A few months ago AMAC sent out a newsletter containing some brief but valuable information regarding extra help to pay for drug costs. Due to the tremendous response we have had from our members requesting more infor mation on help with drug and other Medicare costs, we have put together some information for you to determine if you qualify for extra help.
PACE (Program of All-Inclusive Care for the Elderly): A Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other health care facility. A high level of coordinated care is provided. Different levels of coverage are available depending on your individual situation. Currently 31 states offer the PACE program. To apply, contact your state Medicaid office.
Eligibility:
■ For Medicare and/or Medicaid eligible individuals 55 or older
■ Live in the service area of a PACE organization certified by the state to need a nursing home level of care
■ Be able to live safely in the community with help from PACE
Extra Help for Medicare Part D – also called Low Income Subsidy (LIS): Many people qualify and don’t even know it. To be eligible you must be receiving Medicare benefits and live in one of the 50 states or DC. In 2016, drug costs for most people who qualify are no more than $2.95 for each generic drugs and $7.40 for each brand-name covered drug. Others pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. Once your application is approved you must choose a Medicare Prescription Drug Plan in order to start receiving benefits. If you do not select a plan, Medicare will do so for you. If you do not qualify for extra help, you may be eligible for a Special Election Period to enroll into a Prescription Drug Plan.
Income (based on 2015 amounts) and Resource (based on 2016 amounts) Requirements:
Single person: Up to $17,655 annual income and up to $13,640 in resources Married couple living together: up to $ 23,895 annual income and up to $ 27,250 in resources Even if your income is higher, you may still be able to get some help. Alaska and Hawaii may have higher limits.
Resources that will count towards eligibility: Money in checking or savings accounts, Stocks and Bonds. Contact Social Security to apply at 1–800–772– 1213 or go online at www.socialsecurity. gov/extrahelp.
Medicare Savings Programs: These are state-run programs designed to help with other Medicare costs. You can apply for a Medicare Savings Pro- gram at the same time that you apply for Extra Help (LIS). These programs assist with Medicare Part B premiums, Part A and B deductibles, co-insurance and co-payments. If you are not eli- gible for premium free Medicare Part A, a Medicare Savings Program may also help pay for that premium. There are four levels of coverage depending on your individual situation. Call your state Medicaid office to apply.
State Pharmaceutical Assistance Programs (SPAPs): State administered programs that help people on Medicare with limited income and resources with their prescription drug costs. Most SPAPs work with Part D plans, and “wrap around,” or fill in the coverage gaps of Part D coverage, such as paying for drugs not covered by the plan. Each state’s SPAP plan is different and may go by a different name. SPAPs are available in 21 different states and the US Virgin Islands. To find out if there is an SPAP in your state, please visit our website, amac.us/medicare/toolbox.
Pharmaceutical Assistance Programs/Patient Assistance Programs (PAPs): PAPs are private programs offered by drug companies, and like SPAPs, help people with limited incomes pay for their prescription drugs. However, some do not help those who already have insurance or who already get prescription assistance. To find out if there is a PAP for any of the medications you are taking, go to www.medicare.gov/pharmaceutical- assistance-program/Index.aspx. ★
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