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 A letter arrives in the mail with this opening line: “We are writing
to let you know how you can get help paying your Medicare costs.”
Your fraud detector probably goes on high alert - the mailboxes of
retirees routinely are stuffed with bogus come-ons.
But this letter is no scam. More than 2 million seniors are
receiving letters this month from the Social Security Administration
(SSA) telling them that they could be eligible for Extra Help, a
program that often covers up to 75 percent of prescription drug
costs. Others may be eligible for a partial subsidy on drugs, or for
a Medicare Savings Program in their states, which help pay Medicare
Part B costs.
The letters are sent annually to seniors who do not already obtain
the assistance through Medicaid or the Supplemental Security Income
benefit program. A new twist this year: the SSA is sharing with
community-based groups information on the number of letters the
agency mailed to each ZIP code to help bolster the level of
outreach.
“Seniors do get a lot of mail, so they need to be careful,” said
Melissa Simpson, senior program manager at the National Council on
Aging (NCOA), which operates a network of benefit enrollment centers
around the country. “And this year, the data from Social Security
will help us reach out to seniors who should be enrolled.”
About 30 percent (11 million) of all Medicare Part D enrollees are
in the Extra Help program, according to the Kaiser Family
Foundation. But another 1.2 million low-income Medicare
beneficiaries were enrolled in higher-cost Part D prescription drug
plans last year, paying an average premium of $18.90 per month.
DONUT HOLE
Extra Help enrollees are responsible only for a small co-pay for
drugs that are covered under their plans - the cost is $2.95 for
generic drugs and $7.40 for brand-name medications. Extra Help also
covers costs if you enter the “donut hole” - the coverage gap that
requires most beneficiaries to pay out of pocket after reaching a
cap. In 2016, the gap starts when a beneficiary and her insurance
company have spent a combined $3,310, and coverage resumes when
total spending reaches $4,850.
If you receive the letter, that does not mean you automatically
qualify. Two factors determine your eligibility for Extra Help:
income and assets.
The full benefit relief is available to enrollees with annual income
less than $16,278 (single) or $21,867 (married couple). The income
ceilings are somewhat higher if you have dependents living with you
or if you live in Alaska or Hawaii. Key income sources that are
counted for this purpose include wages, Social Security benefits,
pensions, annuities, alimony, rental income and workers'
compensation.
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The asset limit is $8,780 (single) or $13,930 (married couple). The asset
definition includes funds in checking or savings accounts, stocks, bonds, mutual
funds and Individual Retirement Accounts. Your home, car, life insurance
policies and other miscellaneous items are not counted.
Partial help is available to enrollees with somewhat higher income and assets
(http://bit.ly/20w3IP8).
MEANINGFUL RELIEF
Determine your eligibility by calling the SSA’s toll-free line (800-772-1213) or
apply online (http://1.usa.gov/24640gv). Another key resource for assistance is
your local State Health Insurance Assistance Program (SHIP) - these are
federally funded nonprofits that provide free one-on-one Medicare counseling and
assistance (Find your local SHIP here: http://bit.ly/1OU0sfN).
If you are eligible, you can enroll immediately in a Part D plan that
participates in the Extra Help program through a Special Enrollment period,
rather than wait until the annual fall Medicare plan enrollment window.
For seniors struggling to get by on very limited fixed incomes, programs like
this can provide very meaningful relief - and it is frustrating that the
assistance is not getting to everyone who qualifies. But Extra Help is just the
tip of the iceberg. A recent analysis from NCOA and the National Association of
Area Agencies on Aging found that more than 4 million low-income seniors could
increase their annual budget by up to 29 percent by taking advantage of benefit
programs that help with everything from healthcare to food, utility payments and
property tax relief.
(Editing by Matthew Lewis)
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