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- About Medicaid
- Application Information
- Local Agency Contacts
- Prescription Drug Plan Options
- Finding Help with Prescriptions Guide
Extra Help Paying for Medicare Prescription Drug Coverage (Part D)
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:
- Single person—Income less than $17,655 ($1,478 monthly) and resources less than $13,440
- Married person living with a spouse and no other dependents—Income less than $23,895 ($1,986 monthly) and resources less than $26,860
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:
- Help paying your Medicare drug plan’s monthly premium, yearly deductible, coinsurance, and copayments
- No coverage gap
- No late enrollment penalty
- You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:
- You have full Medicaid coverage
- You get help from your state Medicaid program paying your Part B premiums (in a Medicare Savings Program)
- You get Supplemental Security Income (SSI) benefits
About the Medicare Savings Program
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):
MONTHLY INCOME ASSETS Qualified Medicare Beneficiary SINGLE $1505 $7,280 COUPLES $2,023 $10,930 Specified Low Income Beneficiary SINGLE $1,703 $7,280 COUPLES $2,290 $10,930 Qualified Individual SINGLE $1,852 $7,280 COUPLES $2,490 $10,930
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:
- Your Area Agency on Aging (AAA) at 1-800-986-3505
- SHIP at 1-800-452-4800
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.
Local Agency Contacts
Prescription Drug Plan Options
There are a variety of prescription drug plans to choose from. These plans include:
- Medicare Prescription Drug Plans
- Hoosier Rx
- Low Cost Drugs
- Finding Help with Prescriptions Guide
- Pharmaceutical Manufacturers Association Free Medications Directory
2016 Standard Part D Benefit
Benefit Parameters 2014
2016 Deductible $310 $320 $360 Initial Coverage Limit $2,850 $2,960 $3,310 Out-of-Pocket Threshold $4,550 $4,700 $4,850 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% LIS Copayments 2014 2015 2016 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 Other LIS $2.55/$6.35 $2.65/$6.60 $2.95/$7.40 Partial LIS Deductible/ Cost-Sharing $63/15% $66/15% $74/15%Medicare Prescription Drug Plans
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.
Hoosier RxIndiana'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:
- be an Indiana resident, 65 years old or older.
- have a yearly income of $17,475 or less for a single person, or $23,505 or less for a married couple living together.
- have applied for the "Medicare Extra Help" through Social Security to pay for your Medicare Part D plan, and received either a "Notice of Award" or "Notice of Denial" from Social Security
- Your Social Security "Notice of Denial" must be because your resources are above the limit established by law
- Your Social Security "Notice of Award" must state that you are receiving partial extra help subsidy to help pay for your Medicare Part D premium
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.
VA Prescription Benefit
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.
Low Cost Drugs
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
Pharmaceutical Manufacturers Association Free Medications Directory
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:
- Do not have insurance that covers outpatient prescription drugs
- Do not qualify for government assistance
- Have income within their stated guidelines
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
"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.