Can I get extra help paying for Part D or Parts A an B With Medicare?

Yes, there is help available!  First  I want to make sure we are speaking the same language.  Sometimes people get confused with Part D and Plan D and Part B with Plan B.  Medicare has 4 parts to it.  Part A is hospital coverage and this can be found on your Medicare card which says Part A-hospital insurance and also Part B- doctors insurance. Medicare has a Part C which usually is a Medicare Advantage plan and Part D is a prescription medicine program.

This gets confusing because Medicare Supplements have a Plan A and Plan B a Plan C and a Plan D.   So it may be easier to think of it this way.  Medicare is thought of as PARTS.    Medicare Supplements is thought of as PLANS.  In this article, I want to cover several things such as Medicare savings program (QMB)Is there extra help paying for Medicare Part B premiums?

My name is Mitch Winstead with Allstar Senior benefits.  Call us today for a quote on a Medicare Supplement of any health or life insurance policy.  Our toll-free number is 866-598-8170.  910-538-4547.  Our website is www.allstarseniorbenefits.com.  Our email address is mitch@allstarseniorbenefits.com.  Our Facebook page is www.facebook.com/medsuppguru.    Here is some background information on our agency. I have been working in the physical therapy field for  24 years. Through that, I have helped thousands of patients recover from strokes, Parkinson’s disease, cardiac problems, total hip and total knee replacements just to name a few.   There a NOT a whole of agents that can say that. I co-own a physical therapy practice called physical therapy for life.  I got started in the insurance profession 18 years.  Our agency has been helping people for 34 years.  We know Medicare and have more knowledge than 97% of the agents today   Why?  I have worked as a healthcare provider for 24 years and Medicare is billed for my services.  This agency is veteran owned. I know things that other agents do not know for example, what codes are used in the billing process.   What do the letter codes mean on a Medicare explanation of benefits that patients/clients receive after a service? We know how the Medicare billing system works.  We have an extensive knowledge of medications that agents have to know in order to place you with the right company.  We know them-most agents don’t.  How are claims actually paid and what is the process.  We know underwriting ( health questions on the application to qualify) and how that work to place you with the right company that best for you.   I still help a few people rehab every week for various conditions.  We know Medicare!!  We know Medicare Supplements !!  There are a lot of agents claiming they are the best but when you put them on the spot-they can’t answer questions that impact you.  They are not able to help you effectively. My advice is to hire an experienced brokerage like Allstar Senior Benefits that can impart their knowledge to you and help you better.

Now back to getting help for Part A and B premiums or Part D premiums.  Medicare has 5 kinds of savings programs.

1. Qualified Medicare Beneficiary (QMB) program.

 2. Specified Low income Medicare Beneficiary (SLMB) Program.

3. Qualifying Individual (QI) program.

4. Qualified Disabled and Working Individuals (QDWI) Program.  Also, extra help with paying Part D premiums. 

These programs may pay for Medicare Part A hospital insurance, Part B medical insurance including deductible, coinsurance, and copayments if you meet certain conditions.  If you have income from working, you may qualify for these programs even if your income is higher than the income limits listed below.  What are the income limits for extra help with Medicare?

Qualified Medicare Beneficiary (QMB) Program  (2017)

To qualify the Individual monthly income limit is $1025 Monthly limit.

Married couple monthly income limit $1374

Individual resource limit $7,390,

Married income resource limit $11,090.

This program helps pay for part A premiums, Part B premiums, deductibles coinsurance, and copayments. Please note Medicare providers aren’t allowed to bill you for Medicare deductibles, coinsurance, and co-payments.  When you get services and items Medicare covers, except outpatient prescription drugs. Pharmacists may charge you up to a limited amount but no more than $3.70 in 2018 for prescription drugs covered by Medicare Part D.   To make sure your provider knows you have QMB, show both your Medicare and Medicaid or QMB card each time you get care. If you get a bill for medical care Medicare covers, call your provider or plan about the charges tell them that you have QMB and cannot be charged for Medicare deductible coinsurance and copayment. If this doesn’t resolve the billing problem call 1- 800- Medicare (1-800-633-4227).  

The next program is :

Specified Low Income Medicare Beneficiary (SLMB) Program.  

The income limits are as follows

Individual monthly income limit $1,226.   

Married couple monthly income limit is $1,644.

The individual resource limit is $7,390.

Married couple resource limit is $11,090.

This program helps pay for Part B premiums only.

The next program we will talk about is called a qualifying individual (QI) Program.   You must apply every year for QI benefits QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. You cannot get QI benefits if you qualify for Medicaid.   

QI income and resource limits for 2017

The individual monthly income limit is $1,377.

Married couple monthly income limit is  $1,847.

Individual resource limit is $7,390  

Married couple resource limit is $11,090.

This program pays for Part B premiums only.

The next to last program and we’ll talk about is called a Qualified Disabled and Working Individuals (QDWI) Program.  

The (QDWI) program helps pay for that Part A  premium. You may qualify if any of these apply to you.  You are a working disabled person under 65, you lost your premium-free Part A when you went back to work.

You aren’t getting medical assistance from your state. You meet the income and resource limits required by your state.

Qualified Disabled and Working Individuals Program

 Individual monthly income limit is $4,105

Married couple monthly income limit is $5,499   

Individual resource limit is $4,000  

Married couple resource it is $6,000  

This program helps pay for Part A premiums only.

If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get extra help paying for Medicare prescription drug coverage. These amounts may increase in 2018 if your income and resources are slightly higher you should still apply. Limits are slightly higher in Alaska and Hawaii. If you have income from working you may qualify for benefits even if your income is higher than the limits listed.

Now let’s talk about what items are included in the Medicare Savings Program resource limits?

Countable resources include

Money in a checking or savings account, stocks, and bonds

Countable resources don’t include

Your home 1 car burial plot up to $1,500 for burial expenses if you have that money aside furniture and other household and personal items.

How to apply for Medicare Savings programs?

If you answer yes to these three questions call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state

  1. Do you have or are you eligible, Part A?
  2. Is your income for 2017 at, or below the income limits above?
  3.  Do you have limited resources, below the limits above?

It is important to call or fill out an application if you think you could qualify for savings, even if your income resources are higher than the amounts listed here.

How can I keep my costs down?

Make sure your Medicare card is valid and that you have paid for your Part B premium.

Go to a doctor, other health care provider, or supplier that accepts  Medicare assignment.

Read about how to get help with medical prescription drug costs.

The last program we will address is getting-

Extra help for Medicare prescription drug plan costs.

Anyone who has Medicare can get Medicare prescription drug coverage. Do I have to pay for Part D? Yes, you do. Some people with limited resources and income may also be able to get Extra Help to pay for the costs — monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan. The Extra Help is estimated to be worth about $4,000 per year. Many people qualify for these important savings and don’t even know it.

To qualify for Extra Help:

  • You must reside in one of the 50 states or the District of Columbia;
  • Your resources must be limited to $14,100 for an individual or $28,150 for a married couple living together. Resources include such things as bank accounts, stocks, and bonds. We do not count your home, car, or any life insurance policy as resources; and
  • Your annual income must be limited to $18,090 for an individual or $24,360 for a married couple living together. Even if your annual income is higher, you still may be able to get some help. Some examples where you may have higher income and still qualify for Extra Help include if you or your spouse: —Support other family members who live with you; —Have earnings from work; or —Live in Alaska or Hawaii.

How do I apply? Applying for Extra Help is easy. Just complete Social Security’s Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020). Here’s how:

  • Apply online at www.socialsecurity.gov/extrahelp;
  • Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an application; or
  • Apply at your local Social Security office. After you apply, Social Security will review your application and send a letter to you to let you know if you qualify for Extra Help. Once you qualify, you can choose a Medicare prescription drug plan. If you don’t select a plan, the Centers for Medicare & Medicaid Services will do it for you. The sooner you join a plan, the sooner you begin receiving benefits. If you aren’t eligible for Extra Help, you still may be able to enroll in a Medicare prescription drug plan. Late Enrollment Penalty Medicare Prescription Drug Plan Penalty If you don’t enroll in a Medicare prescription drug plan when you’re first eligible,  you may pay a late enrollment penalty if you join a plan later. You’ll have to pay this penalty for as long as you have Medicare prescription drug coverage. However, you won’t pay a penalty if you get Extra Help or another eligible prescription drug plan coverage. NOTE: The Medicare prescription drug plan late enrollment penalty is different than the Medicare Part B late enrollment penalty. If you don’t enroll in Part B when you’re first eligible for it, you may have to pay a late enrollment penalty for as long as you have Part B coverage. Also, you may have to wait to enroll, which will delay Part B coverage. For information about enrollment periods, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Why should I apply online? Our online application is secure and offers several advantages. It takes you through the process step-by-step with a series of self-help screens. The screens will tell you what information you need to complete the application and will guide you in answering the questions fully. You can apply from any computer. You can start and stop at any time during the process, so you can leave the application and go back later to update or complete any of the required information. We are careful to protect your personal information.

Can state agencies help with my Medicare costs?

When you file your application for Extra Help, you also can start your application process for the Medicare Savings Programs. These state programs provide help with other Medicare costs. Social Security will send information to your state unless you tell us not to on the Extra Help application. Your state will contact you to help you apply for a Medicare Savings Program. These Medicare Savings Programs help people with limited resources and income pay for their Medicare expenses. The Medicare Savings Programs help pay for your Medicare Part B (medical insurance) premiums. For some people, the Medicare Savings Programs may also pay for Medicare Part A (hospital insurance) premiums, if any, and Part A and B deductibles and co-payments. Medicaid or medical assistance is a joint Federal and state program that helps pay medical costs for some people who have limited resources and income. Each state has different rules about eligibility and applying for Medicaid. Contact your state Medicaid office for more information.How can I get more information? For more information about getting Extra Help with your Medicare prescription drug plan costs, visit www.socialsecurity.gov/extrahelp, or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). Social Security representatives are available to help you complete your application. The sooner you apply, the sooner you’ll begin receiving benefits. If you need information about Medicare Savings Programs, Medicare prescription drug plans, how to enroll in a plan or to request a copy of the Medicare & You handbook, please visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048). Your State Health Insurance Counseling and Assistance Program (SHIP) can also help answer your Medicare questions. You can find your local SHIP contact information in the back of your Medicare handbook, online at www.medicare.gov, or you can request it when you call.   A source from (Social Security Administration Publication No. 05-10525)  This article has been written by Mitch Winstead from Allstar Senior Benefits.   Call us today for a quote with no obligation for a Medicare Supplement or life insurance.  Our toll-free number is 866-598-8170 or 910-538-4547.

Our website is http://www.allstarseniorbenefits.com Our email address is mitch@allstarseniorbenefits.com  Our facebook page is http://www.facebook.com/medsuppguru

One final point is when I talk with some of my clients about programs like these, they tell me that they are embarrassed about asking for help.  I can understand that to a certain degree.  If you are having trouble paying for your Medicare premiums, I would encourage you to apply for help.  You most likely worked hard all your life.  Your most likely paid taxes, etc.  So why not ask for help when you need it?   Thanks for reading!