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Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help, also called the low-income subsidy (LIS) if your yearly income and resources are below the following limits in 2016:
These amounts may change in 2017. You may qualify even if you have a higher income (like if you still work, live in Alaska or Hawaii, or have dependants living with you). Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs). Resources don’t include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person), or life insurance policies. If you qualify for Extra Help and join a Medicare drug plan, you will get the following:
Indiana helps eligible, low-income beneficiaries pay for Medicare with the Medicaid program.
Medicaid is a health care program that helps pay for medical services for people who meet specific requirements.
You may be eligible depending on your income and the value of things you own (2016):
|Qualified Medicare Beneficiary||SINGLE||$1505||$7,280|
|Specified Low Income Beneficiary||SINGLE||$1,703||$7,280|
Assets are things you own, such as checking and savings accounts, certificates of deposit, cash value of life insurance, stocks and bonds. Some things you own don't count toward your asset limit, such as your home and furnishings, your car, burial plots, and, at least $1,500 in life insurance.
These limits are guidelines. The only way to know for sure if you are eligible is to apply.
You may visit or call your local Office of Family and Children to apply for Medicare Buy-In. You will need to complete an application form and participate in an interview. The interview can take place in person or over the telephone. Within 45 days, you will receive a notice in the mail that tells you whether your application was approved.
For more information about enrollment centers or Medicaid call:
If your application is denied, you have the right to appeal within 30 days of the denial. You may contact your local Area Agency on Aging or Senior Law Project for assistance with appeals.
There are a variety of prescription drug plans to choose from. These plans include:
|Initial Coverage Limit||$2,850||$2,960||$3,310|
|Total Covered Drug Spend at Out-of-Pocket Threshold||$6,455||$6,680||$7,515.22|
|Minimum Cost-Sharing in Catastrophic Coverage||$2.55/$6.35 or 5%||$.2.60/$6.60 or 5%||$2.95/$7.40 or 5%|
|Institutionalized (with full Medicaid benefits)||$0||$0||$0|
|Up to or at 100% FPL||$1.20/$3.60||$1.20/$3.60||$1.20/$3.60|
|Partial LIS Deductible/ Cost-Sharing||$63/15%||$66/15%||$74/15%|
People with Medicare can enroll in a Medicare prescription drug plan and receive extra help paying for the premiums, deductibles, gaps in coverage and co-pays. The 2015 resource limits are $8,780 ($13,930 if married) for the full low-income subsidy.
Indiana's State Pharmaceutical Assistance Program, HoosierRx, can help pay the monthly Part D premium, up to $70 per month, for members enrolled in a Medicare Part D Plan working with HoosierRx.
To be eligible for HoosierRx (2015), you must:
If you think you meet the eligibility requirements, please call a HoosierRx representative at 1-866-267-4679 or visit the HoosierRx website at http://www.in.gov/fssa/ompp/2669.htm.
If you are an honorably discharged veteran, consider using your VA drug benefit ($8 per prescription per month). Veteran can use the VA drug benefit by mail order for their monthly maintenance drugs and still use Medicare Part D for other prescriptions. To apply, call 1-877-222-8387.
Several national pharmacies have announced they are drastically reducing the cost of generic prescription drugs. Meijer boasts no cost for generic antibiotics. Target, Wal-Mart and Sam's Club charge $4 for generic drugs, but the list includes more than antibiotics.
For a complete listing of what each pharmacy offers, log onto their respective Web sites
Many pharmaceutical companies have programs which provide free or low cost medications to those in need regardless of age.
Most of these programs require that you:
The application process is different for each company. Usually a doctor must sign your completed application form and have his/her office submit it for you. Rx for Indiana can provide assistance with matching your prescriptions with these assistance programs. Contact Rx for Indiana at 1-877-483-9275.
Trained SHIP counselors at sites throughout Indiana can also guide you in getting and completing applications from drug companies.
"Finding Help with Prescriptions" Guide is a free publication. It provides helpful information for lowering your prescription costs including low-income assistance, patient assistance programs, mail order prescription services, veterans pharmacy benefits, and Community Health Centers.
To request a copy, call SHIP free of charge 1-800-452-4800.