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Tag: Extra Help

  • Six tips for keeping your drug costs down if you have Medicare

    Six tips for keeping your drug costs down if you have Medicare

    Many people with Medicare find that they are paying a hefty amount for their drugs, even with prescription drug coverage. Drug companies have considerable power to set high prices for many drugs; insurers have little power to rein them in. Instead, insurers shift costs onto members who need high-cost drugs. That helps explain why government drug price negotiation remains a top policy issue in polls of likely voters. For now, there are ways to keep your drug costs down.

    Whether you are enrolled in a Medicare Part D prescription drug plan or a Medicare HMO or other private Medicare plan, copays or coinsurance for some drugs can be extremely high. Here are some options to save you money.

    1. Review the drugs you are taking with your doctor:  Your primary care doctor might be able to shorten the list of drugs you’re taking and, in the process, save you money. If you’re taking high-cost brand-name drugs, your primary care doctor might also be able to prescribe you lower-cost generic drugs. Generics must have the same active ingredients, same strength and purity and same effect.
    2. Ask your Part D drug plan or private Medicare plan about reducing your copay: If your drug is in the highest tier—requiring a very high copay–the plan might reduce the copay if your doctor can demonstrate that you have no other drug alternative for your condition that safely meets your needs.
    3. Extra Help: If you qualify for Extra Help, a program administered by Medicaid, it will pay for some or all of the cost of your drug coverage. The amount of help with cost-sharing depends on the level of your income and assets. In 2023, you may qualify if you have up to $20,385 in yearly income ($27,465 for a married couple) and up to $16,660 in assets  ($33,240 for a married couple). With Extra Help your drug costs are no more than $4.15 for each generic/$10.35 for each brand-name covered drug. You pay nothing after your total drug costs exceed $7,400. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program. You can apply for Extra Help online here.
    4. Find out if you qualify for a State Pharmaceutical Assistance Program: In some states, state pharmaceutical assistance programs provide help with the cost of drugs. Visit Medicare.gov or contact your State Health Insurance Program to find out about drug benefits your state provides. You can also call 1-800-677-1116 or visit www.eldercare.gov.
    5. Drug company assistance programs: Some drug companies offer eligible individuals reduced prices for their drugs. Contact the Partnership for Prescription Assistance or NeedyMeds to find out if you qualify for help with your drug costs.
    6. Online pharmacies: You can often find significantly lower-priced drugs through online pharmacies. And, increasingly, people are using international online pharmacies to keep their costs down. Kaiser Health News reports that 19 million people in the U.S.–eight percent of Americans–now buy their drugs outside the US to afford them. But, you must be careful you are using a legitimate pharmacy and not an outfit selling counterfeit or expired drugs. Also, it is technically illegal to import drugs from abroad, although it appears that no one has been prosecuted for doing so for personal use. Here’s what to consider.

    Keep in mind: If you are a Vet, you likely can get low-cost drugs through the Veterans’ Administration.

    N.B. This post was originally published on November 18, 2019 and has been updated.

    Here’s more from Just Care:

  • 2022: Programs that lower your health care costs if you have Medicare

    2022: Programs that lower your health care costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs, leaving people with average annual out-of-pocket costs of more than $6,100. So, even with Medicare, many people struggle to afford premiums, deductibles and other costs. Some people qualify for Medicaid, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs. Click here or contact your local State Health Insurance Assistance Program (SHIP) to find out if you are eligible for any of these programs and how to apply.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2021, but vary somewhat by state. You should apply through your local Medicaid office.

    • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20. If you have QMB, you should not have out-of-pocket costs for Medicare-approved services in traditional Medicare or for in-network services in a Medicare Advantage plan.
      • Income limit monthly depends upon where you live but is around
        • $1,153 for individuals
        • $1,546 for couples
      • Asset limit
        • Individuals: $8,400
        • Couples: $12,600
    • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20. SLMB helps pay your Medicare Part B premium.
      • Income limit monthly depends upon where you live but is around
        • $1,379 for individuals
        • $1,851 for couples
      • Asset limit
        • Individuals: $8,400
        • Couples: $12,600
    • Qualifying Individual (QI)—135 percent of FPL +$20, helps pay your Medicare Part B premium.
      • Income limit monthly depends upon where you live but is around
        • $1,549 for individuals
        • $2,080 for couples
      • Asset limit
        • Individuals: $8,400
        • Couples: $12,600

    Several valuable items are not counted as income and assets. No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

    Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, less than a half the people over 65 who qualify for the Qualified Medicare Beneficiary program (48%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (28%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    2. Extra Help with Medicare Part D prescription drug coverage: You will automatically qualify for the Extra Help program, which is administered by Medicaid, if you qualify for any of the above low-income programs. You can also apply for Extra Help independently. Extra Help pays for some or all of the cost of your Part D drug coverage and is estimated to be worth around $5,100 a year. The amount of help with cost-sharing depends on the level of your income and assets. In 2022, you may qualify if you have up to $20,385 in annual income ($27,465 for a married couple) and up to $15,510 in assets  ($30,950 for a married couple). With Extra Help your drug costs are no more than $3.95 for each generic/$9.85 for each brand-name covered drug. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program or receive Supplemental Security Income benefits. You can apply for Extra Help online here. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)

    3. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.

    4. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

    5. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • 2021: Programs that lower your health care costs if you have Medicare

    2021: Programs that lower your health care costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs. So, even with Medicare, many people struggle to afford premiums, deductibles and other out-of-pockets health care costs. Some people qualify for Medicaid, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs. Contact your local State Health Insurance Assistance Program (SHIP) to find out if you are eligible and what you will need to apply for one of these programs.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2021, but vary somewhat by state. You should apply through your local Medicaid office.
      • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20. If you have QMB, you should not have out-of-pocket costs for Medicare-approved services in traditional Medicare or for in-network services in a Medicare Advantage plan.
        • Income limit monthly depends upon where you live but is around
          • $1,094 for individuals
          • $1,472 for couples
        • Asset limit
          • Individuals: $7,970
          • Couples: $11,960
      • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20
        • Income limit monthly depends upon where you live but is around
          • $1,308 for individuals
          • $1,762 for couples
        • Asset limit
          • Individuals: $7,970
          • Couples: $11,960
      • Qualifying Individual (QI)—135 percent of FPL +$20, covers your Medicare Part B premiums
        • Income limit monthly depends upon where you live but is around
          • $1,469 for individuals
          • $1,980 for couples
        • Asset limit
          • Individuals: $7,970
          • Couples: $11,960

      What counts as income and assets? No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

    Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, less than a half the people over 65 who qualify for the Qualified Medicare Beneficiary program (48%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (28%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    1. Extra Help with Medicare Part D prescription drug coverage: You may qualify for Extra Help, a program administered by Medicaid, which pays for some or all of the cost of your Part D drug coverage. The amount of help with cost-sharing depends on the level of your income and assets. In 2021, you may qualify if you have up to $1,630 in monthly income ($2,198 for a married couple) and up to $14,790 in assets  ($29,520 for a married couple). If your income and assets are lower– income up to $1,469 and assets up to $9,470 for an individual) you may qualify for full Extra Help. With Extra Help your drug costs are no more than $3.70 for each generic/$9.20 for each brand-name covered drug. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program or receive Supplemental Security Income benefits. You can apply for Extra Help online here. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)
    2. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.
    3. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.
    4. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • Medicare Part D drug coverage in 2021

    Medicare Part D drug coverage in 2021

    Whether you are enrolled in traditional Medicare or a Medicare Advantage plan, you can get prescription drug coverage that will cover your costs at the pharmacy through a Medicare Part D drug plan. Medicare Part D doesn’t cover your full costs, but it provides important partial coverage. About 75 percent of people with Medicare–46 million–are enrolled in Part D.

    Commercial insurance companies contract with the federal government to provide Part D drug coverage to people with Medicare. In Medicare Advantage plans, the Medicare private option through which private health insurers contract with the federal government to deliver Medicare benefits, Part D coverage is usually administered by the insurer offering the Medicare Advantage plan.

    Here’s how Medicare Part D coverage works in 2021 and what to consider before choosing a Part D drug plan, along with how to enroll in Part D and Part D premiums. In choosing among Medicare Advantage plans, in addition to considering your deductibles and copays for medical and hospital services, you should factor in your prescription drug costs. Your costs could differ considerably in different Medicare Advantage plans.

    • Part D drug plans usually have a deductible, which can require you to pay up to several hundred dollars out of pocket before your coverage kicks in. In 2021, the defined standard benefit deductible is $445. Enhanced drug plans generally have low or no deductibles and cover a wider array of drugs, but they charge higher monthly premiums.
    • After you pay your deductible, your drug plan covers 75 percent of your drug costs. During this “initial coverage period,” you pay 25 percent coinsurance until your total drug costs reach $4,130.
    • If your drug costs are higher than $4,130, you will spend 25 percent of the drug plan’s cost for covered brand-name drugs and 37 percent of the drug plan’s cost for covered generic drugs until your total out-of-pocket costs reach $6,550 ($10,048 in total drug spending.)
    • If your income is low, you may be eligible for the “Extra Help” program, which helps cover your coinsurance costs.
    • No matter which Part D plan you choose, after you have paid $6,550 of your own money for covered drugs, Medicare will pick up 95% of the cost of your drugs. You will pay the greater of 5 percent of the cost or $3.70 for generic drugs and $9.20 for brand-name drugs.

    Keep your costs down: Unfortunately, if you take a lot of high-cost drugs, unless your income is low and you qualify for Extra Help or another low-income program, there is no limit on your out-of-pocket drug costs. No matter what your drugs cost, you can save a lot of money if you do your homework when picking a Part D plan. Each drug plan has different premiums, deductibles and copays and covers different drugs under different conditions.

    • Does the Part D plan cover the drugs you take? You want to make sure the drugs you take are on the Part D drug plan’s formulary and about any restrictions on coverage. If you choose a plan that does not cover some of your drugs, you should ask your doctor if you could take the drug on the formulary instead. Or, you should figure out which plan covers the most of your drug costs.
    • Where can you get your drugs? Find out whether you can continue to use the pharmacy you currently use to get your drugs as well as whether you can get drugs by mail order and when you travel.
    • What will your costs be? Ask what your out-of-pocket costs will be for the monthly premium, the deductible, copays for your drugs at in-network pharmacies and the copays at out-of-network pharmacies. If your income is below 150 percent of the federal poverty level ($19,140 for individuals/$25,860 for married couples in 2020) and you have modest assets (less than $14,610 for individuals/$29,160 for couples in 2020), you qualify for help paying your Part D costs under the Extra Help (Low-Income Subsidy (LIS) program.)
    • Is the drug plan in your service area? If you are enrolled in traditional Medicare, you must choose a drug plan in your service area, so you should understand what that area is.

    You should also check to see whether you are eligible for a state pharmaceutical plan.

    Enrollment: If you have traditional Medicare, you can call Medicare at 1-800-633-4227 to sign up for Part D at the same time you sign up for traditional Medicare, so that you have full coverage. Most Medicare Advantage plans fold Medicare Part D coverage into their benefit package. Again, if your income is low, you may be eligible for help paying the cost of this coverage. And, if you’d like, you can ask to have your Part D premium deducted from your Social Security check.

    Click here for Medicare’s plan finder tool that can help you choose a drug plan. It will tell you which drugs a particular plan covers at any given time.

    Keep in mind that each Fall you will need to study your options if you want to keep your costs down, since most drug plans, as well as Medicare Advantage plans that offer drug coverage, change their premium, deductibles, copays and the drugs they cover from one year to the next. The average drug plan monthly premium is around $33, but the premium can be a lot higher. Premiums, copays and coinsurance vary tremendously depending upon the plan you choose.

    If you use insulin, look into plans that offer low-cost insulin under a new Trump administration initiative.

    Medicare charges you a higher premium if your income is above $88,000. That additional premium for your Part D drug coverage will be as low as $12.30 if your income in 2019 was above $88,000 and no more than $111,000, and as high as $77.10 a month if your annual income in 2019 was above $500,000.

    NB: Because out-of-pocket costs for drugs can be very high, Kaiser Health News reports that millions of people who use a lot of costly drugs buy them from abroad at far lower cost.

    Here’s more from Just Care:

  • Medicare Part D drug coverage in 2020

    Medicare Part D drug coverage in 2020

    Whether you are enrolled in traditional Medicare or a Medicare Advantage plan, you can get prescription drug coverage through a Medicare Part D drug plan. It doesn’t cover your full costs, but it provides important partial coverage. About 75 percent of people with Medicare–46 million–are enrolled in Part D.

    Part D drug companies are commercial insurance companies that contract with the federal government to provide drug coverage to people with Medicare. In Medicare Advantage plans, Part D coverage tends to be administered by the insurer offering the Medicare Advantage plan.

    Here’s how Medicare Part D coverage works in 2020 and what to consider before choosing a Part D drug plan, along with how to enroll and premiums. If you are choosing among Medicare Advantage plans, you should factor in your prescription drug costs with different Medicare Advantage plans, as well as your costs for medical and hospital coverage.

    • Many Part D drug plans usually have a deductible, which can require you to pay up to several hundred dollars out of pocket before your coverage kicks in. In 2020, the defined standard benefit deductible is $435. Enhanced drug plans generally have low or no deductibles, cover a wider array of drugs, and provide more coverage in the coverage gap, but they charge higher monthly premiums.
    • After you pay your deductible, your drug plan covers 75 percent of your drug costs. During this “initial coverage period,” you pay 25 percent coinsurance until your total drug costs reach $4,020.
    • If your drug costs are higher than $4,020, you will spend 25 percent of the drug plan’s cost for covered brand-name drugs and 37 percent of the drug plan’s cost for covered generic drugs until your total out-of-pocket costs reach $6,350.
    • If your income is low, you may be eligible for the “Extra Help” program, which helps cover your coinsurance costs.
    • No matter which Part D plan you choose, after you have paid $6,350 of your own money for covered drugs, Medicare will pick up 95% of the cost of your drugs. You will pay the greater of 5 percent of the cost or $3.60 for generic drugs and $8.95 for brand-name drugs.

    Keep your costs down: Unfortunately, if you take a lot of high-cost drugs, unless your income is low and you qualify for Extra Help or another low-income program, there is no limit on your out-of-pocket drug costs. And, no matter what your drug costs, you can save a lot of money if you do your homework when picking a Part D plan. Each drug plan has different premiums, deductibles and copays and covers different drugs under different conditions.

    • Does the Part D plan cover the drugs you take? You want to make sure the drugs you take are on the Part D drug plan’s formulary and whether there are any restrictions on coverage. If you choose a plan that does not cover some of your drugs, you should ask your doctor if you could take the drug on the formulary instead.
    • Where can you get your drugs? Find out whether you can continue to use the pharmacy you use to get your drugs as well as whether you can get drugs by mail order and when you travel.
    • What will your costs be? Ask what your out-of-pocket costs will be for the monthly premium, the deductible, the copays for the drugs you take at in-network pharmacies and the copays at out-of-network pharmacies.
    • Is the drug plan in your service area? If you are enrolled in traditional Medicare, you must choose a drug plan in your service area, so you should understand what that area is.

    You should also check to see whether you are eligible for a state pharmaceutical plan or for Extra Help with your prescription drug costs.

    Enrollment: If you have traditional Medicare, you can call Medicare at 1-800-633-4227 to sign up for Part D at the same time you sign up for traditional Medicare, so that you have full coverage. Most Medicare Advantage plans fold Medicare Part D coverage into their benefit package. If your income is low, you may be eligible for help paying the cost of this coverage.

    Click here for Medicare’s plan finder tool that can help you choose a drug plan. It will tell you which drugs a particular plan covers at any given time.

    Keep in mind that each Fall you will need to study your options if you want to keep your costs down, since most drug plans, as well as Medicare Advantage plans that offer drug coverage, change their premium, deductibles, copays and benefits from one year to the next. The average drug plan monthly premium is $30, but the premium can be a lot higher. Premiums, copays and coinsurance vary tremendously depending upon the plan you choose.

    Medicare charges you a higher premium if your income is above $87,000 and that additional premium could be $70 a month if your annual income is above $163,000.

    NB: Because out-of-pocket costs for drugs can be very high, Kaiser Health News reports that millions of people who use a lot of costly drugs bought them from abroad at far lower cost.

    Here’s more from Just Care:

  • Programs that lower your costs if you have Medicare

    Programs that lower your costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs. So, even with Medicare, many people struggle to afford premiums, deductibles and other out-of-pockets health care costs. Some people qualify for Medicare, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2018, but vary somewhat by state. You should apply through your local Medicaid office.
      • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20
        • Income limit monthly depends upon where you live but is around
          • $1,061 for individuals
          • $1,430 for couples
        • Asset limit
          • Individuals: $7,730
          • Couples: $11,600
      • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20
        • Income limit monthly depends upon where you live but is around
          • $1,260 for individuals
          • $1,711 for couples
        • Asset limit
          • Individuals: $7,730
          • Couples: $11,600
      • Qualifying Individual (QI)—135 percent of FPL +$20
        • Income limit monthly depends upon where you live but is around
          • $1,428 for individuals
          • $1,923 for couples
        • Asset limit
          • Individuals: $7,730
          • Couples: $11,600

      No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

      Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, less than a half the people over 65 who qualify for the Qualified Medicare Beneficiary program (48%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (28%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    2. Extra Help with Medicare Part D prescription drug coverage: You may qualify for Extra Help, a program administered by Medicaid, which pays for some or all of the cost of your drug coverage. The amount of help with cost-sharing depends on the level of your income and assets. In 2018, you may qualify if you have up to $18,735 in yearly income ($25,365 for a married couple) and up to $14,390 in assets  ($28,720 for a married couple). With Extra Help your drug costs are no more than $3.40 for each generic/$8.50 for each brand-name covered drug. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program or receive Supplemental Security Income benefits. You can apply for Extra Help online here. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)
    3. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.
    4. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.
    5. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • Prescription drug costs soar for people with Medicare Part D

    Prescription drug costs soar for people with Medicare Part D

    A new Kaiser Family Foundation issue brief reports that out-of-pocket prescription drug costs are soaring  for people with Medicare Part D, particularly for people who use a lot of medicines. In 2020, the Part D benefit will shrink, so out-of-pocket costs are sure to rise further.

    Nearly 45 million people with Medicare–70 percent of the Medicare population–are enrolled in Medicare Part D, either in a stand-alone plan if they have traditional Medicare or in a plan that they get through their Medicare Advantage plan.

    On average, people with Part D spent $486 out of pocket for their prescription drugs in 2017. But, beware! If you need expensive medications, your out-of-pocket costs with Medicare Part D can be thousands of dollars. Two percent of people with Part D spent an average of $3,214 out of pocket in 2017.

    One million people–one in fifty with Medicare Part D–had out-of-pocket drug costs above the Part D catastrophic cap in 2017. Once you reach that cap, you are still liable for five percent of the cost of your drugs. Their average annual out-of-pocket costs were just over $3,200.

    Another 2.2 million people with Medicare Part D had total drug costs above the catastrophic cap. But they had a Low-Income Subsidy. That subsidy, Extra Help, helps pay Part D premiums and cost-sharing for about three in ten people enrolled in Part D.

    Premiums, copays and coinsurance vary tremendously, depending upon the plan you choose and the drugs you take. As of 2019, premiums ranged from $10.40 to $156 a month. In 2018, the average monthly drug plan premium was $41.

    Overall, generic drugs have far smaller out-of-pocket costs than brand-name drugs, though those costs have risen considerably over the last few years. Drugs that are considered “specialty,” which cost a minimum of $670, often have cost-sharing as high as one-third of the drugs’ price. Forty percent of people with Medicare are enrolled in Part D drug plans that charge coinsurance this high.

    In 2020, the Part D standard benefit will cover a smaller portion of people’s drug costs. The deductible is $435, up from $415 in 2019. Coinsurance is 25 percent, up to an initial coverage limit of $4,020 in total drug costs (up from $3,820 in 2019), after which you are in the coverage gap. Unless you are enrolled in the Extra Help program, which helps cover your costs if your income is low, once your drug costs are higher than $4,020, you will spend 25 percent of the drug plan’s cost for covered brand-name drugs and 37 percent of the drug plan’s cost for covered generic drugs until your total out-of-pocket costs reach $6,350 (up from $5,100 in 2019) and you are no longer in the donut hole.

    After that, you pay the higher of 5% of your drug costs or $3.40 for each generic and $8.50 for each brand-name drug. There is no out-of-pocket catastrophic cap.

    You can check out your Part D drug options on the Medicare Plan Finder, which includes information on premiums, deductibles and the costs of drugs in different Part D drug plans. Unfortunately, the Medicare Plan Finder can be misleading and difficult to use. You can get free help from your State Health Insurance Assistance Program or SHIP. Or, you might consider these other options for keeping your drug costs down.

    If you want Congress to rein in drug prices, please sign this petition.

    Here’s more from Just Care:

  • Medicare Part D drug coverage

    Medicare Part D drug coverage

    Whether you are enrolled in traditional Medicare or a Medicare Advantage plan, you can get prescription drug coverage through a Medicare Part D drug plan. Part D drug companies are commercial insurance companies that contract with the federal government to provide drug coverage to people with Medicare. About 80 percent of people with Medicare–43 million–take advantage of it.

    Here’s how Medicare Part D coverage works and what to consider before choosing a Part D drug plan, along with how to enroll and premiums.

    • Many drug plans have a deductible, which can require you to pay up to several hundred dollars out of pocket before your coverage kicks in. Enhanced drug plans generally have low or no deductibles, cover a wider array of drugs, and provide more coverage in the coverage gap, but they charge higher monthly premiums.
    • Most drug plans will make you pay more for your drugs after you and your plan have spent around $3,820 (2019) on covered drugs. At that point, you are in the coverage gap, sometimes called the “donut hole.”
    • Unless you are enrolled in the “Extra Help” program, which protects you from the coverage gap if your income is low, you will be eligible for the “Coverage Gap Discount Program.” Under that program, in 2019 you will pay no more than 25% of the drug’s costs for covered brand-name drugs and 37% of the the drug plan’s costs for covered generic drugs while you are in the donut hole.
    • No matter which plan you choose, after you have paid $5,100 of your own money for covered drugs (2019), Medicare will pick up 95% of the cost of your drugs. You will pay the greater of 5 percent of the cost or $3.40 for generic drugs and $8.50 for brand-name drugs.

    Keep your costs down: Do your homework. Each drug plan has different premiums, deductibles and copays and covers different drugs under different conditions. You can save a lot of money by choosing your plan carefully.

    • Does the Part D plan cover the drugs you take? You want to make sure the drugs you take are on the Part D drug plan’s formulary and whether there are any restrictions on coverage. If it does not, you should ask your doctor if you could take the drug on the formulary instead.
    • Where can you get your drugs? Find out whether you can continue to use the pharmacy you use to get your drugs and whether you can get drugs by mail order and when you travel.
    • What will your costs be? Ask what your out-of-pocket costs will be, including the monthly premium, as well as the deductible and copays for the drugs you take at in-network pharmacies and what they will be at out-of-network pharmacies.
    • Is the drug plan in your service area? You must choose a drug plan in your service area, so you should understand what that area is.

    You should also check to see whether you are eligible for a state pharmaceutical plan or for Extra Help with your prescription drug costs.

    Enrollment: If you have traditional Medicare, you can call Medicare at 1-800-633-4227 to sign up at the same time you sign up for traditional Medicare, so that you have full coverage. Most Medicare Advantage plans fold Medicare Part D coverage into their benefit package. If your income is low, you are eligible for help paying the cost of this coverage.

    Click here for Medicare’s plan finder tool that can help you choose a drug plan. It will tell you which drugs a particular plan covers at any given time.

    Keep in mind that each fall you will need to study your options if you want to keep your costs down, since most drug plans change their premium, deductibles, copays and benefits from one year to the next. The average drug plan monthly premium is $41.46. And some are as high as $60. But premiums, copays and coinsurance vary tremendously depending upon the plan you choose. Medicare charges you a higher premium if your income is above $85,000 and that additional premium could be nearly $75 a month if your annual income is above $160,000.

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  • Medicare and Medicaid: How they work together

    Medicare and Medicaid: How they work together

    Nearly 12 million people with Medicare also are enrolled in Medicaid. If you have Medicare and Medicaid… What does each cover? Who does it cover? It’s important to know how they work together.

    Medicare is the federal program to help older adults (65 years and older) and people with disabilities pay for medical care. Because Medicare typically covers about half of a person’s health care costs, people with Medicare generally have extra coverage that fills the gaps.  People get this extra coverage from a former job, or they buy it from a health insurer or get it through Medicaid.

    Medicaid is a joint federal and state program. People with incomes and assets below set levels qualify for Medicaid. Medicaid may cover dental, vision, and hearing and long-term care services that Medicare does not cover. People with both Medicare and Medicaid, sometimes called “dual eligibles” have lower incomes and fewer assets than people who do not qualify for Medicaid. More than 85 percent of people with Medicare and Medicaid have annual incomes below about $16,500.

    Many states let people with Medicare (and others) “spend down” to Medicaid eligibility levels if their income is otherwise too high to qualify. These states let you reduce your income by the amount of health care costs that you pay for out of pocket. If your income then meets the Medicaid eligibility limit, you will qualify for Medicaid. Call your Medicaid office to see if your state has a Medicaid “spend-down” or “excess income” program and how to qualify. (Depending upon the rules in your state, you may go on and off Medicaid at different times during the year; and, you may be eligible for different types of Medicaid benefits, including home and community-based care.)

    People with Medicaid automatically qualify for Extra Help. If you spend down to Medicaid, depending upon your income, some or all of your Medicare Part D premiums, deductibles and copays, will be covered from the month you qualify for Medicaid through the end of the year.

    If you have both Medicare and Medicaid, Medicare pays first. Medicaid picks up health care costs that Medicare does not pay. To have your costs covered in full, you must see doctors who take both Medicare and Medicaid.

    People with Medicare and Medicaid–about one in five people with Medicare–tend to have greater health care needs than the general Medicare population. They are more likely to have chronic illnesses as well as cognitive and functional impairments. They also tend to need more hospital and long-term care.

    It is difficult to predict your future health care needs. Your income and assets may be too high to qualify for Medicaid, but not so high that, if you needed costly care, you could spend down to Medicaid eligibility levels. If so, call your local State Health Insurance Assistance Program or your Area Agency on Aging about planning ahead to qualify for Medicaid. You might want to contact an elder law attorney. In some states you can set up a “Special Needs Trust” or another kind of trust that permits you to put some of your income and assets in the trust. You may then qualify for Medicaid because that income and those assets are not counted for purposes of qualifying for Medicaid.

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