Savvy Senior: Medicare Savings Programs

by | November 17, 2004 12:00 am

Dear Savvy Senior,

I was hoping you could help me. I’m a senior citizen on a very limited income who doesn’t have any health insurance except through Medicare, and I only have the Part A coverage. I can’t afford Part B on what I make. But, my neighbors’ daughter was recently telling me that I might be eligible for some type of government assistance which could help with some of those Part B costs. How can I find out about this?

Underinsured Erma

Dear Erma,

For the millions of older Americans like yourself, whose resources don’t stretch far enough to cover their health care needs, help is available. Here’s what you should know.

Medicare Cost

For those eligible, Medicare Part A (hospital insurance) is premium-free, but Part B (medical insurance) isn’t. Part B costs a monthly premium of $66.60, plus an annual deductible of $100, plus 20 percent coinsurance (the uncovered 20 percent of the medical cost). For a person on a limited income, this can be a real budget breaker. But, there are several different options that might be able to help.

Medicare Savings Programs

Depending on you financial situation, three different programs are available that can help qualified seniors save hundreds of dollars per year. They include:

• Qualified Medicare Beneficiary Program (QMB): Pays for all Medicare premiums, deductibles and coinsurance. To qualify, you cannot have a monthly income limit greater than $796 if you are an individual, or $1,061 for a couple. There is also an asset limit of $4,000 per person or $6,000 per couple.

• Specified Low-Income Medicare Beneficiary Program (SLMB): Pays for Medicare’s Part B premium only. The income limit is $951 per month for an individual and $1,269 for a couple. This program also has an asset limit of $4,000 per person or $6,000 per couple.

• Qualifying Individual-1 Program (QI-1): Pays for Medicare’s Part B premium. The income limit for this additional program is $1,068 per individual and $1,426 per couple. Some states also have the asset limit of $4,000 per person or $6,000 per couple. Money for the QI-1 program is limited and available on a first-come, first-served basis until the money runs out for the year.

Savvy Tips: Even if you’re slightly over the income or asset limits, you may still qualify for these programs because different states calculate income differently. Be sure to call and check! Also, in calculating your assets, your house, one automobile and burial fund are generally not included.

Medicaid

If your income and assets are even more limited than the ones I listed in the Medicare Savings Programs, you may qualify for Medicaid, which will also pay your Medicare premiums, coinsurance and deductibles. To qualify, you must meet the income and asset limits set by your state, which will vary. If you’re eligible, Medicaid also offers additional benefits not offered by Medicare, like prescription drugs and long-term care coverage.

How to Apply

For more information or to find out how to apply for either the Medicare Savings Programs or Medicaid, contact your county Medicaid office. To locate them, look in your local phone book under your county’s Department of Human or Social Services or Health Department. Or, call Medicare’s hotline at 1-800-633-4227.

Savvy Resource

State Health Insurance Counseling Program (SHIP): Offers free counseling to Medicare beneficiaries. They can provide additional information on these programs and help you apply. To locate your local SHIP call Medicare at 1-800-633-4227 or visit www.shiptalk.org.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior.org. Jim Miller is a regular contributor to the NBC Today Show and author of “The Savvy Senior” book.

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