June 14, 2005
Low-Income Medicare Beneficiaries to Get Extra Help Paying for Prescription Drugs
By Dr. Robert Wynia
(Second in a series)
A new prescription drug benefit offered through Medicare next year will include extra financial help for some elderly and disabled people living on limited incomes.
Beginning next Jan. 1, everyone with Medicare will be able to get prescription drug coverage through the new Medicare-approved drug plans, which were authorized by the Medicare Modernization Act of 2003. Like other forms of health insurance, the plans will require most beneficiaries to pay premiums, deductibles, coinsurance, and copayments. But some low-income Medicare recipients will be able to get help paying those costs, too.
This summer, the federal Social Security Administration will mail information to millions of Medicare beneficiaries who may be eligible for that extra help. The mailing will include an Application for Help with Medicare Prescription Drug Plan Costs. If you get an application, be sure to complete it and return it in the envelope that is provided. An online application will be available after June 25.
Social Security officials will review the applications and send letters informing applicants whether they qualify for the extra help. Everyone who qualifies will need to take the next step--enrolling in a Medicare-approved prescription drug plan--in November.
Medicare beneficiaries with annual incomes below $14,355 ($19,245 for a couple) and resources valued at less than $11,500 ($23,000 for a couple) will qualify for the extra help. Income includes earned income (such as wages, net self-employment earnings, royalties, and in-kind income) and unearned income (such as Social Security benefits, veterans' benefits, pensions, rental income, dividends, and interest).
Resources include cash, bank accounts, stocks and bonds, retirement accounts, mutual fund shares, and real property other than a primary residence. Some items that are not considered resources are the principle place of residence, burial spaces and funds for burial expenses, and non-liquid resources such as family heirlooms, jewelry, and vehicles.
Some people will automatically qualify for the extra help. They are Medicare beneficiaries who also:
- Get Supplemental Security Income (SSI) payments;
- Get prescription drug coverage through Medicaid; or
- Have their Medicare premiums paid through Medicaid.
If you fit into one of these categories, Medicare will send you a letter informing you of your automatic eligibility.
If you want to find out whether you qualify for the extra help before submitting your application to the Social Security Administration, you can log on to www.socialsecurity.gov/prescriptionhelp and click on "Online Tool." The site also provides more information about applying for help with prescription drugs.
If you apply for help with Medicare prescription drug costs and are turned down, you may appeal the decision. Instructions for appeals will be included with the mailing from the Social Security Administration.
Remember, getting extra help with prescription drugs is a two-step process. You must apply with the Social Security Administration to get help paying for drug coverage. Then, beginning in November, you must choose and enroll in a Medicare prescription drug plan.
In October, Montanans will begin getting information about Medicare prescription drug plans that are available to them. You can pick the plan that best fits your needs anytime between November 15, 2005, and May 15, 2006.
For more information about getting help with Medicare prescription drug costs, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit www.socialsecurity.gov .
To learn more about the Medicare prescription drug plan, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov .
(Dr. Robert Wynia is director of the Montana Department of Public Health and Human Services. This is the second in a series of monthly columns explaining the new Medicare Part D prescription drug plans.)
Page last updated: 06/15/2006
