Q. My wife and I are struggling with the financial cost of paying our Medicare premiums, deductibles and copayments. I hear there may be some government assistance available for seniors in our shoes. Do you know anything about these programs?
A. Yes. You refer to the Medicare Savings Programs (“MSP’s”) available for low-income seniors to help them with monthly Medicare premiums, and other related costs such as deductibles, coinsurance and copayments. Eligibility is based upon income and resources, and each program has its own criteria. All are designed to help seniors with their health care costs.
Note: When considering your resources, note that some resources are counted, while some are considered exempt and are not counted. Resources that count: Money in the bank, stocks, bonds, and rental property. Exempts assets that do not count: your home, one car, household goods, burial funds and certain other assets.
There are four MSPs, each with its own income and resource caps, as follows:
(1) Qualified Medicare Beneficiary (QMB): This MSP pays for Part A and Part B Premiums, and also helps with Medicare Deductibles, Coinsurance and Copayments: Monthly Incomes must be at or below: $1,032/single or $1,392/married. This program offers the most financial assistance.
(2) Specified Low Income Medicare Beneficiary (SLMB): This MSP pays for part B premiums only; Monthly Incomes must be at or below $1,234/single or $1,666/married.
(3) Qualifying Individual (“QI”): This MSP pays for part B premiums only; Monthly Incomes must be at or below $1,386/single or $1,872/married.
(4) Qualified Disabled and Working Individuals (“QDWI”): This MSP pays for Part A premiums only; Monthly Incomes must be at or below $4,132/single or $5,572/married.
Those enrolled in MSP’s numbered (1) – (3), above, also qualify for another program, called “Extra Help” (aka the “Low-Income Subsidy”) for assistance paying for Medicare Part D prescription drug costs. However, if you do not meet the eligibility criterion for one of those MSP Programs, you can still qualify for “Extra Help” with prescription drug costs if your income and resources are under the following, somewhat higher, limits: monthly income up to $1,517.50/single or up to $2,057.50/married couple, with resources under $14,100/single and $28,150/ married couple. For enrollees, drug costs in the Extra Help program are no more than $3.35 for each generic or $8.35 for each brand-name drug.
Even though the MSP programs are in place to help with Medicare costs, the programs are administered by the state Medi-Cal program. Enrollment is therefore handled by the county Medi-Cal agency. To apply, persons in Alameda County should call the local Medi-Cal office at 510-577-1900 (Hayward) or 510-777-2300 (Oakland). To get a jump on enrollment, you may access the 3 page application by going on line to www.dhcs.ca.gov and searching for form MC 14 A.
Studies indicate that there is a very significant under-enrollment in these programs, which means that many eligible low-income seniors are missing out on available financial assistance. To encourage eligible seniors to apply, the Social Security Administration and the Center for Medicare and Medicaid Services is in the process of sending a joint letter to over 2 million persons who appear eligible based upon their income, urging them to apply through their local Medi-Cal office. Even if you do not receive that letter, if you feel you might qualify you should apply by contacting your local Medi-Cal office.
References: Article on Medicare Savings Programs by Justice in Aging; Article on Medicare Savings Programs by National Center on Law and Elder Rights; Letter from CMS and SSA to seniors who may be eligible for MSP’s and Extra Help; ACWDL 18-03 setting forth the Federal Poverty Level Incomes for 2018.
Chart by CMS showing MSP Income Limits for 2018; Medi-Cal Application Form MC 14A for the MSP Programs; Medicare’s short summary of the 4 MSP Programs; Article on the MSP Program eligibility requirements.
“Senior Resource Guide for Central Alameda County” (Castro Valley, Hayward, San Leandro, San Lorenzo), showing contact agencies and phone numbers.
Article by National Center on Law & Elder Rights highlighting 5 Facts You Should Know About the Medicare Low Income Subsidy.