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A mixed bag for those with lower incomes
Medicare has special rules for people on Medicaid and other people with low income. Pay attention.
By Stephen Nohlgren, Times Staff Writer
Published October 30, 2007
People who don't have much money can gain a lot, or lose a lot, under Medicare's drug benefit. It depends on how aggressively they work the system.
Some of the biggest hassles that arose two years ago, when the drug benefits first kicked in, involved people known as "dual eligibles." These are poor or disabled people who qualify for both Medicare and Medicaid.
They were happily getting drug coverage from Medicaid, with minimal cost and headache, until the government switched their drug coverage to Medicare.
Pharmacies and companies struggled to adapt. People ended up paying excess charges. Problems took months to unsnarl, while telephone calls to the insurance companies and to Medicare seemed to fall on deaf ears.
"If this kind of feasance is rampant, Medicare is doomed," wrote Tampa resident Jim Donald, who told the Times he represented a 53-year-old disabled man who had been overcharged $9,572 by his Medicare plan. Donald wrote that it took him nine months to get the overcharges lifted.
Meanwhile, several million low-income people eligible for good, cheap drug coverage never signed up.
If you are on Medicaid or have limited income, you should pay attention to a few important wrinkles to today's Medicare. It could save you hundreds of dollars and hours of aggravation.
People on Medicaid
In bureaucrat-speak, you are a "dual eligible," which means you qualify for both Medicaid and Medicare.
Whether you like it or not, Medicare will handle your drug coverage. But don't count on Medicare doing a good job without your input. You have to take charge.
If you don't enroll in a drug plan or Medicare Advantage plan with drug coverage by Dec. 31, Medicare will assign you to one. It won't necessarily be the same plan you use this year and it won't necessarily cover your drugs.
That's because Medicare randomly assigns "dual eligibles" to plans with the lowest monthly premiums, then pays the premium for you. Plans that made it into this pool for 2007 may not make it for 2008.
And plans in this low-premium pool could cost you hundreds of dollars if they don't cover your prescriptions.
Just like everyone else on Medicare, you should compare the cost of all possible drug and health care plans using Medicare's Web site and your individual list of drugs.
Don't just look at the no-cost-premium plans. A plan that costs you $3 or $4 a month in premiums could save you $100 a month in drug costs.
This is true for both stand-alone drug plans and HMOs.
One other thing to remember: Dual eligible people are not locked into their choices after Jan. 1, as are others on Medicare. If you get stuck with a plan you don't like, you can switch once a month.
Low-income people
When Congress approved Medicare drug coverage in 2003, it included special subsidies for people who aren't poor enough for Medicaid but still have limited means. Medicare literature calls this "extra help."
Despite several years of advertising the "extra help" benefit, however, many people who qualify have yet to sign up. Here's how it works:
You have to meet both an income test and asset test to qualify.
If you are single, your 2007 income must be less than $15,315 and your liquid assets must be less than $11,710.
If you are married and live with your spouse, your combined income must be less than $20,535 and your assets less than $23,410.
Liquid assets are things such as savings, stocks and CDs. Your house and car do not count as liquid assets.
In some cases, eligibility rules may not count all your sources of income and liquid assets. So if you are at all close to these thresholds, it's a good idea to apply for the extra help and see what happens.
If you qualify, Medicare will pay all, or part of your drug plan premiums, deductibles and copayments, including those in the coverage gap.
For more information or an application, call the Social Security Administration at toll-free 1-800-772-1213 or go to www.socialsecurity.gov.
Stephen Nohlgren can be reached at (727) 893-8442 or nohlgren@sptimes.com.
[Last modified October 30, 2007, 06:47:28]
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