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Indiana’s Money Saving Programs for People with Medicare. Medicare Savings Programs, Extra Help for Part D, and Hoosier Rx (2008). What We Will Cover Today?. Programs that help pay your Medicare out-of pocket costs: Medicare Savings Program (MSP)

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indiana s money saving programs for people with medicare

Indiana’s Money Saving Programs for People with Medicare

Medicare Savings Programs,

Extra Help for Part D,

and Hoosier Rx

(2008)

what we will cover today
What We Will Cover Today?

Programs that help pay your Medicare

out-of pocket costs:

  • Medicare Savings Program (MSP)
  • Extra Help to pay for your Part D drug costs
  • State Pharmaceutical Assistance Program - Hoosier Rx

Who is eligible for these programs?

How do you apply for these programs?

How do they work with other programs?

section 1
Section 1

What is the

Medicare Savings Program?

what is a medicare savings program
What is a Medicare Savings Program?

Medicare Savings Programs (MSPs) help people who have low incomes pay for the out-of-pocket costs of Medicare.

MSPs are joint federal/state programs.

You apply through your local Medicaid office called the Office of Family Resources.

what are the different types of msps
What are the different types of MSPs?

The three different MSPs are:

QMB

SLMB

QI

Each program helps with different costs.

Each program has different income limits

to qualify.

what costs could msp cover
What costs could MSP cover?

Depending on program, MSP could help you pay

some of the following costs:

  • Standard Part B premium: $96.40*
  • Part A premium (if you have worked less than

10 years and you must pay a Part A premium)

  • Part B deductible: $135*
  • Hospital deductible: $1,024*/benefit period
  • Coinsurance for services (doctor, hospital,

skilled nursing facility, home health, hospice)

*2008 figures

are there any other benefits
Are there any other benefits?
  • When you enroll in an MSP, you automatically get full “Extra Help” for Part D drug coverage.
  • Extra Help is a federal program that helps

pay for most of the costs of the Medicare

drug benefit (Part D) including the gap in coverage.

  • You will be automatically enrolled in a Part D plan if you do not choose one.
how do msp eligibility rules work
How do MSP eligibility rules work?
  • Each program has its own eligibility limits

(income/assets).

  • Minimum limits set by federal government; can vary by state.
  • Income limits change in March or April of

every year (with Federal Poverty Limit).

  • Income limits given here became effective in

March of 2008.

qualified medicare beneficiary qmb
Qualified Medicare Beneficiary (QMB)

QMB has lowest income limits:

  • $887 a month or less for an individual
  • $1,197 a month or less for a couple

Asset limits:

  • $4,000 for an individual
  • $6,000 for a couple

QMB offers the most help:

  • Pays for Original Medicare’s Part A and B premiums, deductibles, and coinsurance.
  • Or be used to qualify for a Special Needs Medicare Advantage Plan in place of Original Medicare.
specified low income medicare beneficiary slmb
Specified Low-Income MedicareBeneficiary (SLMB)

Income limits:

  • $1,060 a month or less for an individual
  • $1,420 for a couple

Asset limits:

  • $4,000 for an individual
  • $6,000 for a couple

Pays the Medicare monthly Part B premium

qualifying individual qi
Qualifying Individual (QI)

QI has the highest income limits:

  • $1,190 a month or less for an individual
  • $1,595 a month or less for a couple

Asset limits:

  • $4,000 for an individual
  • $6,000 for a couple

Pays the monthly Part B premium.

Must not be eligible for Medicaid benefits.

should you apply if your income is over the limit
Should you apply if your income isover the limit?

Yes!

  • Indiana has its own process for counting

income called Buy-in.

  • How your income is counted depends on

whether or not you are working and/or

receiving Social Security benefits.

  • You may be able to deduct certain

expenses from your income.

how do you apply
How do you apply?
  • Contact your local Office of Family Resources or SHIP for an application.
  • You may submit an application by mail, fax,

or in person.

  • Provide with the application:

proof of income;

proof of assets; and

a copy of your Medicare card.

  • Make a copy of the application for your

records before submitting.

when does coverage start
When does coverage start?
  • You should be notified of your application

status within 45 days of applying for an

MSP (Notice of Action).

  • You continue to pay Medicare costs until

approved, then you will be reimbursed.

  • Coverage generally begins from the first

of the month in which you apply.

  • You may receive retroactive benefits for up to

three months before you applied for SLMB and QI.

what if you are denied enrollment
What if you are denied enrollment?

You have the right to appeal:

  • Submit an appeal request to the address shown on the denial notice.
  • You will receive a Notice of Action within 45 days of your appeal.
  • You must continue to pay your monthly Part B premium during this time.

If you win your appeal:

  • The state will pay your Part B premium starting the month indicated on your new Notice of Action.
  • You will receive a lump-sum check as reimbursement for the months before the Part B premium ($96.40 a month in 2008) is added to your Social Security check back to the month of application.
medicaid and msps
Medicaid and MSPs
  • When you enroll in Medicaid, you should make sure you are also enrolled in QMB.
  • This is how Medicaid pays for your Medicare Part B premium.
  • MSPs will increase your monthly income by

the amount of the Part B premium ($96.40 in 2008).

  • Make sure the increase will not make you ineligible for Medicaid.
what is medicaid
What is Medicaid?
  • Pays for most medical costs for people with low or limited incomes and assets.
  • You can have both Medicare and Medicaid.
  • Medicaid pays your Medicare deductibles and coinsurance if you go to providers who accept both kinds of insurance.
  • If you have both Medicare and Medicaid, you must get your drug coverage from Medicare (Part D). You will get Extra Help paying for Part D.
  • Go to the local Office of Family Resources or www.IN.gov/fssa for more information about coverage and eligibility.
section 2
Section 2

What is Extra Help?

what is extra help
What is Extra Help?

Extra Help is a federal program through the Social Security

Administration that helps you pay for some or most of the

costs of Medicare Part D drug coverage.

You are eligible if income is below $1,711* a month ($1,276* for

couples) and have assets below $11,990 ($23,970 for couples).

  • No or low premium and deductible.
  • Low co-payments (as low as $1.05; no more than 15 percent of cost of drug).
  • No gap in coverage (the donut hole).
  • The level of Extra Help you are eligible for depends on your income and assets (“Full” and “Partial” Extra Help).

*Based on Federal Poverty Level

full extra help
“Full” Extra Help

You pay:

  • No premium or deductible as long as you choose a drug plan that offers basic coverage with a premium at or below your regional benchmark (the premium amount Extra Help will pay for in full).
  • You only pay a small co-pay for each drug you buy.
  • Your co-pay amount depends on your income and whether you have full Medicaid. ($1.05 generic/3.10 brand name or $2.25/$5.60)
  • You pay nothing after $5,762.25 in total annual drug costs in 2008 (catastrophic coverage).
partial extra help
“Partial” Extra Help

You pay:

  • A sliding-scale premium based on your income
  • Up to $56 deductible
  • 15 percent of the cost of each drug you buy, or the plan’s co-pay for non-Extra Help members, whichever is lower)
  • After $5,726.25 in total annual drug costs in 2008 (catastrophic coverage):

Five (5%) percent of the cost of each drug, or $2.25/generic and $5.60/brand-name drug co-payment (whichever is greater)

other benefits of extra help
Other benefits of Extra Help

If you get Extra Help:

  • There’s no gap in coverage (the donut hole).
  • You get a Special Enrollment Period to enroll in a Medicare Part D drug plan.
  • No penalty to enroll even if you enroll after first eligible for Part D (in 2008).
  • Can change drug plans once a month.
who gets extra help automatically
Who gets Extra Help automatically?

If you are enrolled in

  • Medicaid;
  • Supplemental Security Income (SSI); or
  • Medicare Savings Program (MSP) such as QMB, SLMB or QI

You do not have to apply for Extra Help—you get it

automatically.

what happens if you have medicaid spend down
What happens if you haveMedicaid spend-down?
  • You automatically get Extra Help the first month you meet your spend-down amount.
  • Get Extra Help for the rest of the calendar year.
  • If you have Medicaid spend-down, you qualify for Full Extra Help, just like everyone else with Medicaid.
  • If your income is more than 100% of the Federal Poverty Level, you may pay slightly higher

co-pays.

what if you do not automatically get extra help
What if you do not automaticallyget Extra Help?

You have to fill out an LIS application. You and your spouse

can apply with the same application.

You can apply through:

  • Social Security Administration
  • Mail in print application (use original application!)
  • Fill out online application (www.ssa.gov)
  • Apply by phone (800-772-1213)
  • Apply in person at local SSA office

You can declare your income and assets (do not need to

provide proof). If you are denied, you can appeal

what should you count as your income and assets
What should you count as your income and assets?
  • Earned income: wages, earnings from self employment.
  • Unearned income: Social Security, Veterans Benefits, pension, etc.
  • Assets: stocks, bonds, mutual funds, retirement accounts, checking and savings accounts.

Certain income and assets will not be counted, so apply even if it looks

like you are over the limits. You must also include income and assets

of spouse unless legally separated.

what if you do not receive extra help
What if you do not receiveExtra Help?
  • If you apply through Social Security, request an administrative review from Social Security.
  • Choose a telephone hearing or case review.
  • You can appoint a personal representative if you want a family member or caregiver to help you with the process.
  • SSA decision can be appealed in federal court.
how do you get medicare drug coverage once you get extra help
How do you get Medicare drugcoverage once you get Extra Help?
  • You should choose a Medicare private drug plan that covers the prescriptions you need at a price you can afford.
  • You will be automatically enrolled in a Medicare drug plan unless you choose a plan yourself.
  • If you do not already have Medicare drug coverage, you can enroll outside the normal enrollment periods.
  • You will have an ongoing Special Enrollment Period (SEP) to switch plans once a month.
extra help could affect other assistance programs
Extra Help could affectother assistance programs

If Medicare pays for your prescription drugs, your income will be higher. Your change in income may affect:

  • Food Stamps
  • Help paying your rent or public housing (such as Section 8 Housing)
  • Other assistance based on monthly income

If you are in several of these programs, call your local Case

Worker for help. What you save in prescription drug costs

may offset what help you receive from these programs.

section 3
Section 3

What is Hoosier Rx?

hoosierrx
HoosierRx

Indiana’s State Pharmaceutical Assistance Program, HoosierRx, can help pay the monthly Part D premium, up to $70 per month, for members enrolled in a Medicare Part D Plan working with HoosierRx.

to be eligible for hoosierrx you must
To be eligible for HoosierRx you must:
  • Be an Indiana resident, 65 years old or older.
  • Have a yearly income of $15,840 or less for a single person, or $21,240 or less for a married couple living together. Assets are not considered.
  • Have applied for the “Medicare Extra Help” through Social Security to pay for your Medicare Part D plan, and received either a “Notice of Award” or “Notice of Denial” from Social Security.
    • Your Social Security “Notice of Denial” must be because your resources are above the limit established by law.
    • Your Social Security “Notice of Award” must state that you are receiving partial extra help subsidy to help pay for your Medicare Part D premium.
companies offering prescription drug plans working with hoosierrx
Companies offering Prescription Drug Plans working with HoosierRx:
  • AARP/United Healthcare
  • CIGNA Healthcare
  • Coventry AdvantraRx
  • First Health
  • Humana
  • MemberHealth
  • Prescription Pathway
  • SilverScript
  • WellCare
section 4
Section 4

Other Options?

other options
Other Options?
  • Talk to your doctor about changing to generic drugs. Generics cost significantly less than brand names. You may be able to avoid the gap in Part D coverage.
  • If you are an honorably discharged veteran, considering using your VA drug benefit ($8 per prescription per month). Veterans can use the VA drug benefit by mail order for their routine maintenance drugs and still use Part D for other prescriptions.
  • During the gap in Part D drug coverage, you may be eligible for no or low cost drugs from the Drug Manufacturers’ Patient Assistance Programs.
things to remember
Things to remember
  • If you have difficulty paying your Medicare out-of-pocket costs, call SHIP or your local Office of Family Resources to see if you qualify for help.
  • You may qualify for some programs even if your income is slightly higher than the advertised limits.
  • If your application for Extra Help or a Medicare Savings Program is denied, you have the right to appeal.
for more information and help
For more information and help:
  • State Health Insurance Assistance Program (SHIP) at 800-452-4800 or www.medicare.in.gov
  • Area Agencies on Aging (AAAs) at 1-800-986-3505 or www.iaaaa.org
  • Medicare at 800-MEDICARE (800-633-4227) or www.medicare.gov
  • Social Security at 800-772-1213 or www.ssa.gov
  • Hoosier Rx at 866-267-4679 or www.IN.gov/HoosierRx
  • Pharmaceutical Manufacturers’ Patient Assistance Programs at 877-793-0765 or www.rxforindiana.org
  • Veterans Prescription Benefit at 1-877-222-8387
additional resources
Additional Resources
  • SSA Brochure: Show Someone You Love How Much You Care
  • LIS Application
  • MSP Brochure: Help With Medicare Costs
  • MSP Application
  • Hoosier Rx Application
  • SHIP Low-Income Assistance Packet (includes all of the above)
  • SHIP Eligibility Chart
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