Getting help with your Medicare
costs when money is tight
Wednesday, August 20, 2014 5:00 PM
Medicare provides vital health insurance for 50 million seniors and people with disabilities. But even when you have Medicare, health care is not free. People with Medicare pay premiums and have other costs that they pay out of pocket, like deductibles and co-insurance. For lower-income people, these costs can be overwhelming.
There are several programs that help low-income people with Medicare pay their health care costs-but many Medicare beneficiaries don't know about these programs. Let's see if we can shed some light on them.
Why might I need help?
Anyone with Medicare knows that the program has significant costs. Here are some common costs for 2014:
Medicare Part A, which covers inpatient care, has a $1,216 deductible that you'll have to pay if you're unfortunate enough to be hospitalized.
Medicare Part B, which covers outpatient care (like doctor visits), has a monthly premium of $104.90.
Doctor visits also come with a 20 percent copayment, and so do lab tests.
If you have Part D drug coverage, that's an additional premium, which averages about $40 a month, plus copayments for your prescriptions.
Finally, there are a number of services that Medicare does not cover, like most long-term care.
Half of people with Medicare live on incomes below $23,500 a year, so it's no surprise that a lot of seniors spend a good share of their budget on health care.
What help is available to beneficiaries with low incomes?
The Part D "Extra Help" program can cover all or part of your Part D premiums and costs.
Each state runs three Medicare Savings Programs. Different states have different names for these programs. All of these programs will cover your Part B premium. Lower-income people can also get their Medicare co-insurance and deductibles covered.
Some beneficiaries with low incomes or high health care expenses may qualify for their state's Medicaid program, which covers a number of services that Medicare does not.
How can I qualify?
Income limits vary from state to state and are adjusted every year. But they are low. In general, the 2014 income limit for any type of assistance is about $17,500 a year for an individual and $23,600 a year for a couple.
Most programs also look at how much you have in assets (bank accounts, retirement, etc.), although the value of your home and car usually don't count toward asset limits. In 2014, the asset limit is about $7,000 for an individual and $11,000 for a couple. But some states have adopted higher asset limits or eliminated them altogether, so check to see what the rules are in your state.
How do I apply?
You can learn more about the Part D Extra Help program and apply through the Social Security website at www.socialsecurity.gov/prescriptionhelp.
To apply for your state's Medicare Savings Programs or Medicaid, contact your state's Medicaid agency. A counselor with your local SHIP can help you start the process and advise you if you run into problems.
Are there other options for getting help with Medicare costs?
Maybe. These options are worth investigating.
It's always a good idea to explore options in your area. Some states provide additional help with prescription drug costs.
If you are a veteran, you may qualify for additional help through the Department of Veterans Affairs (VA).
Make sure you're taking full advantage of any help you may get from a former employer.
Finally, you may want to explore getting a Medicare supplement (Medigap) or Medicare Advantage plan. But be careful, because some of these plans can be costly, and others may limit which doctors you can see. A local SHIP counselor can help you assess your options.
Families USA is the national organization for health care consumers. We have advocated for universal, affordable, quality health care since 1982. Ron Pollack is the Executive Director of Families USA.
What Medicare does (and doesn't) cover
By David Sayen
Medicare helps pay for a wide variety of medical services and goods in hospitals, doctor's offices, and other healthcare settings. But it doesn't cover everything, and it's useful to know what is and isn't included.
Services are covered either under Medicare Part A or Part B. If you have both Part A and Part B, you can get many Medicare‑covered services whether you have Original Medicare or a Medicare health plan.
Part A is Hospital Insurance and it helps pay for:
Inpatient care in hospitals;
Inpatient care in a skilled nursing facility (not custodial or long‑term care);
Hospice care services;
Home health care services:
Inpatient care in a religious nonmedical health care institution.
You can find out if you have Parts A and B by looking at your Medicare card. If you have Original Medicare, you'll use this card to get your Medicare-covered services. If you join a Medicare health plan, in most cases you must use the card from the plan to get your Medicare-covered services.
Part B (Medical Insurance) helps cover medically necessary doctors' services, outpatient care, home health services, durable medical equipment such as wheelchairs and walkers, and other medical services.
Part B also covers many preventive-care services.
Under Original Medicare, if the yearly Part B deductible ($147 in 2014) applies, you must pay all costs (up to the Medicare-approved amount) until you meet the Part B deductible before Medicare begins to pay its share.
After your deductible is met, you typically pay 20% of the Medicare‑approved amount of the service, if the doctor or other healthcare provider accepts assignment. ("Accepting assignment" means that a doctor or other provider agrees to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.)
If you're in a Medicare Advantage plan (like an HMO or PPO) or have other insurance, your costs may be different. Contact your plan or benefits administrator directly to find out about the costs.
Under Part B, Medicare pays for many preventive services (such as screenings for cancer and heart disease) that can detect health problems early when they're easier to treat. You pay nothing for most covered preventive services if you get the services from a doctor or other qualified provider who accepts assignment.
Medicare doesn't cover everything, of course. If you need certain services that aren't covered under Part A or Part B, you'll have to pay for them yourself unless:
You have other insurance (or Medicaid) to cover the costs;
You're in a Medicare health plan that covers these services.
Some of the services and goods that Medicare doesn't cover are:
Long-term care (also called custodial care);
Routine dental or eye care;
Hearing aids and exams for fitting them.
David Sayen is Medicare's regional administrator for Arizona, California, Nevada, Hawaii, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).