Extra help may be available to pay for prescription drugs

William C. Lane, Ph.D.
Posted 12/30/18

The Medicare Part D Open Enrollment period is over for 2019. So, we can sit back and enjoy the benefits we have earned over the years and protections afforded us by Medicare. While this is true for …

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Extra help may be available to pay for prescription drugs

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The Medicare Part D Open Enrollment period is over for 2019.

So, we can sit back and enjoy the benefits we have earned over the years and protections afforded us by Medicare.

While this is true for most beneficiaries, both problems and opportunities do arise during the year. Many of these problems and opportunities are covered by special enrollment periods.

For example, if you move to a new address that isn’t in your plan service area you will be allowed to select a new plan so that you will not lose coverage. However, there is one opportunity that is covered by a special enrollment period that many eligible Oneida County residents do not utilize. That is, signing up for one of several programs that assist beneficiaries in paying out-of-pocket costs related to Medicare Parts A, B, and D as well as Medicare Advantage plans.  

The first of these programs is known by the very descriptive term Extra Help. Extra Help (the formal name is the Low-Income Subsidy or LIS) refers to a Medicare program to help people with limited income and resources pay their prescription drug costs. Extra Help programs can reduce or eliminate your out-of-pocket expenses under Medicare Part D and Medicare Advantage plans by covering such things as co-payments, deductibles and even premiums.

Many people who do not consider themselves to fall into a “low income category,” are eligible for help. For 2018, the amounts (which may increase for 2019) are an income for a single individual of less than $18,210 per year with other resources that do not exceed $14,100 per year.

For a married couple these limits are a combined income of less than $24,690 with resources that do not exceed $28,150. Resources comprise checking or savings accounts, stocks, bonds, mutual funds and IRAs. Excluded from the counted resources are your home, car, household items, burial plot and burial expenses of $1,500 per person as well as life insurance. 

You automatically qualify for one of the Extra Help options if (1) you have full Medicaid coverage, (2) you get help from your state Medicaid program in paying for your Part B premium or (3) you receive Supplemental Security Income (SSI) benefits. If you meet one or more of these criteria Medicare will send you a purple letter that you should retain for your records. If you get this letter, you don’t need to fill out any qualifying paperwork to enroll. HIICAP counselors can answer any questions you have about this purple letter. 

In addition to Extra Help, which assists in the payment of your Part D drug costs, there are also Medicare Savings Programs. There are four kinds of Medicare Savings Programs (MSP):

Qualified Medicare Beneficiary (QMB) Program. If you are eligible, the QMB program helps to pay for your Part A and/or Part B premiums. In addition, providers are not allowed to bill you for deductibles, coinsurance and co-payments, except for prescription drugs.

Specified Low-income Medicare Beneficiary (SLMB) Program. SLMB is a program that helps pay for your Part B premiums only.

Qualifying Individual (QI) Program. QI helps pay your Part B premiums only. There are a limited number of allotted openings and you must reapply each year. Assistance is granted on a first-come, first-served basis.

Qualified Disabled and Working Individuals (QSWI) Program. This program helps to pay Part A premiums for those who have a disability and are working.

More information about all of these programs can be found by going to the Medicare.gov website or by reviewing your options in Section 8 of the annual Medicare and You publication.

All the data indicates that all of the programs, and Extra Help in particular, are underutilized. This includes the residents of Oneida County. The question is why? Writing in the current issue of Aging Today, Bakk and Cadet state that “Reluctance to share personal financial information has been cited as a reason for low LIS enrollment.” Many are also confused by the complexity of the programs and the exact benefits that they will receive.

Working on outreach programs to increase LIS enrollment in counties in the Capital District and the North Country, the author has found that many older people are worried that if they sign up for any of these programs, they will lose other benefits. Remember, when calculating your income to determine eligibility for these programs the benefits received through Supplemental Nutrition Assistance Program (SNAP), housing assistance, home energy assistance (HEAP) or Earned Income tax Credit payments are not considered.

Even if any payments for such things as housing existence are reduced slightly, the major savings achieved through assistance under Extra Help and/or MSP will more than compensate for any such reductions in assistance. 

The Oneida County HIICAP program can help you review all your options in terms of Extra Help and MSP programs. If you feel that you may qualify for one of these programs, do not hesitate to apply. A program may save you several hundred of dollars a month. And remember, any information you provide a HIICAP counselor is held in strict confidence. The worst thing that can happen is that you find that you will not meet the eligibility requirements. 

How do I contact a HIICAP counselor to make an appointment? The Oneida County Office for the Aging/Continuing Care/NY Connects HIICAP offices are open year around. Counselors can meet with you at the following locations; 

Ava Dorfman Senior Center, 305 E. Locust St., with hours of operation on Tuesday and Thursday from 10 a.m. to 2 p.m. Consumers are seen on a “first come, first served” basis you may call the Dorfman Center at 315-337-1648 to see how busy they are;

North Utica Senior Citizens Community Center, 50 Riverside Drive, Utica with hours of operation on Monday, Wednesday and Friday from 10 a.m. to 2 p.m. Consumers are counseled on a “first come, first served” basis. However, if you want to call ahead to see how busy the office is you may call the Center’s HIICAP program at 315-724-8680;

HIICAP services are provided by Oneida County Office for Aging and Continuing Care/NY Connects. Anyone with questions about HIICAP, as well as Community Based Long Term Care services and support, should call the program directly at 315-798-5456 and press 4 in the choice list. It will direct you to someone who can assist you.

Dr. William Lane is owner of William Lane Associates, a gerontological consulting firm located in Homer, NY. He does not sell insurance, work for any insurance company or recommend any specific insurance products. 

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