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Special assistance for people who have low incomes

Special assistance for people who have low incomes

This page is especially for people who are already covered by Medicare but do not have the means to pay for copayments and prescription drug coverage.

There are people who, in spite of the improvements in Medicare plans, are finding it difficult to avail of services because of their limited income. In fact, they often find it difficult to even pay premiums for their medicare plans. They are usually people on social security benefits and cannot pay their costs. For these people, special facilities are available under which they can secure the benefits. These are the programs outlined below:

People with limited income may get prescription drug coverage. If you meet the eligibility criteria, you may be helped in paying premiums for the drug plans you chose. You may also get help in paying for copayments for certain drug plans. Whether you receive assistance or not will depend on your asset level and your income. If you are single, with asset levels less than $11500, you may qualify for the assistance. You may also qualify if your asset level is below$23000 in case you have a spouse. You will get more information on whether you qualify from your Social Security Administration.

Once you qualify for help under the Medicare plan, you will have to select a plan and join it by May 15th; else you will receive an automatic enrollment in a plan. This will take place by 1st of June. If you do not like the plan Medicare has chosen for you, you may opt for a change by 31st December. Usually, changes are allowed between November 15th and 31st December in a year. Contact your insurance department for details.

Your share of costs for prescription drugs and personal liabilities may go down to a great extent once you qualify for this assistance. Your monthly premium will be $0 if you annual income is below $12920 and your asset valuation between $7500 and $11500. Your annual deductible will be $0 and the copayment for prescription drugs will be $2 for generic drugs and for brand name drugs it will be $5 for incomes at the same level and assets under $7500, your premium per month for prescription drugs will be 15% for generic drugs and 15% for brand name drugs. For annual incomes between $12920 and $14355 and assets less than $11500, premiums per month for standard prescription drugs will be receiving discounts. The level of annual deductible will be $50 and you will have to pay copayments of 15% for generic drugs and 15% for branded drugs.

You automatically qualify for this program if you have full Medicaid cover and a medicare plan and if the state Medicaid is already making payments towards your prescription drugs. From 31st December, 2005, Medicaid no longer pays for drugs. You will automatically qualify for a prescription drug plan and have low income assistance if you get supplemental security income or get help in paying your costs from a state Medicaid program. If you qualify under these conditions and have Medicare, Medicaid and are staying in a nursing home, you pay a monthly premium of $0 for a drug plan. Your deductible, copayment for both generic and brand drugs is nil. If your annual income is less than $9570 and you have Medicaid, your premiums on a monthly basis for prescription drug coverage are nil and so is your annual deductible. You pay a copayment amount of$1 for generic drugs and an amount of $3 for drugs with brand names. If your annual income is more than $9570 and you have Medicaid, your premiums on a monthly basis for prescription drugs coverage are nil and so is your annual deductible. You pay a copayment amount of$2 for generic drugs and an amount of $5 for drugs with brand names. This is also true for cases where the person has Medicare and the state is helping him/her in making payments for it. It is also true for people getting supplemental security income. As details change with time, it is best to contact your state department.

Analyze the other insurances you may have like group plans and other sources and compare how they might affect your benefits under Medicare. As the Medicare plan may be the second payer in such a situation, your benefits may be reduced. Consider whether the benefits you are receiving are already covered under a separate plan you have.

Medicaid also helps in providing help at the state level for paying premiums for Medicare. It helps by paying the medical bills of people who have limited resources and incomes. It works together with the federal government and the state government. Your medical costs are all covered with prescription drug coverage if you have both Medicare and Medicaid. You may also get access to the covers that were not completely covered under Medicare original plan. However, the incomes for qualifying may vary from state to state as these are state funded programs. Contact the state social security department to know more about your qualifying levels.

Medicare savings programs are also provided at the state level and this also helps in paying for the premiums for Medicare. They may also help you in paying for deductibles and coinsurances. You must have Medicare Part A in order to qualify for this state help. Also, you must have personal assets that are less than $4000 in value and your income per month may not be more than $1097(Contact Company for current levels). They also vary between states.

Supplemental security income benefits (SSI) is a benefit paid by the social security administration on a monthly basis. It is paid to people with limited incomes and resources and people who are blind, disabled or over the age of 65. These benefits give you cash for basic needs such as food and shelter. If you want to qualify, you must be a resident of the US, and not be absent from the country for a period that is longer than 30 days. You may also belong to a select group of non citizen people.

The PACE program provides financial assistance to people who are ‘frail’. Some PACE programs also help people to cover prescription drugs. However, these programs are mainly geared to the provision of social, medical and long term care services to people who qualify. It is also a state sponsored program and the eligibility conditions vary from state to state.

Medicare approved drug discount cards are also available to people who have Medicare. These helped the people by making them pay less for prescription drugs till the new program started in 2006. The cards were temporary in nature and were replaced by the Medicare drug plans.

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