savings Program program for which you qualify, assuming you are enrolled in a benchmark plan.

You haveYour Assets Are at or Below1You Pay
Medi-Cal without a Share of Cost . This includes the Aged & Disabled Federal Poverty Level program . Medi-Cal with a SOC and your SOC is met in any one month.

Single: $2,000

  • No annual deductible
  • Copayments of $1.30/generic and $4.00/brand name

The above applies until the end of the year if SOC is met before July 1. If SOC is met between July 1 and Dec 31, Extra Help remains until Dec of following year.

Note: If you have Medi-Cal and are living in a nursing home or are receiving Medi-Cal Home and Community Based Services , you will have no drug copayments.

a Medicare Savings Program, such as Qualified Medicare Beneficiary , Specified Low-Income Beneficiary or Qualified Individual program.

Single: $7,970 Couple: $11,960

  • Copayments of $3.70/generic and $9.20/brand
  • name. No copayments during catastrophic coverage.

1 Asset limit does not include the allowed amount for burial expenses: Single, $1,500 Couple, $3,000. Note that for Medi-Cal, this $1,500 per person for burial expenses cannot be in a bank account. It must be invested in a burial policy.

How Do I Know If I Am Eligible For Extra Help

Depending on your income and resources, you may qualify for Medicares Extra Help program. Qualifying limits are adjusted annually. For 2021, your income must be limited to $19,320 in yearly income , and your resources must be limited to $14,790 to qualify.2

Resources that count toward the limit include:3,4

  • Money in your checking and saving accounts
  • Stocks and bonds
  • Real estate you own other than your primary home

Resources that are not part of this limit include:5,6

  • Your primary home
  • Burial plots
  • Furniture and other household or personal items

If you have full Medicaid coverage, those receiving Supplemental Security Income and those who receive help from a Medicare Savings Program are automatically qualified for Extra Help.7 However, if you dont automatically qualify, you can still apply for Medicares Extra Help program.

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Estimates Of Potential Eligibility For Low

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The 2003 Medicare Prescription Drug Improvement and Modernization Act added a new prescription drug benefit to the Medicare program known as Part D , as well as the Low-Income Subsidy program to provide extra help with premiums, deductibles, and copayments for Medicare Part D beneficiaries with low income and limited assets. This analysis was designed to provide an independent estimate of the LIS-eligible population as of 2006, to examine the robustness of the estimate against alternative assumptions and estimation methods, to examine the characteristics of the LIS-eligible population, and to project the size of the LIS-eligible population to 2008. An estimated 12 million persons, or 29 percent of Medicare beneficiaries, were potentially eligible for the LIS in 2006 and most were eligible for the full subsidy. The eligibility rate is higher for the under-age-65 population and for those in nursing homes. There is considerable uncertainty around the estimated number of LIS eligibles, however, due to differences in the two main data sources employed, the Survey of Income and Program Participation and the Health and Retirement Study.

How To Enroll In A Low

Medicare Extra Help â Low Income Subsidy (LIS)

To enroll in the low-income subsidy, youll need to apply. You can fill out an SSA-1020 form with the Social Security Administration.

This form is available online and in person at your local social security office. You can also call the Social Security Administration and apply over the phone or request that an application is mailed to you.

Some people are automatically enrolled in the low-income subsidy. If you have Medicare and Medicaid or Medicare and Supplemental Security Income , you automatically receive this subsidy.

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Best Available Evidence For Low Income Subsidy Beneficiaries

The Centers for Medicare & Medicaid Services requires health plans like SummaCare to provide the cost-sharing subsidy to Medicare beneficiaries who are eligible for low-income subsidies even if our system and the system at CMS do not yet reflect that eligibility.

SummaCare is required to provide you with the tools you need to submit a request to have our system updated to meet your Low Income Subsidy level as awarded to you by the Social Security Administration . For more information on how to have your subsidy level updated, please call SummaCare Customer Service or visit the CMS website and download the appropriate form.

For more information about adjusted plan premiums for those who are eligible to get extra help to pay for Medicare prescription drug plan costs, please click on the link below to view our Plan Premium Summary Sheet for Low Income Subsidy:

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: . TTY/TDD users should call 877.486.2048, 24 hours a day/7 days a week The Social Security Administration at between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 800.325.0778 or your State Medicaid Office.

SummaCare P.O. Box 3620Akron, OH 44309-3620

Medicare Extra Help For Low Income Persons

For individuals who receive Part D prescription drug coverage and are low-income, there is assistance available for the costs of deductibles and co-pays. This Extra Help is also known as the Low Income Subsidy .

Who is eligible?To receive Extra Help, persons must be eligible for Medicare Part D and have income less than 100% of the Federal Poverty Level for a full benefit or less than 150% of the Poverty Level for a partial benefit.

What are the benefits?Benefits vary based on the recipients income and on living situation. In general, Extra Help will pay for a persons monthly drug plan premium for an Extra Help approved plan. It will also pay the annual deductible amount , though it will leave $99 deductible for partial subsidy recipients to pay out of pocket. Extra Help will also cover all drugs in the coverage gap, or doughnut hole, or 85% of drug costs for partial subsidy recipients. Individuals will pay $3.95/generic or multi-source drug and $9.85 for other drugs.

In the standard benefit, when Medicare beneficiaries have spent $4,430 in 2022 in prescription costs, the coverage gap begins however, individuals who are receiving Extra Help will continue to pay co-payments between $3.95 for generic or multisource drugs with a retail price under $79 and 5% for those with a retail price greater than $79. For brand-name drugs, beneficiaries would pay $9.85 for those drugs with a retail price under $197 and 5% for those with a retail price over $197.

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What Counts As Income

  • Wages or earnings from jobs or self-employment
  • Income from pensions, annuities, and benefits, such as from Social Security, the Railroad Retirement Board, and Veterans Affairs
  • Alimony
  • Bank accounts such as checking, savings, and certificate of deposit
  • Investments such as stocks, bonds, savings bonds, mutual funds, and individual retirement accounts
  • Any other cash

Help With Medicare Premiums Qmb Program

What is the Low Income Subsidy Program? (LIS)

If youre struggling to pay your premiums, you should apply for a QMB program. Keep in mind that this program is called MQB in North Carolina and replaced with Medicaid in Nebraska.

A QMB program pays your premiums for Part A and Part B, your annual deductible for Part B, and coinsurance and deductibles for Part A services. Its the most comprehensive MSP available, so its income and resource limits are the lowest. Please note that 2021 limits are not yet available and this content will but updated when they are.

Applicant
$5,892

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Do I Qualify For Medicare Extra Help

You automatically qualify for Extra Help if you receive Medicaid coverage, are enrolled in a state-sponsored Medicare Savings Program, or get Supplemental Social Security benefits. You may also be eligible if your:

  • Income is no more than $19,140 per year . Payments that do not count toward your total income include food stamps, housing assistance, disaster assistance, scholarships, and/or education grants.
  • Resources total no more than $14,610 . Resources that count toward your total include savings and checking accounts, stocks, and/or bonds. Items such as your house, car, and/or furniture do not.
  • The cutoff amounts differ if you are caring for dependents or if you live in Alaska or Hawaii.

    How To Apply For The Low

    You can apply for the Low-Income Subsidy through your states Medicaid program or by contacting the Social Security Administration . You can reach Social Security by:

    Please note that even if you arent eligible for the Extra Help program one year, you can always reapply another year if your income levels change.

    Do you have more questions on the Low-Income Subsidy? If youd like help finding Medicare plan options that could help with prescription drug costs, contact us to speak with a licensed eHealth insurance agent. Compare Medicare prescription drug plans at your convenience by typing your zip code in the box on this page.

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    Extra Help Paying For Medicare Prescription Drug Coverage

    Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help, also called the low-income subsidy if your yearly income and resources are below the following limits in 2021:

    • Single personIncome less than $1,469 monthly and resources less than $9,470

    These amounts may change each year. You may qualify even if you have a higher income . Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts . Resources dont include your home, car, household items, burial plot, up to $1,500 for burial expenses , or life insurance policies. If you qualify for Extra Help and join a Medicare drug plan, you will get the following:

    • Help paying your Medicare drug plans monthly premium, yearly deductible, coinsurance, and copayments
    • No coverage gap
    • No late enrollment penalty
    • You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:
    • You have full Medicaid coverage
    • You get help from your state Medicaid program paying your Part B premiums
    • You get Supplemental Security Income benefits

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