Assistance with Medicare and Drug Costs

Need Help with Medicare Costs?

There may be help for you! Our knowledgeable staff can work with you to see if you may be eligible to reduce your Medicare costs and are also able to assist you as you apply for these benefits.

Any of these programs can give you savings, take away any of the Medicare penalties, allow you to review and/or change your drug plan at any time of the year, and are not subject to estate recovery.

Contact us for more information or for assistance to apply!

 

Extra Help from Social Security

Extra Help, also known as LIS, provides assistance with the costs of prescriptions and Medicare drug plan premiums.

Extra Help can help with the costs of medication and prescription drug insurance. It is a tiered program that pays all or part of Medicare Drug Plan premiums, deductibles, and copays. Some people who qualify for the most assistance pay may have no drug plan premium and no annual deductible. Copays for covered prescriptions may be as low as $3.35 for generics and $8.35 for name-brand medications.

Extra Help is a program from Social Security for Medicare beneficiaries who meet income and resource guidelines. It is a tiered program, with the amount of benefits based upon both resources and income. Gross income is counted. (Gross income means the amount you receive prior to taxes or other deductions.)

Income includes: Social Security, pensions, interest from investments, employment, alimony, veterans benefits, rental income, etc.

Income doesn't include: stipends from Title V programs such as Senior Companions or Foster Grandparents

Resources include: checking and savings accounts, CDs, IRAs, investments, additional property or rental properties, etc

Resources don't include: your home (provided you are living in it), the property on which your home is located, one vehicle, life insurance cash value, and prepaid burial accounts.

Income and resource limits are tied to the Federal Poverty level and are adjusted annually.

2018 Income and Resource Limits are:

                       Income                          Resources

Single:          $1,538/month                    $14,100

Couple:         $2,078/month                    $28,150

 

Medicare Savings Programs - SLMB and QMB

Medicare also has two additional programs that can help with the Medicare Part B premium and the other costs that occur when you use Medicare to visit your doctor or have other medical care. If you qualify for these programs, you are automatically eligible for Extra Help's assistance with drug costs.

The Medicare Savings Programs, like Extra Help, have income and resource guidelines. They are national programs, but are administered differently in each state. In Iowa, the program is run through the Department of Human Services (DHS) and are considered  "limited Medicaid" programs. Neither SLMB or QMB are currently subject to estate recovery, which makes them different from other Medicaid programs. Contact us to apply for these programs.

Income  and resources are counted similarly to Extra Help. However, DHS does count the value of life insurance and any prepaid burial contacts that are not irrevocable. 

 

SLMB - A Medicare Savings Program

Medicare beneficiaries who qualify for SLMB will get help paying their Medicare Part B premiums. This limited Medicaid program has Iowa's Department of Human Services paying this premium to Social Security. In addition to having this premium paid, those who qualify for SLMB also qualify for the lower costs for Medicare Part D drug plan premiums, deductibles and drug copays.

                            Income                       Resources

Single:                $1,386/month               $7,560

Couple:               $1,872/month               $11,340

Many who are eligible for Medicare Part B choose to decline this coverage due to the cost, not knowing SLMB is available. SLMB, a limited Medicaid program, pays the full premium. Part B services include doctor visits, emergency room, preventative health benefits, and so much more that beneficiaries should have in place.

QMB - A Medicare Savings Program

Medicare beneficiaries who qualify for QMB will get help paying their Medicare Part B premiums, their Medicare deductibles and copays. This limited Medicaid program has Iowa's Department of Human Services paying this premium to Social Security and when Medicare pays first, QMB covers the remaining Medicare approved amounts for hospitals, doctors, and other Medicare approved costs.  In addition to having these savings, those who qualify for QMB also qualify for the lower costs for Medicare Part D drug plan premiums, deductibles and drug copays.

                           Income                        Resources

Single:               $1,032/month               $7,560

Couple:              $1,392/month               $11,340

A person who qualifies for QMB doesn't need to worry about deductibles and copays when Medicare pays first. They also do not need to have a supplement in place either. QMB will pay just like a supplement - paying the remainder of Medicare approved amounts when Medicare pays first!