Health & Medical

Medicare Extra Help a Lifesaver

3 – 4 Million Seniors Miss Out on This Low-Income Subsidy. Are You Among Them?

When Dennis Carter and his wife, Linda, both 71 and living solely on their monthly Social Security payments, found they could no longer afford to pay for their medicine under Medicare Part D, they called for help, only to be turned down flat.

“Sorry,” said Florida’s Department of Children and Families, administrators of Medicare subsidies. “We offer no benefit like that.”

Yet, as I explained to Dennis after he e-mailed me, they do. It’s the Medicare Extra Help program. And every state offers it.

Unfortunately, this generous policy providing seniors with an average annual savings of $3,335 isn’t well publicized, even within Medicare itself.

In fact, when I searched Medicare’s Website for Extra Help, I was directed to leave that site for the National Council On Aging’s “Benefits Check Up” where, after answering 25 questions and supplying a complete list of my medications, the site recommended that I enroll in Part D and, if necessary, apply for the various drug manufacturers’ free patient assistance programs.

Not a word about Extra Help.

This thing must be really good if they go to such lengths to hide it!

Turns out the folks at Social Security administer eligibility for this particular Medicare subsidy. Go figure.

But it’s worth the chase.

If you qualify, Extra Help pays all or part of your monthly Medicare premium ($96.40 in 2009), plus all or part of your Plan D premiums, deductibles, and co-payments. Extra Help will even cover the no-pay Donut Hole. That alone can save up to $4,050.

(News this week revealed that this cursed out-of-pocket drug cost for 2009 isn’t going to disappear for at least 12 years under a current proposal in the U.S. House of Representatives.)

In practice, this generally means that you pay $2.40 for generics and six bucks for branded drugs. This can cover either a 30-day or 90-day supply.

What a deal!

How to Get Extra Help

To qualify, your annual income must be less than $16,245 and resources less than $12,510 for singles, less than $21,885 annual income for married couples living with a spouse with no more than $25,010 in liquid assets.

Cars, homes, furniture, and other belongings don’t count. Only cash and other assets easily converted to cash. (New York State has no asset test using their Qualified Individual program.)

Of course, you must be enrolled in Part D or some other Medicare drug program.

Unfortunately, millions of seniors haven’t gotten the word. “Despite our best efforts along with those of the Social Security Administration and a host of other organizations, between 3.4 million and 4.4 million eligible individuals remain unenrolled,” said Robert Hayes, president of the Medicare Rights Center.

If you feel that you qualify for this program, simply complete the online application at ssa.gov or apply at a local Social Security Administration or Medicaid office. If you have Medicaid or a Medicare Savings Program (QMB, SLMB or QI-1), or if you receive Supplemental Security Income (SSI), you automatically qualify.

Even if your annual income exceeds Extra Help’s maximums, although ineligible for help with Medicare’s monthly premium, you may receive help with drug payments through Social Security. Find out at 1.800.772.1213.

Meanwhile, now with Extra Help, the Carter’s pharmaceutical expenses dropped from around $400 to an affordable $31 a month.

Remember, there are millions of seniors who don’t know about this lifesaving subsidy. If you know folks who may be eligible, please, please let them know.

SOME USEFUL CONTACTS:

  • Tips on applying for Extra Help are at MedicareRights.org. Search “Extra Help.”
  • Get help with your state Medicaid is at State Health Insurance Assistance Programs / by calling 1.800.677.1116.
  • Call at 1.800.633.4227.

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