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PO Box 360
Trenton, NJ 08625-0360
|Poonam Alaigh, MD, MSHCPM, FACP|
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TRENTON—Health and Senior Services Commissioner Poonam Alaigh, M.D. is encouraging low-income Medicare beneficiaries to enroll in two under-utilized federal programs that can help reduce their out-of-pocket health and prescription drug costs.
The two programs, known as Medicare Savings Programs (MSPs) and the Low Income Subsidy (LIS), help eligible individuals pay some or all their Medicare Parts B and D premium, deductible, coinsurance and/or co-pay costs. A person on MSP can save at least $1,000 a year, while individuals on LIS save an average of $3,900 annually.
“For individuals with low incomes and limited assets these programs can be, if accessed, a true life-saver,” said Dr. Alaigh. “Unfortunately, too few seniors and people with disabilities on Medicare know about these programs or where and how to apply.”
Dr. Alaigh said a one-year federal grant program has made it easier for low-income Medicare beneficiaries in select counties to find out about these programs and get help completing the necessary applications. Grants were awarded earlier this year to eight agencies that will conduct outreach and enrollment activities in 12 counties now through March 2011.
The specific programs promoted by the grants include the Medicare Savings Programs known as QMB, SLMB and QI-1, the Medicare prescription drug program’s Low Income Subsidy (also known as Extra Help), as well as the State’s own Pharmaceutical Assistance to the Aged and Disabled (PAAD) program. Eligible individuals can now get all three programs by completing a single application developed by the State.
It is estimated that only 33% of individuals eligible for QMB and 13% of those eligible for SLMB or QI-1 have actually signed up for benefits. Likewise, just 53% of those eligible for LIS who are not automatically enrolled through their participation in Medicaid or SSI are believed to receive the subsidy.
QMB covers all approved out-of-pocket Medicare expenses for individual with limited assets who are living below the federal poverty level, currently set at $10,830 for a single person and $14,570 for a married couple. Individuals enrolled in QMB with assets up to $4,000 if single and $6,000 if married, are also eligible for Medicaid coverage.
SLMB and QI-1 pay Medicare Part B premiums for individuals with incomes between 100% and 135% of the federal poverty level, currently standing at $10,830 up to $14,621 for individuals and at $14,570 up to $19,670 for married couples. Changes in Medicare law effective Jan. 1, 2010, raised the program’s asset limits to $6,600 for individuals and $9,910 for couples. A beneficiary’s primary residence and vehicle, if used for medical appointments or for work, are not counted as assets. The Part B premium normally ranges from $96.40 to $110.50 per month and is usually taken directly out of a person’s Social Security check.
The Low Income Subsidy provides extra help to qualified low-income Medicare beneficiaries in paying their Part D drug plan’s monthly premium, annual deductible, coinsurance and/or co-pays. Benefit levels vary by income. With LIS, there is also no Part D coverage gap – commonly called “the donut hole” – and no late enrollment penalty. On full LIS without Medicaid, individuals pay no more than $2.50 for each generic drug and $6.30 for each brand-name drug they purchase.
To be eligible for LIS, an individual must have an annual income of less than $16,245 and resources less than $12,510. The income and asset limits for married couples are $21,855 and $25,010, respectively. The asset levels assume the applicant plans to use $1,500 for burial expenses.
For assistance learning about and applying for these programs, low-income Medicare beneficiaries are encouraged to contact one of the following grantees:
Individuals residing outside the grant coverage areas (Bergen, Cape May, Hunterdon, Middlesex, Morris, Passaic, Somerset, Sussex and Warren Counties) should call the New Jersey Division of Aging and Community Services at 1-800-792-8820 for information and referral services.
For more information on getting help paying your Medicare costs, go to www.aging.nj.gov.
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Department of Health
P. O. Box 360, Trenton, NJ 08625-0360