Low-Income Subsidies for Medicare Beneficiaries - Western Asset Protection
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Low-Income Subsidies for Medicare Beneficiaries

Do your clients need a little extra help? Medicare provides low-income subsidies, also called Extra Help, to qualifying individuals. This is important information for insurance agents as well as beneficiaries. Keep your clients satisfied by ensuring that they receive all the help they’re entitled to and tap into the low-income audience if you haven’t already. Here’s what you need to know.

Extra Help

Extra Help refers to low-income subsidies that help Medicare beneficiaries with prescription drug costs.

Medicare beneficiaries can qualify for Extra Help in several ways:

  • Their income and countable resources are below the limit. Countable resources include money in a checking or savings account, stocks and bonds. See the chart for the 2018 limits.
  • They have full Medicaid coverage.
  • They get help from their state’s Medicare Savings Program. There’s more information on this below.
  • They get Supplemental Security Income benefits.

Extra Help can be a full low-income subsidy or a partial low-income subsidy, depending on the beneficiary’s situation. Individuals who qualify for the full subsidy will pay no monthly premium and no annual deductible. In 2018, their copay will not be more than $3.35 for generic prescriptions and $8.35 for brand name prescriptions. Additionally, the catastrophic copay is $0.

Medicare beneficiaries can apply for Extra Help here. Changes in income can impact eligibility. If your client’s situation changes at any time, they may be eligible to apply and should do so as soon as possible.

Once they qualify for Extra Help, beneficiaries should make sure their plan is charging them the correct amount. To do this, they may need to contact their plan provider and supply a notice of their eligibility for the Extra Help program. For more information on which documents to use, look here.

Other Programs

While Extra Help makes it easier for individuals to afford prescription drugs, other Medicare Savings Programs can help with the costs of Medicare Part A and Medicare Part B.

Medicare Savings Programs are done through the states. To apply for help, Medicare beneficiaries should contact their state Medicaid program. As with Extra Help, eligibility is determined based on income and assets, but the details vary from state to state.

In Arizona, the Arizona Health Care Cost Containment System manages the state’s Medicaid programs, including Arizona’s Medicare Savings Program.

Reaching the Low-Income Audience

Many people who are eligible for help paying for Medicare don’t realize it. Make sure your clients know about these programs and encourage them to apply.