Social Security & Medicare Questions: Can I get financial assistance to replace my discontinued HMO?

Q: My Health Maintenance Organization (HMO) is discontinuing service and there are no other HMOs in my area. When I checked Medigap plans for fee-for-service Medicare, the premiums were very high even for the most basic of plans, let alone one that covers prescription drugs. I do not have any pension or savings, just my Social Security. What can I do?

A: You may be eligible for help through your state. Each state has programs that may pay for Medicare premiums, and most states also have programs that provide assistance with prescription drugs. Each year more than half the seniors who are eligible never apply. You may qualify for assistance as a Qualified Medicare Beneficiary (QMB), Specified Low Income Beneficiary (SLMB), or Qualifying Individual (QI-1).

These state programs may pay some or all of Medicare's premiums and may also pay Medicare deductibles and coinsurance. To qualify, you must have Part A Hospital Insurance, and a limited income (see below). Your assets, such as bank accounts, stocks, and bonds must be no more than $4,000 for a single person, or $6,000 for a couple, although some states have waived these asset limits.  When figuring your savings, do NOT include your home, a car, burial plots, up to $1,500 in burial expenses, furniture, and up to $1,500 worth of life insurance.

• Qualified Medicare Beneficiary Program (QMBP). If your income in 2002 is $9,108 or less for an individual, or $12,180 or less for a couple, this program pays all or part of Medicare premiums ($54.00 in 2002), deductibles and co-insurance. Your state covers these costs through its Medicaid program, but you don't have to be on Medicaid to qualify.
• Specified Low-Income Medicare Beneficiary Program (SLMB). This program has higher income limits. If your income in 2002 is $10,872 or less for an individual, or $14,568 or less for a couple, your state will pay your monthly Medicare Part B premium.
• Qualified Individual Program-1 (QI-1). Your state also pays your Medicare Part B premium under this program but the income limits are higher still. You may be eligible if your income in 2002 is $12,204 or less for an individual or $16,368 or less for a couple. Some states have capped the amount they will spend on this program and there may be waiting lists.

For more information about these programs, call (800) MEDICARE (800-633-4227). You will be given the number to call for your state.
 
For more details, see “Are You Eligible for a Medicare Savings Program?” at http://www.tscl.org/NewContent/101525.asp.

Updated 8/02/02

This article first appeared in Volume 6, Issue 2 of "The Social Security and Medicare Advisor" newsletter (December/January/2001).  To receive future editions of "The Advisor" in its special, free e-mail version, please click here.

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