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Millions of Seniors May Be Unaware of Medicare Help
to Pay for Drug Program
Senior couple can qualify for help
even if annual income is $19,000
Dec. 6, 2005 Millions of senior citizens may be
qualified for financial assistance with the Medicare prescription drug
program and not know it. Extra help to pay for the program is not just
available for indigent seniors but also for many with modest annual
incomes as high as $14,355 and holding assets of less than $10,000, not
counting their car or home.
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Click below for more news on:
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Medicare Drug Program
> Medicare
> How to join a Medicare
Drug Plan
> Medicaid |
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Medicare is offering extra help with paying for its
new prescription drug coverage to these beneficiaries that will cover
some 85 percent of their drug costs, discount the monthly premium (on a
sliding scale), reduce the annual deductible, and eliminate the coverage
gap, according to a news release from the Medicare Rx Education Network.
The Centers for Medicare & Medicaid Services (CMS)
estimates that there are 2.4 million beneficiaries nationwide who are at
the upper income limit for extra help who may be eligible.
To qualify, beneficiaries must meet the following
criteria:
● Annual income of no more than $14,355 for an
individual in 2005 ($19,245 for a couple). That works out to a monthly
income of some $1,197 for an individual ($1,604 for a couple).
● Assets less than $10,000 for an individual
($20,000 for a couple). According to CMS, assets are generally defined
as resources that can be converted to cash within 20 days, such as
stocks, bonds, and checking, savings and retirement accounts. A
principal home, car, and burial space do not count toward the asset
limit. Also excluded are $1,500 for funeral or burial expenses, life
insurance policies with a face value of up to $1,500, and items such as
wedding rings and family heirlooms.
The majority (54 percent) of Medicare beneficiaries
have limited assets, with more than half with countable assets of
$20,000 or less (in 2002). Many Medicare beneficiaries also have modest
incomes. For example, for 80 percent of the elderly, Social Security
comprises at least half of their annual income.
For those who qualify, Medicare helps by:
● Limiting the deductible to no more than $50
(compare to Medicare's "standard" plan deductible of $250).
● Helping (on a sliding scale, depending on
income) with the cost of the monthly premium. (The national average
monthly premium in 2005 is $32.20.)
● Limiting co-payments (per prescription) to 15
percent
● Eliminating the coverage gap.
In other words, in addition to the monthly premiums
(which are discounted on a sliding scale) and after the discounted
annual deductible of $50, the beneficiary pays 15 percent and the plan
pays 85 percent of the cost of the beneficiary's prescription drugs.
That continues until the beneficiary qualifies for catastrophic
coverage. At that point, the beneficiary only makes co-payments of
$2/generic and $5/brand name per prescription.
When applying for this extra assistance, the
beneficiary will be asked for information about his/her income and
resources and will be asked to sign a statement that the answers are
true. Social Security checks the information from computer records at
the Internal Revenue Service and other sources. The applicant may be
contacted if more information is needed.
People who think they might qualify should visit
the Social Security Web site at
http://www.socialsecurity.gov/ or call 1-800-772-1213 and ask for an
application. Beneficiaries can apply:
● via the Social Security Web site.
● at the local Social Security office (SSA will
also take applications by phone).
● through their state Medicaid office, or
● through their state's health insurance
assistance program (SHIP).
This summer, the Social Security Administration
mailed applications to potentially eligible individuals. You can also
find the forms and additional information on the SSA Website at
http://www.socialsecurity.gov/, or simply call the SSA to request
the form.
Once a beneficiary qualifies for this extra help,
he/she needs to enroll in a Medicare low income-subsidy prescription
drug plan.
Enrollment in the Medicare prescription drug
benefit is voluntary. Open enrollment began November 15, and continues
through May 15, 2006.
The Medicare Rx Education Network provides
information and assistance with outreach and enrollment for the new
Medicare Part D prescription drug benefit.
The network, which includes 70 national
organizations, is chaired by U.S. Senator John Breaux, former Democratic
leader on the Senate's Special Committee on Aging.
Members share an interest in educating Medicare
beneficiaries about the new Medicare prescription drug benefit and work
closely with the appropriate federal agencies to obtain up-to-date
information to ensure that information disseminated by the network about
Medicare Part D is factual and accurately conveyed, thereby pre-empting
confusion about the benefit and equipping beneficiaries and their
caregivers to make informed choices.
By sharing information with each other about member
organizations' independent efforts, collaborating on activities, and
identifying ways to work together, the network aims to eliminate
duplication of efforts and maximize the effectiveness of outreach
efforts. The network does not engage in legislative activities or take
positions on pending legislative or administrative policies related to
the Part D benefit and its implementation.
Click to Website - Medicare Rx Education Network
Click for more news on:
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Medicare Drug Program
> Medicare
> How to join a Medicare
Drug Plan
> Medicaid
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