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Low-income qualifiers may be unaware or even misinformed.
By STEPHEN NOHLGREN, Times Staff Writer
Published December 16, 2007
[Martha Rial | Times]
More than 15,000 low-income residents of the Tampa Bay area are missing out on a terrific deal from Medicare.
If they ask, they can qualify for subsidies that will pay for their prescription drugs and in some cases put $93.50 a month in their pockets by paying for Medicare's premium.
Savings average $3,335 a year, but frustrated advocates still have a hard time reaching everyone who could benefit.
Many people don't know about the subsidies. Others refuse to sign up because they distrust government. And in some cases, state employees charged with dispensing information have dropped the ball.
At the Florida Department of Children and Families, for example, some Medicaid eligibility workers don't even know about one type of Medicare subsidy.
Worse, a DCF Web site designed to screen low-income people for various programs sometimes determines that people don't qualify for a Medicare subsidy when in fact they do.
"We are butting our heads against a stone wall trying to locate these missing people who are not in the system," says advocate Robert Archer. "If we don't get help from people who should know about the program, in this case state employees, how are we going to get the job done?"
Archer is volunteer coordinator for the Pinellas SHINE program, which helps disabled people and people 65 and older sort through Medicare, Medicaid and other insurance issues. A primary SHINE thrust is identifying people who would qualify for one of Medicare's three low-income subsidies.
Last month, Archer tested DCF's regional call center by posing as a 65-year-old man with income of $12,500 a year. He asked whether any state or federal program would help with his Medicare drug bills.
That income level could qualify someone for a Medicare subsidy worth thousands of dollars.
Archer made 11 calls to DCF. Six times he got a recording telling him to call back later. The other five times, call center workers said no program could help him.
Four of the five workers had not even heard of that particular Medicare subsidy.
After inquiries by the St. Petersburg Times, spokeswoman Sarrah Troncoso said Friday the agency would retrain DCF's roughly 400 call center employees so they can help people with all Medicare subsidies.
DCF technicians may also retool the agency's Web site, she said, so it won't give out misinformation. "If they can do it, they will. This should be easy for us."
Help with drug costs, premiums available
Confusion at DCF stems directly from the patchwork way in which state and federal governments help people with medical bills.
Medicare carries a hefty monthly premium, plus copayments and deductibles.
Three different subsidies help low-income people defray these out-of-pocket expenses. One is Medicaid, a state-run program for the poorest of the poor that also covers some Medicare expenses. The other two pay Medicare's monthly $93.50 premium, Medicare drug bills, or both.
Eligibility and benefits vary according to a person's resources, but to qualify for at least some help, single people must have incomes below $15,315 and liquid assets below $11,710. Married couples must have income below $20,535 and liquid assets below $23,410. Liquid assets include stocks, CD's and savings accounts but do not include a house, car and furniture.
Unfortunately for clarity's sake, DCF determines eligibility for two of the three subsidies while the Social Security Administration determines eligibility for the other.
DCF's Web-based screening tool simply ignores the subsidy that typically runs through Social Security. In fact, it tells those people they aren't eligible for any Medicare help.
Loretta Savard, a 65-year-old St. Petersburg resident, is one of the lucky ones. She has received Medicare disability coverage for 10 years. Her Medicare HMO, run by Humana, alerted her that she could probably qualify for one of the subsidies.
She did, and it paid her monthly Medicare premium. That saved her almost $1,200 a year, when her disability income hovered around $12,000.
"It's a godsend," she says. "That's grocery money or gas money" for her 1995 Chevy van. Without it, "I'd have to give up a few of the prescriptions that are not paid for" under her Medicare plan. "Dental ... forget that, and eyeglasses."
In 2006, the first year of Medicare's Part D drug coverage, the federal government spent $19-million on outreach programs trying to identify people whose economic circumstances probably makes them eligible for a subsidy.
The effort got off to a rocky start, when the Social Security Administration sent out more than 19-million letters to potential candidates but received only 2-million or so applications.
SHINE's Archer, who has made more than 150 public presentations about Medicare drug coverage, says many people told him they received the letter but threw it in the trash because of the return address.
The Social Security Administration had set up a special processing center in Wilkes Barre, Pa. People figured it was just another fraudulent mailer, Archer says, because it didn't come from Washington or Baltimore.
The application also asked people to list their income and assets.
People said they didn't want the government knowing how much money they had in the bank, Archer says. "They just don't trust the government."
But the subsidies are such a good deal, that Medicare's outreach efforts eventually paid off.
Millions receive federal subsidies
Right now, about 10-million Americans receive one of the subsidies out of the roughly 13-million who would qualify, says Medicare spokesman Jeff Nelligan. That's a much higher participation rate than for other federal subsidies, such as food stamps, Head Start and housing assistance.
"We are performing better than programs that have been around for decades," he says.
Based on census data, Medicare estimates that 15,369 Tampa Bay area residents should qualify, but for whatever reason they haven't tried.
That breaks down to 6,343 for Pinellas County, 4,490 for Hillsborough, 3,217 for Pasco and 1,319 for Hernando.
The Hillsborough SHINE program gets about 300 calls a month, almost all about Medicare, says area volunteer coordinator Jim Mulchy. About 30 of those turn out to be people who qualify for one of the Medicare subsidies.
SHINE helps them sign up, but every month, new low-income people go onto Medicare, not knowing about the subsidies, Mulchy says.
"They are homebound, they don't read the newspaper, they don't watch TV, they're in nursing homes or in assisted living. We just can't get through to them for some reason."
Steve Nohlgren can be reached at email@example.com or (727) 893-8442.
Q&A | MEDICARE'S LOW-INCOME DRUG SUBSIDIES
What are the benefits?
Subsidies can pay all or part of your Medicare premium (now $93.50 a month), plus all or part of your drug plan premiums, deductibles and copayments, including coverage in Medicare's so-called donut hole. Benefits vary with income level.
People with incomes less than $15,315 a year ($20,535 for a couple) and liquid assets below $11,710 ($23,410 for a couple). Some earned income from a job may not count. Liquid assets do not include your house, car and furniture and a few other exceptions.
You must enroll in either a Part D drug plan, Medicare HMO or some other Medicare drug plan to qualify.
The subsidies even benefit people who take no drugs because, by signing up for a free drug plan now, they avoid penalties in the future if they do need a drug plan.
How do I apply?
If you receive Medicaid, you automatically receive a Medicare drug subsidy.
People with resources a little too high for Medicaid can enroll in a state Medicare Savings Program, which pays their $93.50 a month Medicare premium, plus drug coverage. Apply by calling the Florida Department of Children and Families toll-free at 1-866-762-2237 or at www.dcf.state.fl.us/ess.
Other people, with higher incomes and assets, receive help with drug payments but not with Medicare's monthly premium. Apply to the Social Security Administration by calling 1-800-772-1213 or by filling out a form on www.socialsecurity.gov.
The nonprofit National Council on Aging runs a Web site that evaluates whether you qualify for low-income Medicare subsidies, as well as other programs, such as food stamps and energy assistance. Go to www.accesstobenefits.org and click on "Go To BenefitsCheckUp."
Florida's SHINE program has volunteers who help people age 65 and older and disabled people with insurance problems. They can help you select a Medicare drug plan and figure out if you should qualify for a low-income drug subsidy. Call the elder help-line at 1-800-963-5337 and ask for the SHINE program. A volunteer will call you back within a few days.
Florida's SHINE program needs volunteers to help people age 65 and older and disabled people with health insurance questions. Volunteers should have some computer skills, but will be trained on the workings of Medicare, Medicaid and other programs.
In Pinellas or Pasco counties, call Susan Samson at 727-570-9696 Ext. 234, or write to firstname.lastname@example.org. In Hillsborough County, call Diane Hollrah at 813-740-3888, ext. 5593, or write to email@example.com.
[Last modified December 16, 2007, 02:09:07]