Extra help in paying your Medicare premiums


Cases of the COVID-19 virus are again on the rise, and recently published data indicates that the new Omicron variant is much more transmissible than the Delta variant.

However, being fully vaccinated with a booster shot will provide you with protection against serious illness. According to a recent notice from Medicare, “A booster shot increases the strength of your antibody response, so when the COVID-19 virus mutates, a boost makes it more likely that your antibodies can protect you against variants, like Omicron and Delta.”

Medicare fully covers the cost of your COVID-19 vaccination as well as your booster. If you got a Pfizer or Moderna COVID-19 vaccine, you are eligible to get a booster shot six months after you have completed your second dose.

If you received a Johnson & Johnson single dose vaccine, you can get a booster shot two months after you got your initial single shot. And, do not forget your annual flu shot. You can get your flu shot at the same time you get your COVID-19 booster. As always, Medicare fully covers the cost of your annual flu shot. 

Medicare Advantage Plan Enrollment Period: There is an annual Medicare Advantage Plan Enrollment Period which began on Jan. 1 and runs through March 31. During this time, if you are currently enrolled in a Medicare Advantage Plan you can switch to a different Plan with or without drug coverage or go back to Original Medicare either with or without a drug plan.

Your new coverage will start the first day of the month after your new plan gets your request for coverage. What you cannot do during this enrollment period is drop your Original Medicare coverage and replace it with a Medicare Advantage Plan.

Medicare Part B Premiums to Increase for 2022: As reported last month, starting in January, Social Security benefits will increase by 5.9% for all beneficiaries, disabled veterans and federal retirees. This will be an additional $92 per month for the average retiree.

However, this increase is offset by an average $30 per month increase in the Medicare Part B premium. So, if you have not done so, now is a good time to look into the various Extra Help options to assist you in paying for a variety of health costs covered by Medicare. 

Four types of Medicare Savings Programs: There are four types of Medicare Extra Help programs, more formally known as Medicare Savings Programs (MSPs). These four MSPs can be confusing but a trained HIICAP counselor can help you sort out the differences. Here is a basic definition for each of the programs as well as their income and resource limits. The 2021 income and resource limits are still being used. 

Qualified Medicare Beneficiary (QMB) program: The QMB program is designed for beneficiaries known as dual eligibles, those who are enrolled in both Medicare and Medicaid.  For 2021 the monthly income limit for an individual is $1,094 while it is $1,472 for a married couple. The individual resource limit is $7,970 for an individual and $11,960 for a married couple. This program helps you pay for both Medicare Part A and Part B premiums as well as deductibles.  

Specified Low-Income Medicare Beneficiary (SLMB) program: SLMB is a state program that helps people with limited incomes pay for their Part B premiums. All applicants must have Medicare Part A in order to apply. Individuals with incomes below $1,308 and married couples with monthly incomes below $1,762 are eligible.  The resource limits for SLMB are $7,970 for individuals and $11,960 for married couples.

Qualifying Individual (QI) program: QI is also a state program that helps people pay for their Part B premiums.  However, both the income and resource limits are higher for this program than for the QMB program.  But you must reapply every year for QI with benefits granted on a first-come, first-served basis.  Preference is given to applicants who are currently on the program.  You are not eligible for QI benefits if you are on Medicaid. The income limits are $1,469 for individuals and $1,980 for married couples while the resource limits Are $7,970 and $11,960 respectively.

Qualified Disabled and Working Individuals (QDWI) program.  This program helps people pay for Part A only, not Part B. To qualify for QDWI you must fall into one of the following categories: (1) be a working disabled person under age 65, (2) have lost your premium-free Part A coverage when you returned to work, (3) are getting medical assistance from New York State or (4) you meet the income and resource limits. Those income limits are $4,379 for individuals and $5,892 for married couples.  The resource limits are $4,000 for individuals and $6,000 for married couples.  

If you qualify for QMB, SLMB or QI you automatically qualify for Extra Help in paying for your Medicare Part D drug coverage. All of these are State run programs and are administered by your Local Department of Social Services. However, HIICAP counselors can provide you with all the necessary forms and will assist you in making an application. 

HIICAP Counseling Procedures for 2022. Following a highly successful fall season, the HIICAP program has announced their revised counseling procedures for 2022. These contact hours and procedures will be adjusted as the program responds to changing client demands.

The Oneida County HIICAP Office is continuing to provide counseling services by phone as they have throughout the pandemic.  If you would like to do a HIICAP counseling session over the phone or schedule an appointment at one of the two in-person locations call 315-798-5456 and select No. 2 from the choice list.  In most cases you will be asked to leave your contact information on a voice mail and a staff member will return your call within 72 hours (3 business days).

Copper City Community Connection, 305 E. Locust St., will offer assistance on either Tuesday or Thursday afternoon (the day has not yet been finalized). The HIICAP program will also be scheduling at Copper City.

North Utica Senior Citizens Center, 50 Riverside Drive, Utica has hours of operation from 9 a.m. to 3:15 p.m. on Friday only.  Sessions are expected to run 45 minutes.  Call the HIICAP office to schedule an appointment. 

Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.


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