Wednesday, July 17, 2024

Who Is Eligible For Medicare Extra Help

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Other Things To Know About The Qmb Program:

Extra Help: Eligibility

Medicare providers arent allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments, except outpatient drugs. Pharmacists may charge you up to a limited amount for prescription drugs covered by Medicare Part D.

  • If you get a bill for Medicare charges: Tell your provider or the debt collector that youre in the QMB Program and cant be charged for Medicare deductibles, coinsurance, and copayments.
  • If you already made payments on a bill for services and items Medicare covers: You have the right to a refund.
  • If you have a Medicare Advantage Plan: Contact the plan to ask them to stop the charges.

In some cases, you may be billed a small copayment through Medicaid, if one applies.

Make sure your provider knows you’re in the QMB program

Specified Low-Income Medicare Beneficiary Program

The SLMB Program is a state program that helps pay Part B premiums for people who have Part A and limited income and resources.

What Are The Medicare Advantage Benefits That Are Different From Original Medicare

Under federal law, all Medicare Advantage plans must include, at a minimum, all the benefits included in Original Medicare, except for hospice care, which is still covered under Medicare Part A. You do not lose any benefits if you enroll in or switch to a Medicare Advantage plan.

However, you may be able to enroll in a plan that also includes additional Medicare Advantage benefits, such as:

Keep in mind that there may be annual limits and restrictions on these additional Medicare Advantage benefits, and that you may need to pay a deductible, copayment, or coinsurance amount when you access them. If these benefits are important to you, check your plan documents before you enroll in a Medicare Advantage plan.

Your Local Experts In Medicare

If you have questions about Extra Help, Medicare Part D, or how to find the right benefits, RetireMEDiQ is ready to help. To request information about RetireMEDiQ, call 1-866-921-6468 or email .

If you are already a RetireMEDiQ client, you can contact your advisor by calling 1-877-222-1942 or emailing .

Also Check: How Can I Enroll In Medicare Part D

Interested In More Information

Medicare Supplement Insurance Plans

1Refer to your Evidence of Coverage for additional details on extra help/Low Income Assistance . Search for plans in your area and view the LIS premium chart located on the plans detail page. The chart will show you what your monthly plan premiums would be if you get extra help.

  • Customer Plan Links
Medicare Advantage Policy Disclaimers

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All clinical products and services of the LivingWell Health Centers are either provided by or through clinicians contracted with HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. or employees leased by HS Clinical Services, PC, Bravo Advanced Care Center, PC , Bravo Advanced Care Center, PC and not by Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only.

Cigna contracts with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans in select states, and with select State Medicaid programs. Enrollment in Cigna depends on contract renewal.

Medicare Supplement Policy Disclaimers

Y0036_22_101121 | Page last updated 10/01/2021.

How To Apply For Extra Help

Medicare Part D: What is Extra Help?

Applying for Extra Help is not complicated at all. In fact, it is similar to applying for Original Medicare and other plans.

You can complete the application for Extra Help with Medicare Prescription Drug Plan Costs . You can use any of these methods

Once an application is submitted, Social Security will review your application based on the eligibility criteria discussed above and send a letter notifying whether you qualify for Extra Help.

After being qualified, you can choose a Medicare prescription drug plan. However, if you arent eligible for Extra Help, you can still enroll in the Medicare Prescription Drug Plan.

It is also possible that you are not satisfied with the Social Security decision in case of not qualifying for Extra Help. So, you can appeal to the administration to review the status and get a new decision.

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Medicare Extra Help Eligibility

You will be automatically get the Medicare Extra Help if you are enrolled in both Medicaid and Medicare, if you receive Supplemental Security Income , and/or if qualify for a Medicare Savings Program. If any of these scenarios apply to you, it is not necessary to then apply for Extra Help.

However, if you are not receiving benefits from any of the aforementioned programs, you will need to apply to Social Security in order to receive the Extra Help.

How Does Medicare Extra Help Work

Low-income Medicare recipients may qualify for additional coverage with their states Medicaid program. Extra Help can help reduce out-of-pocket costs for qualifying Medicare recipients in need of Medicare Part D prescription drug coverage.

Qualifying for Medicare-Medicaid Dual Eligibility

Medicaid is a federally funded program, but each state is in charge of administering the program for its qualifying residents. Due to changes in the cost of living in each state, eligibility for Medicaid can be different in each state. Eligibility rules can also change throughout the year.

Medicaid eligibility criteria will typically consider the following:

  • Income. Both earned and unearned income is considered when an applicant applies for Medicaid services. There may be qualifying deductions subtracted from the total amount of income that can lower the measurable amount below any program limit.
  • Assets. Resources with cash value, such as savings and investment accounts or certain types of property may be measured against program limits. Some states may not have an asset limit for certain demographics.
  • Spend down. If an applicants income or resources exceed program limits, qualifying expenses may be subtracted from their measurable income or resources to bring them under their states program limits for eligibility.

Benefits with the Medicare Part D Extra Help Program

Recipients who qualify for this low-income assistance can expect the following benefits:

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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

What Does Medicare Extra Help Pay For

How to Lower Medicare Part D Costs with Extra Help | Boomer Benefits

If you have Medicare, youre eligible for Medicare prescription drug coverage, also called Medicare Part D. But there are costs associated with this prescription drug coverage, including copays and deductibles. Thats where Medicare Extra Help comes in.

If you have limited income and savings, Medicare Extra Help can cover prescription drug copays and prescription plan premiums.

Medicare Extra Help may provide up to $4,900 of assistance annually if you qualify. This program is limited to prescription drug coverage. If you need help paying for other parts of Medicare, like Medicare Part A or Medicare Part B , there are other programs funded by some states that may be able to assist you.

Medicare Extra Help also doesnt apply to Medicare Advantage or Medigap programs.

  • real estate aside from your primary residence

The Extra Help resource limits for 2021 are:

  • Individual: $14,790

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Medicare Extra Help Program: Getting Help With Part D Costs

July 30, 2021 / 6 min read / Written by Jill H.

  • Eligibility for the Low-Income Subsidy programJump to
  • Automatic enrollment in Extra HelpJump to
  • Applying for Extra HelpJump to
  • If you dont qualify for Extra HelpJump to
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If you have Medicare Part D prescription drug coverage through a Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug plan, you may be eligible for help with Part D costs. The Medicare Extra Help program offers financial assistance for Medicare beneficiaries who meet certain income and resource limits and have Medicare Part D.

Also referred to as the Low-Income Subsidy program, Extra Help helps pay for expenses like Part D annual deductibles, monthly premiums, copayments, and/or coinsurance. Individuals enrolled in the program wont enter the Part D coverage gap .

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Once You Give Your Plan This Information Your Plan Must:

  • Make sure you pay no more than the LIS drug coverage cost limit. In 2021, prescription costs are no more than $3.70 for each generic/$9.20 for each brand-name covered drug for most people enrolled in the program.
  • Contact Medicare so we can get confirmation that you qualify, if it’s available. Your request can take anywhere from several days to up to 2 weeks to process, depending on the circumstances. Call us at 1-800-MEDICARE . TTY: 1-877-486-2048.

Be sure to tell your plan how many days of medication you have left. Your plan and Medicare will work to process your request before you run out of medication, if possible.

What Is Not Counted Toward Income Limit

Medicare Part D

Medicare does not count certain kinds of payment or assistance towards the income limit for Medicare Extra Help.

Typically, payments from the federal or local governments do not count. For example:

  • Supplemental Nutrition Assistance Program or food stamps
  • housing assistance
  • earned income tax credit payments
  • disaster assistance
  • victim compensation payments
  • scholarships and education grants

Medicare also does not count any money that someone else provides to help towards an individuals household expenses.

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The Benefits Of Extra Help

The Medicare Extra Help program offers people several benefits, including:

  • Payment of premiums. Payment of Medicare Part D premiums will be taken care of by Extra Help, up to a set amount. The amount varies state-by-state.
  • Payment toward drugs. Prescription drug costs are reduced, providing a persons prescription is on their PDP formulary, and they use pharmacies within the plans network.
  • Help with enrollment. A Special Enrollment Period applies that allows additional time to enroll in a PDP.
  • Removal of penalties. Late enrollment penalties can apply to PDPs if someone delays enrollment. These penalties will not apply.

Medicare Extra Help does not replace Medicare Part D and cannot exist on its own.

A person must still have original Medicare and a PDP to receive Medicare Extra Help benefits.

How Do I Apply For A Low Income Subsidy

You can apply for a low include subsidy by following three steps:

  • Find out if you are eligible by using the Extra Help Calculator.
  • Contact the Social Security Administration by phone or fill out the necessary forms online.
  • If you need assistance, get in touch with a licensed insurance agent who can walk you through the process.
  • If you are automatically eligible for Extra Help, either do to your Medicaid enrollment or other qualifying program, you do not need to apply in order to receive the benefits of a low-income subsidy.

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    What Assets Are Included

    Your assets include money that you have across all types of savings accounts, checking accounts, and investment accounts. Make sure to consider your retirement accounts like an IRA or 401, as well any stocks or bonds you own. Real estate that you own other than your primary residence also counts toward your total assets in most cases.

    Your assets do not include your home, a car, a burial plot, furniture, or any other personal items. Life insurance policies are excluded and you can subtract $1,500 per person for burial expenses. You donât have to include any advance tax credits you get, such as for the earned income tax credit, or money you received for housing assistance. You can find a complete list of exemptions on the SSA website.

    What Does Medicare Extra Help Cover

    Help With Medicare Costs (2021)

    The Extra Help Program assists with coverage for your Medicare Part D prescription drug premiums, deductibles, coinsurance, and co-payments.

    It can also eliminate your Part D late enrollment fee if you were going to be charged .

    When you qualify for Extra Help, you also qualify for a Special Enrollment Period. That means that you can make changes to your Medicare coverage once per quarter during the first three quarters of the year instead of having to wait until the Annual Enrollment Period.

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    Applying For Extra Help

    After reviewing your application, Social Security will send you a letter to notify you if youre eligible for Extra Help. If you qualify for the Extra Help program, you can then enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan . If you dont enroll in a plan, Medicare will choose a plan for you and automatically enroll you in Part D . Because of your eligibility for Extra Help, you can make changes to your Medicare prescription drug coverage at any time, which will take effect at the start of the following month.

    Who Is Eligible For Medicaid

    Medicaid is a health insurance program that is jointly operated by federal and state governments and provides coverage for individuals and families who have low incomes or limited financial resources.

    Because each state administers its own Medicaid program, eligibility criteria can vary by state. Medicaid eligibility generally depends on your income, family size and state. You may use this tool from to help determine your Medicaid eligibility.

    Also Check: Who Qualifies For Medicare Part C

    Dual Eligibility: How Medicare And Medicaid Work Together

    If you are dual eligible and visit a health care provider who accepts both Medicare and Medicaid, Medicare will be the primary payer and Medicaid will be the secondary payer.

    This means Medicare will pay its share of your health care costs first. As the secondary payer, Medicaid can help pay for the out-of-pocket costs Medicare doesnt cover, such as your coinsurance, copayment and deductible costs. This combination of insurance payers means you pay little to nothing for your covered health care services.

    If you are enrolled in a Medicare Savings Program, you may also receive help paying for your Medicare premiums and deductibles.

    Dual eligible beneficiaries are also automatically eligible for the Medicare Extra Help program, which helps pay for prescription drug costs .

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    What Are The Income Limits For Medicare Extra Help

    The Medicare Extra Help program is designed to help beneficiaries with limited incomes pay for their medications. To qualify, Medicare requires that you meet a few requirements.

    First, youll need to be eligible for Medicare and enrolled in parts A and B, also called original Medicare. Next, youll need to meet the income qualifications.

    The Medicare Extra Help income limits are set by a government standard called the federal poverty level. This is redetermined every year and looks at factors like the cost of living and average incomes in each state.

    The federal poverty level is then used to help the government set qualifications for programs like Medicaid, Housing Assistance, and Medicare Extra Help. This means the income limits for Extra Help might change slightly each year as the federal poverty level does.

    Youll need to meet the current limit to qualify for the program.

    In 2021, you need to have an income of less than $19,320 if youre single. If youre married and live with your spouse, your combined income needs to be less than $26,130.

    However, if your income is slightly higher, you might still qualify in certain cases. Examples include:

    • living in Alaska or Hawaii
    • supporting a dependent family member
    • having earnings from work youve done

    Plus, Medicare doesnt count all the payments you receive in a year toward the income limit.

    • SNAP
    • earned income tax credit payments

    Medicare also wont count the money you received in an emergency situation. Examples include:

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