MEDICARE PART-D
Low Income Subsidy
ANYONE WHO HAS MEDICARE can get Medicare drug coverage. Do you know someone who is on Medicare and needs assistance in paying for their prescription drugs?
Medicare beneficiaries may be eligible for the federal “Extra Help” Low Income Subsidy (LIS) program if he/she has limited income and resources. The Extra Help program can pay for all or part of the monthly premiums, annual deductibles and provide lower prescription co-payments related to a Medicare prescription drug plan. To qualify for Extra Help, the annual income must be limited to $15,600 ($1,300 monthly) for an individual and $21,000 ($1,733 monthly) for a married couple living together. Additionally, the total resources must be limited to $11,990 for an individual ($23,970 for a married couple living together). The resources do not include a primary HOME or a vehicle. If you believe someone you know may qualify for the Extra Help program, please encourage them to apply on-line at www.socialsecurity.gov , contact the local Area Agency on Aging Office or call our office toll free at 800-868-9090 to seek assistance with completing the on-line application or to request a paper application.
IF YOU DO NOT QUALIFY FOR the “EXTRA HELP” PROGRAM,
YOU MAY BE ELIGIBLE FOR GAPS
The Gap Assistance Pharmacy Program (GAPS) for senior citizens,
age 65 and older, is administered by the South Carolina Department of Health and Human Services (DHHS) to operate in conjunction with the Medicare Part D prescription drug program. Some people who join a Medicare Part D plan will be responsible for
100% of the drug cost between
$2,700.01 and
$6,153.75. The GAPS program is designed to provide assistance with prescription costs during the
100 % coverage gap. If your prescription costs reach the Medicare Part D “coverage gap or doughnut hole" the GAPS program will pay
10% of the cost of covered drugs during the coverage gap. Seniors eligible for GAPS will pay approximately
90% of their prescription costs during the gap. To qualify, the monthly income must be limited to
$1,750 for an individual and
$2,333 monthly for a married couple living together.
More information about GAPS and an application for the program can be found on the web site for the
South Carolina Department of Health and Human Services (DHHS), or call DHHS toll-free at 1-888-549-0820. You can also complete the GAPS application on-line at
www.scaccesshelp.org, and then click on eforms.
THINGS TO REMEMBER
- To enroll in a Medicare Part D plan, you must have your Medicare number, effective date of Medicare Part A coverage, date of birth, zip code and list of medications including the dosages and the drug strengths.
- If your prescription drug coverage is through an employer plan and it is as good as the Medicare drug plan, you don’t need to enroll in a Medicare Part D plan.
- If you missed your Medicare Part B enrollment date, you can enroll in Part B during the general enrollment period which is January 1 through March 31 yearly; the effective date of coverage is July 1.
- Check with your doctors before enrolling in a Medicare Advantage plan to be sure the plan is accepted.
- Know if you can afford the Medicare Advantage plans’ copays and deductibles. Please pay close attention to amounts owed. Under Medicare the deductible for a hospital stay is $1,068 for a period of 60 days (If you are discharged within 5 days and return 10 days later and stayed 15 days, it is within the 60 days period, no more payment is due). Under a Medicare Advantage Plan, a copay may be charged for up to 7 days for each hospital stay. (If you are discharged within 5 days, you could pay $300 per day/$1,500. If you return 10 days later and stayed 5 days, you could be charged $300 per day/$1,500).
- Never give your Medicare numbers to strangers.
- Always review your Medicare Summary Notice for mistakes and/or fraud such as billing for services not received and billing for same service twice. If you have questions about your bill, call your doctor first. If you are not satisfied with the response, call your local Area Agency on Aging or the Lt. Governor’s Office on Aging at 800-868-9095 to report fraud.