Chapter 2

Johns Hopkins Medicine - Department of Psychiatry and Behavioral Sciences

TALKING TO YOUR PATIENTS
ABOUT MEDICARE PART D

Chapter 2 - Helping Low Income Patients Apply for Extra Help with Costs

Select a link below for quick reference:

Any individual whose income is below $14,355 per year ($1196 per month) and whose liquid assets are below $11,500 should apply for extra help.

Any couple living together whose income is below $19,245 per year ($1604 per month) and whose liquid assets are below $23,000 should apply for extra help.

Any person who received a letter from Social Security inviting them to apply for extra help should apply for extra help. These letters were sent out this summer, and include an application form. These invitations were based on income only and not assets.

Some people who qualify do not need to apply. They have been enrolled already. These include people with:

• Medicare and full Medical Assistance
• Medicare with QMB, QLMB, and SLMB
• Medicare with SSI

They should have received a letter from Social Security or Medicare informing them that they qualify for extra help.

Also, people who have Medicare and Maryland Pharmacy Assistance do not need to apply. They are being automatically qualified through the state of Maryland. But people who have Medicare and have been getting help through the Maryland Pharmacy Discount Program will need to apply for the extra help.

How can someone apply for extra help?

Online applications can be made at:
www.socialsecurity.gov/prescriptionhelp/

Telephone applications can be made at: 1-800-772-1213

Paper applications (Form SSA-1020) can be mailed to:
     Social Security Administration
     Wilkes Barre Data Operations Center
     PO Box 1020
     Wilkes Barre, PA 18767-1020

In person: May apply at any Social Security office, state Medical Assistance office, or State Health Insurance Assistance Program (SHIP) office.  Click here for contact information of local SHIP offices (refer to page 11 of PDF)

The fastest response will come from in person, telephone, or online applications. Social Security will mail applicants a letter when a determination has been made.

What levels of extra help are available?

Full extra help is available to people with the following income and asset profiles:    

• Single: Income less than $1077 per month, and assets less than $7500
• Couple: Income less than $1443 per month, and assets less than $12,000

Full extra help entitles the recipient to the following benefits:

• May enroll in any of 15 low cost programs with no deductibles and no monthly premiums.
• Copays will be $1 for generics and $3 for brands for the recipients with the lowest income, and $2 for generics and $5 for brands for the recipients with slightly higher incomes.
• May enroll in any of the 47 programs. Medicare will apply up to $33.46 to the monthly premium for any basic program (in MD), and the enrollee will have to pay the difference. Copays will remain the same.
• Enrollees who receive full extra help may switch programs at any time. There will be no coverage gap.  Click here to view Maryland COPAY information

Partial extra help is available to people with the following income and asset profiles:   

• Single: Income less than $1196 per month, and  assets less than $11,500
• Couple: Income less than $1604 per month, and assets less than $23,000

Partial extra help entitles the recipient to the following benefits:

• May enroll in any of the 47 programs.
• Will pay a $50 annual deductible.
• Will pay a percentage of the monthly premium, which will be 25%, 50%, or 75% of the full premium amount, depending on the income/asset profile of the enrollee.
• Copays will be 15% initially, up to the $3600 out of pocket level.
• There is no coverage gap.
• After $3600 of out of pocket expenses, generics will cost $2 and brands will cost $5.  Click here to view Maryland COPAY information

Janet A. Bachur LCSW-C
12/12/05

APPLYING FOR EXTRA HELP: RELEVANT LINKS and CONTACTS

Social Security Administration 
Phone: 1-800-772-1213

“Help with Prescription Drug Costs” online application
www.socialsecurity.gov/prescriptionhelp/

Paper application (Form SSA 1020)
       Social Security Administration
       Wilkes Barre Data Operations Center
       PO Box 1020
       Wilkes Barre, PA. 18767-1020

Medicare: “Your Guide to Medicare Prescription Drug Coverage”
www.medicare.gov/Publications/Pubs/pdf/11109.pdf
“Help with your Medicare drug plan costs” (pages 21-30)

AARP: “The New Medicare Prescription Drug Coverage: Extra Help for People with Limited Incomes”
www.aarp.org/health/medicare/drug_coverage/medicare_lowincome1.html

Medicare Rights Organization: “Medicare Drug Coverage 101: Everything you need to know about the new Medicare prescription drug benefit”
www.medicarerights.org/drughelp.html
“Can I get extra help paying the Medicare Drug benefit if my income is low?” Questions 20-47

Maryland Department of Aging: “The New Medicare Prescription Drug Plans: What you need to know” www.mdoa.state.md.us/PartD/PartDhandout.pdf