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Help for Medicare recipients

By Jennie L. Phipps · Bankrate.com
Sunday, September 25, 2011
Posted: 9 am ET

Medicare open enrollment comes earlier and ends earlier this year than it has previously. It starts Oct. 15 and runs through Dec. 7. For most people living in retirement, this is the only opportunity to change plans, so even if you are happy with your plan, it can be wise to examine your options and make sure that you're getting the best deal.

Using the programs you're entitled to wisely is key to retirement planning.

A good place to begin is MyMedicareMatters.org, which is managed by the National Council on Aging, or NCOA. While you are there, be sure to click on the "Find Extra Help Paying" link. Even if you don't qualify, you may know someone who does who isn't getting the help he or she deserves.

Howard Bedlin, vice president, public policy and advocacy for NCOA, says that only one-third of the people who are eligible for help paying their Medicare costs actually apply and get assistance. He says these programs aren't well publicized, in part because they are run by the states where money is tight and officials aren't aggressive about getting the word out.

Here are the three extra-help programs for which Medicare recipients may qualify:

  • Qualified Medicare Beneficiary Program, or  QMB -- This program pays Medicare cost sharing and premiums for seniors with incomes below 100 percent of the federal poverty level and who have limited assets. It covers all monthly premiums and all the cost sharing, including co-pays and deductibles. The 2011 poverty levels are: $907.50/month ($10,890/year) for an individual; $1,225.83/month ($14,710/year) for a couple.
  • Specified low-income Medicare beneficiaries, or SLMBs -- Medicare beneficiaries with incomes between 100 percent and 120 percent of the federal poverty level and limited resources get help with paying Medicare premiums. The limit for this group is $1,089/month ($13,068/year) for an individual; $1,471/month ($17,652/year) for a couple.
  • Qualified Individual, or QI - Annually, the federal government gives the states enough money to pay, on a first come, first served basis, the Medicare Part B premium for Medicare beneficiaries with incomes between 120 percent  and 135 percent of the federal poverty level and limited resources.  The limit for this group is $1,225.13/month ($14,701.50/year) for an individual; $1,654.88/month ($19,858.50/year) for a couple.

There are similar programs for Medicare Part D.

If you need help deciding whether you qualify for these programs, you can also check out BenefitsCheckup.org, an excellent resource, which NCOA has developed to help people of all ages find programs that will help them.

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