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Assistance for Individuals With Limited Income

There are many Medicare eligible persons that, in spite of the improvements with Medicare, are finding it difficult to pay their share of cost for prescription drugs and even their Medicare premium. Persons on a fixed income, or those that rely solely on Social Security benefits, may not be able to afford to pay their costs. For these people, there may be additional assistance available. The following assistance programs are outlined below: Medicaid, Medicare Savings Programs, Supplemental Security Income Benefits, the PACE program, and Medicare approved discount drug cards. There may be other assistance programs offered through your state or local government offices.

Medicare Prescription drug assistance may be available to some persons with limited income. If you qualify, you will get assistance in paying your selected drug plans monthly premium and yearly deductible. Assistance may also help you in paying the co-payments that are required on some types of Medicare prescription drug plans. The help you receive will be based on your income and assets (excluding your home or car). You may qualify if you are single and your resources are less than $11,500 or $23,000 if you have a spouse. To find out if you qualify for this assistance program, contact your Social Security Administration office.

If you apply and qualify for extra help you will have to join a Medicare Prescription Drug plan by May 15, 2006, or a plan will be automatically assigned to you by June 1, 2006. If you do not care for the plan Medicare has chosen for you, you can change plans once before December 31, 2006. Changes can normally be made November 15 through December 31 of each year.

Qualifying for this prescription drug assistance program will dramatically lower your prescription drug share of costs and annual personal liabilities. If your annual income is below $12,920 and your personal assets are between $7,500 and $11,500, your monthly premium for the standard prescription drug plan will be $0, your annual deductible will be $0, and your co-payment for prescription drugs will be $2 generic and $5 for brand name drugs. If your annual income is below $12,920 and your personal assets are less than $7,500, your monthly premium for the standard prescription drug plan will be $0, your annual deductible will be $50, and your co-payment for prescription drugs will be 15% generic and 15% for brand name drugs. If your annual income is between $12,920 and $14,355 and your personal assets are less than $11,500, your monthly premium for the standard prescription drug plan will be discounted, your annual deductible will be $50, and your co-payment for prescription drugs will be 15% generic and 15% for brand name drugs.

You will automatically qualifying for extra help and not needing to apply if you have Medicare and full coverage from a state Medicaid program that is currently making payments toward your prescription drugs. Effective December 31, 2005, Medicaid will no longer pay for prescription drugs. If you get supplemental security Income, or get help from your state Medicaid program that assists with your medical costs, you will also be automatically enrolled in a new prescription drug plan and qualify for low income assistance. For those that qualify under one of these situations: If you have Medicare and also Medicaid and live in a nursing home, your monthly premium for the standard prescription drug plan is $0, your annual deductible is $0 and your co-payments are $0 for generic drugs and $0 for brand name drugs. If you have Medicaid and your annual income is below $9,570, your monthly premium for the standard prescription drug plan is $0, your annual deductible is $0 and your co-payments are $1 for generic drugs and $3 for brand name drugs. If you have Medicaid and your annual income is above $9,570, your monthly premium for the standard prescription drug plan is $0, your annual deductible is $0 and your co-payments are $2 for generic drugs and $5 for brand name drugs. This also applies if you have Medicare and your state helps pay your Medicare premiums or you get Supplemental Security Income. The income levels listed here are for 2005 and may increase annually.

Medicaid is another source that provides assistance in paying medical bills for persons with limited income or resources. This is a joint program between Federal and State governments. If you have both Medicare and Medicaid, most of your health care costs, including prescription drugs, are covered in full. You may also be entitled to services that are not fully covered under Original Medicare. Since this is a partially funded state program, the income levels to qualify will vary from state to state. Contact your state Social Security department to find out the qualifying income levels in your state.

Medicare Savings Programs are available at the state level under the Medicare program and will provide assistance in paying your Medicare premiums. Some of these programs may also provide assistance in paying your Medicare deductibles and coinsurance percentages. To qualify for these state assisted programs you must have Medicare Part A. Your personal resources must be less than $4,000 and your monthly income must be less than $1,097 (2005 income levels). Income limits will change slightly in 2006, These income levels may also vary by state.

Supplemental Security Income Benefits (SSI) is a monthly benefit paid by the Social Security Administrations that are of limited income or resources and who are disabled, blind, or over the age of 65. SSI benefits give you cash to pay for needs such as food, clothing and shelter. To qualify for this cask assistance you must reside in the United States and not be absent from the country for more than 30 days. You must also be a US citizen or national, or fall into one of a select few categories of eligible non-citizens.

The PACE Program (Programs of All-inclusive Care for the Elderly) is designed to provide financial assistance for "frail" people. Some PACE programs will provide assistance for prescription drug costs, but the program is primarily designed to provide medical, social and long-term care services to those that qualify. PACE is a state sponsored program and the qualifications for eligibility on this coverage will vary from state to state.

Medicare-approved Drug Discount Cards were made available to help people with Medicare pay less for their prescription drugs until the new prescription drug program started in 2006. The discount cards will be temporary and Medicare approved drug discount cards have been replaced by the new Medicare prescription drug plans. You can use your card until May 15, 2006, or until you join a drug plan.

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