Extra Help for People with Limited Incomes
The new Medicare prescription drug program offers extra financial help for people with limited incomes and assets. You may qualify for this extra help if your income is below $14,355 a year (or $19,245 if you are married and living with your spouse—and more if you have dependent children or grandchildren living with you), and if your assets are below $11,500 (or $23,000 if you are married). Your assets include things like bank accounts, stocks, bonds, and life insurance policies. They do not include the house you live in, your cars and other personal possessions such as your furniture or jewelry.
If you have very limited income, you will have no coverage gap, will pay no premiums or deductibles, and will have copayments for each prescription of $1 or $2 for generics and $3 or $5 for brandname drugs. If you have slightly higher income, you will have no coverage gap, will pay a reduced monthly premium that will vary depending on your income and where you live, and a reduced deductible of $50 a year. Your copayments will be 15 percent of the cost of each prescription.
You may already be receiving some form of government assistance that makes you automatically eligible for the Extra Help—for example, Medicaid, a Medicare Savings Program that pays your Medicare Part B premium, or Supplemental Security Income (SSI). If so, you will automatically be able to get extra help and need not apply.
If you do not participate in one of these government programs but think you may qualify for the Extra Help based on your limited income and assets, you will need to apply for it with the Social Security Administration. You can apply on your own or, if you prefer, someone else can help you. This includes a family member, friend, caregiver, legal representative, social worker or a counselor who helps people with health insurance issues. The application can be made:
- By Mail—Get an application from the
Social Security Administration. Fill it
out and mail it to the Social Security
Administration. If you are married,
both you and your spouse must apply
separately. Send the application to:
Social Security Administration
Wilkes-Barre Data Operations Center
P.O. Box 1020
Wilkes-Barre, PA 18767-9910
- By Phone—Call the Social Security
Administration at 1-800-772-1213 (TTY:
1-800-325-0778). A Social Security
worker will complete the application
with you over the phone.
- By Internet—You may apply online
through the Social Security
Administration’s website.
No signature is required.
- In Person—You may apply by going to
your local Social Security or Medicaid
office, or to a nonprofit agency such as
your State Health Insurance Assistance
Program (SHIP) where a counselor can
give you free personal help. (To find
addresses and phone numbers, see our Guide on the
New Medicare Prescription Drug Coverage.)
The Social Security Administration will inform you whether or not you qualify for the Extra Help. If you do qualify, you will still need to choose a Medicare prescription drug plan during the open enrollment period—November 15, 2005 to May 15, 2006. If you qualify and don’t choose a plan, you will be automatically enrolled in one.
If the Social Security Administration determines that you are not eligible for Extra Help, you may appeal their decision. You can still enroll in a Medicare drug plan to get the standard level of Medicare prescription drug coverage, even while the decision about Extra Help is being appealed.
