Page 9 - Senior Times South Central Michigan - October 2016 - 23-10
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Medicaid – Get Help
Senior Times - October 2016
Page 9
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Medicaid
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services. You may also be eligible for extra help paying for Medicare prescription drug coverage (Part D), even if your income exceeds Medicaid income levels, under the spend down rules if you are medically needy.
Medicaid Spend Down
Even if your income exceeds Medicaid income levels in your state, you may be eligible under Medicaid spend down rules. Under the "spend down" process, some states allow you to become eligible for Medicaid as "medically needy," even if you have too much income to qualify. This pro- cess allows you to "spend down," or subtract, your medical expenses from your income to become eligible for Medicaid.
To be eligible as "medically needy," your measurable resources also have to be under the resource amount allowed in your state.
Dual Eligibility
Some people who are eligible for both Medicare and Medicaid are called “dual eligibles.” If you have Medicare and full Medicaid coverage, most of your health care costs are likely cov- ered. You can get your Medicare cov- erage through Original Medicare or a Medicare Advantage Plan (Part C). If you have Medicare and full Medicaid, you'll get your Part D prescription drugs through Medicare, and you'll automatically qualify for Extra Help paying for your Medicare prescription drug coverage (Part D). Medicaid may still cover some drugs and other care that Medicare doesn’t cover.
PACE
PACE (Program of All-inclusive Care for the Elderly) is a Medicare and Medicaid program that helps people meet their health care needs
in the community instead of going to
a nursing home or other care facility. PACE covers adult day primary care, dentistry, emergency services, home care, hospital care, laboratory/x-ray services, meals, medical specialty ser- vices, nursing home care, nutritional counseling, occupational therapy, physical therapy, prescription drugs, Part D covered drugs, preventive care, social services, caregiver training, sup- port groups, respite care, social work counseling, and transportation if medi- cally necessary.
With PACE, the focus is on you
– you have a team of health care professionals working with you and your family to make sure you get the coordinated care you need. When you enroll in PACE, you may be required to use a PACE-preferred doctor. These doctors are best suited to help you make health care decisions. If you don't have Medicare or Medicaid, you can pay for PACE privately. Note: You can leave a PACE program at any time.
Medicare Savings Programs
Medicare Savings Programs (MSP) help pay your Medicare premiums, your Medicare Part A (hospital insur- ance) and Medicare Part B (medical insurance) deductibles, coinsurance, and copayments, and Medicare pre- scription drug coverage costs.You may qualify for the Qualified Medicare Beneficiary (QMB) Program, Specified Low-Income Medicare
Beneficiary (SLMB) Program, Qualifying Individual (QI) Program, or Qualified Disabled and Working Individuals (QDWI) Program, even if your income and resources are higher than the state limits.
If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.
Save on Drug Costs
You may qualify for extra help from Medicare to pay the costs of Medicare prescription drug coverage if you meet certain income and resource limits.
If you have Medicaid, get help pay- ing your Part B premiums (Medicare Savings Program), or get Supplemental Security Income (SSI) benefits, you automatically qualify for extra help. Contact your Medicaid office for more information.
If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage.
In 2016, costs are no more than $2.95 for each generic or $7.40 for each brand-name covered drug.
Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level.
In 2016, you may qualify if you have up to $17,820 in yearly income ($24,030 for a married couple) and up to $13,640 in resources ($27,250 for a married couple).
If you don't qualify for Extra Help right now, you can reapply for Extra Help at any time if your income and resources change.
Find out the level of extra help you may get to cover costs of medica- tion with Medicare prescription drug coverage (Part D) by providing a purple notice from Medicare saying you qualify for extra help, a yellow
or green automatic enrollment notice from Medicare, an extra help Notice of Award from Social Security, an orange notice from Medicare about your copayment, or your Supplemental Security Income (SSI) award let-
ter. You may also submit proof that you have Medicaid and live in an institution or get home- and commu- nity-based services, a copy of your Medicaid card, or a document from your state showing you have Medicaid.
Other ways to lower your prescrip- tion drug costs:
• Look into generic drugs. Ask your doctor if there are generics that will work as well as your current brand- name drugs.
• Ask your doctor about less expen- sive brand-name drugs.
• Consider using mail-order pharmacies.
• Use the Medicare Plan Finder to compare Medicare drug plans to find a plan with lower costs at www.medicare.gov/find-a-plan/ questions/home.aspx.
• Find out if the company that makes your drug offers help paying for it.
Supplemental Security Income (SSI) The Supplemental Security Income (SSI) program pays benefits to disabled adults and children who have limited income and resources. SSI benefits also are payable to people 65 and older without disabilities that meet the financial limits. Get more informa- tion at https://www.ssa.gov/ssi.
For more details call 1-800-MEDICARE (1-800-633-4227).
Paying Costs
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