Question: What are the 2011 Federal Poverty Level (FPL) Guidelines
Answer: The 2011 Federal Poverty Level (FPL) Guidelines determine the income level requirements for people applying for the Low Income Subsidy (LIS) program. If your income is below 135% of the FPL ($14,701.5...
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Question: Are there any Medicare Part D prescription drug plans that are free for Medicare beneficiaries over the financial limits for Medicaid and Extra Help?
Answer:
There are no Medicare Part D plans that are totally "free" to low-income Medicare beneficiaries.
However, if a Medicare beneficiary is eligible for both Medicare and Medicaid (du...
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Question: How do I search for a Medicare Part D plan that qualifies for the $0 premium Low-Income Subsidy?
Answer: Our PDP-Finder offers Extra Help information for beneficiaries, advocates and nursing homes who are trying to see which Medicare Part D plans qualify for the $0 monthly premium for Medicare beneficiar...
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Question: I have a relative who is getting SSD along with health coverage. His mother just passed away and he will receive a substantial amount of funds from the sale of her estate. Can this effect his health coverage?
Answer: It is my understanding that there are no financial restrictions on receiving SSD. Since you are writing to our website which is primarily focused on Medicare Part D, I will note that there are "r...
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Question: Is Lifeline (personal response system) a covered benefit under Medicare if there is a medical indication for it?
Answer: No, Medicare does not cover Lifeline as a benefit. However, Medicaid does cover it on a state by state basis. Most states except for MO, AR, and LA will cover it, so you may wish to check with...
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Question: How will people know if their copayment amounts will change?
Answer: People whose copayment amounts will change as of January 1, 2007 received a letter from Medicare in early October letting them know their new copayment amounts. Copayment amounts may either incr...
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Question: How does this affect people who currently automatically qualify for extra help?
Answer: Some people who automatically qualified for extra help in 2006 will no longer automatically qualify in 2007. People who no longer have both Medicare and Medicaid (full-benefit dual-eligibles), belong ...
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Question: What efforts are underway affecting people who qualify for extra help paying for their Medicare prescription drug coverage?
Answer: As part of an annual process, the Centers for Medicare & Medicaid Services and the Social Security Administration are determining if people who qualify for extra help paying for Medicare prescript...
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Question: What if people don't agree with Social Security's decision on "extra help"?
Answer: People have the right to appeal if they disagree with Social Security's decision. The decision letter they get from Social Security will explain their appeal rights....
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Question: What should people do if they think there's been a mistake determining their eligibility for extra help?
Answer: People who will no longer automatically qualify for extra help in 2007 received a letter from Medicare in late September. The letter includes a paper application for extra help from Social Secur...
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Question: Will everyone with extra help get a letter from Medicare or Social Security?
Answer: No. People with no changes who continue to automatically qualify for extra help as of January 1, 2007, won't get a letter.(Source: U.S. Department of Health & Human Services)...
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Question: How does this affect people who applied and qualified for extra help (i.e., those that did not automatically qualify)?
Answer: The Social Security Administration reviewed the eligibility of people who applied and qualified for extra help before May 2006. Social Security mailed these people a letter at the end of August ...
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Question: How will people know if they no longer automatically qualify for extra help?
Answer: People who will no longer automatically qualify for extra help in 2007 received a letter from Medicare in late September. The letter includes a paper application for extra help from Social Secur...
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Question: What should people do if they no longer automatically qualify for extra help in 2007?
Answer: People who no longer automatically qualify for extra help should apply to Social Security or their State Medical Assistance (Medicaid) office as soon as possible to see if they still qualify for extra...
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Question: How often do I need to apply for the extra help?
Answer: Your eligibility will be reviewed every year to see if you still qualify for extra help. If you do qualify, you don’t need to reapply because the review will be sent to you automatically. Howeve...
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Question: How often can I change plans if I have Medicare and full Medicaid coverage?
Answer: If you have Medicare and full Medicaid coverage, you can change plans at any time. The change will be effective at the beginning of the next month. (Source: U.S. Department of Health & Human Servi...
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Question: What if Medicare doesn't cover my prescription at all? Will Medicaid still pay for it?
Answer: Some state Medicaid programs may choose to cover some or all of the few prescriptions not covered by Medicare prescription drug coverage. Contact your State Medical Assistance Office for more informat...
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Question: What information do I need to apply for the extra help?
Answer: You will need your Social Security number and financial information for you and your spouse (if married and living together), including information on deposits in bank accounts, income from pensions, ...
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Question: If I am not certain whether or not I qualify, should I apply for extra help?
Answer: Yes, because there is no risk or cost to apply. And, if you qualify, you will get extra help paying for the annual deductible, premiums, and copayments for Medicare prescription drug coverage.
You ca...
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Question: I work in the Senior Community Service Employment Program (SCSEP, Title V of the Older Americans Act). Will Medicare count this as income when determining if I qualify for extra help paying for Medicare prescription drug coverage?
Answer: Yes. Wages or salary paid under this program are counted as earned income when determining if you qualify for extra help.(Source: U.S. Department of Health & Human Services)...
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