Do You Qualify for Government-Provided Medicare Prescription Drug Assistance?

Watch your mailbox this summer. According to government estimates, some 14 million Medicare beneficiaries — about one out of every three — are eligible for substantial additional assistance to pay for prescription drugs under the new Medicare drug law. In order to determine whether you are eligible, the Social Security Administration is mailing 20 million applications to people who might qualify.

For those who are eligible, especially if your savings are low and you have little income other than your Social Security benefits, not only is there additional assistance paying for drugs, but you may also learn that you are eligible for assistance paying your Medicare Part B premium, deductible, and co-insurance amounts.

There are two major levels of assistance for prescription drug coverage.

• If your savings are limited and your monthly income is about $1,077 (for individuals) or $1,444 (for couples) or below, you may qualify for Medicare to pay all the premium and deductible for your drug coverage. In addition you would receive continued coverage beyond the standard coverage limit. Depending on your income and resources you would pay only a $1-$2 co-payment for generic drugs and a $3-$5 co-payment for all others.
• Medicare beneficiaries with slightly higher incomes may also be eligible for extra assistance. If your income is about $1,197 (individual) or $1,604 (for couples) or below, you may qualify for a lower monthly premium calculated on a sliding scale, a $50 deductible, continuation of coverage beyond the initial limit, co-insurance of 15% of out-of-pocket costs, and co-payments of $2 for generic drugs and $5 for others once the out-of-pocket limit is reached.

Don’t be put off by the application sent by Social Security. Even if you already have drug coverage through state pharmacy assistance programs or Medicaid, that coverage will be ending December 31 of this year and will be provided instead under Medicare. It is essential for you to complete the application or get reputable help doing so. You should never give your Medicare or Social Security number to persons calling you on the phone or going door-to-door purporting to assist seniors fill out forms for the new drug benefit. Medicare and Social Security do not transact business in this fashion. If you need help completing it call Social Security at 1-800-772-1213 or your local Agency on Aging. You may complete an online application at www.socialsecurity.gov.

Source: “Overview of the Medicare Prescription Drug Benefit,” CMS, January 21, 2005. “2005 HHS Poverty Guidelines,” Department of Health and Human Services, February 18, 2005. “Medicare Applications Sent to Low-Income Americans,” Robert Pear, The New York Times, March 29, 2005.

June 2005

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