Medicare: Additional Programs

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Transcript: Patients have access to a range of additional Medicare programs, plans, and savings options to help access essential healthcare services while effectively managing expenses or direct assistance to help pay for premiums, copays, coinsurance, and other expenses. One program is Extra Help (also known as Part D Low- Income Subsidy or LIS), which helps people with limited income and assets pay for Part D premiums and prescription costs. Some people qualify for Extra Help automatically, while others need to apply. You will receive Extra Help automatically if you have Medicaid coverage, are enrolled in a Medicare Savings Program, or receive Supplemental Security Income (SSI) benefits from Social Security. In most cases, to qualify for Extra Help, your income and resources must be below a certain limit. These limits are adjusted annually. The income limit is based on your previous year’s income. If you qualify for Extra Help, Medicare will enroll you automatically in Part D, if you don’t already have one. The Part D Late Enrollment penalty is discontinued when you qualify for Extra Help. To apply, visit SSA.gov or contact your local Social Security office. Another resource is Medicare Savings Programs (MSP), which are federally funded programs administered by individual states. There are four types of Medicare Savings Programs: Qualified Medicare Beneficiary program (QMB), Specified Low-Income Medicare Beneficiary program (SLMB) Qualifying Individual program (QI) and Qualified Disabled & Working Individuals program (QDWI). If you are eligible for these savings programs, they may help pay for Medicare premiums, deductibles, coinsurance, and copays. Eligibility for each program is different and based on income and resources, which can change each year. Resources that count toward these limits include money in your checking or savings account, stocks, and bonds. To apply for any of the Medicare Savings Programs, contact your state Medicaid program, which can be found at www.medicaid.gov/contact-us. The first program, Qualified Medicare Beneficiary program (QMB), helps eligible individuals pay for Part A and Part B premiums, deductibles, coinsurance, and copayments. Second, there’s the Specified Low-Income Medicare Beneficiary program (SLMB), which helps eligible individuals pay for Part B premiums. Third, the Qualifying Individual program (QI) also helps eligible individuals pay for Part B premiums. If you qualify for Medicaid, you are not eligible for QI benefits. Lastly, the Qualified Disabled & Working Individuals Program (QDWI) helps eligible individuals pay for Part A premiums if you are a working disabled person under 65 or lose SSDI due to returning to work. There is also the Program for the All-Inclusive Care for the Elderly (PACE), which is a joint Medicare and Medicaid program for supporting people and their healthcare needs within the community instead of moving to a nursing home or other care facility. To qualify for PACE, you must be 55 or older, live in a PACE service area, require nursing home-level care, and be able to live in the community with support from PACE. Under PACE, beneficiaries receive a dedicated healthcare team to ensure that you receive coordinated care while living in the community. In most cases, you will be required to see a PACE- preferred doctor. All Medicare and Medicaid services determined necessary by your PACE team to improve and maintain your health are covered under PACE. Some covered services include: adult day primary care, dentistry, emergency services, home care, hospital care, laboratory work, x-rays, meals, nursing home care, and more. The cost of participating in PACE is based on your financial situation, but it is possible to pay for PACE privately. If you qualify for Medicaid, you will not have to pay a premium for the long-term care portion of the PACE benefit. There is no deductible or copayment for any medication, service, or care approved by your healthcare team. If you do not qualify for Medicaid but are enrolled in Medicare, you will be charged a monthly premium for the long-term care portion and a premium for Medicare Part D. To apply for PACE, you can look for a PACE program in your area or contact your local Medicaid office. [The screen fades to show a thumbnail of a faded white background of a doctor holding hands with another individual] Deaf. Healthy. DeafHealth. Learn more at www.deafhealthaccess.org. [The screen fades to show a thumbnail of a blue lighthouse] Paf. Patient Advocate Foundation. www.patientadvocate.org.]