Senior and Disabilities Services

Medicaid/Extra Help/Medicare Savings

 

 

MEDICARE SAVINGS (BUY-IN) PROGRAM
The Medicare Savings/Buy-In Programs help Medicare beneficiaries with limited income and resources pay their Medicare costs. There are 3 programs—the Qualified Medicare Beneficiary (QMB) program, the Specified Low-income Medicare Beneficiary (SLMB) program, and the Qualifying Individual-1 (QI-1) program.

Who is eligible for the Medicare Savings Programs?
Those who receive Medicare Part A Hospital Insurance and have limited income and resources.

What is Qualified Medicare Beneficiary (QMB)?
QMB can pay for:

  1. Monthly Medicare Part B Medical Premium ($96.40 for 2009)
  2.  Annual Medicare Part B Medical Deductible ($135 for 2009)
  3.  Monthly Medicare Part A Hospital Premium ($443 for less than 30 quarters *if beneficiary  does not received Part A free of charge due to work history*)
  4. Coinsurance costs - the 20% of approved charges for doctor’s services that Medicare does not             pay

What is Specified Low-income Medicare Beneficiary (SLMB)?
If a beneficiary’s income is too high to qualify for QMB, SLMB can pay the monthly Medicare Part B Medical premium ($96.40 for 2009).

What is Qualifying Individual-1 (QI-1)?
If a beneficiary’s income is too high for SLMB, QI-1 can pay the monthly Medicare Part B Medical premium ($96.40 for 2009). *There are limited funds available for this program. Applications are approved on a first-come, first served basis*
Income & Resource Limits:


2009 Poverty Guidelines

QMB

SLMB

QI-1

Federal Poverty Level (FPL)

100% + $20*

120% + $20*

135% +$20*

Individual:

$1,148.00

$1,373.00

$1,543.00

Couple:

$1,538.00

$1,841.00

$2,069.00

 *$20 = amount of the monthly SSI income disregard*
Resources: $4,000—Individual; $6,000—Married Couple

Where do I apply for the Medicare Savings (Buy-In) Program?
The beneficiary should contact their local Division of Public Assistance (DPA) office at toll free 1-800-478-3537 and submit a standard Medicaid application.
Public Assistance Offices Contact List: http://hss.state.ak.us/dpa/features/org/dpado.htm
Printable Medicaid Application: http://www.hss.state.ak.us/dpa/forms/gen50b-packet.pdf

LOW-INCOME SUBSIDY (LIS) OR “EXTRA HELP” PROGRAM
A federal program that helps Medicare beneficiaries with the Medicare prescription drug plan costs.

Medicare beneficiaries who qualify for LIS get the following:

  1. Help paying the Medicare drug plan’s monthly premium
  2. Help paying the Medicare drug plan’s yearly deductible (if applicable)
  3. Help paying coinsurance and copayments for prescription drugs that are covered by the plan
  4. No coverage gap (also known as the “donut hole”)

What are the Income and Resource Limits for LIS?
LIS is based on the Federal Poverty Guidelines (FPL). To qualify, a Medicare beneficiary must be at or below 150% FPL. See the chart below for 2009 annual and monthly guidelines:
2009 Annual Guidelines (Alaska Only) * add $4,680 for each additional member


Family Size

100% FPL

120% FPL

135% FPL

150% FPL

1

$13,530.00

$16,236.00

$18,265.50

$20,295.00

2

$18,210.00

$21,852.00

$24,583.50

$27,315.00

3

$22,890.00

$27,468.00

$30,901.50

$34,335.00

*Indicates maximum income to qualify for LIS*
2009 Monthly Guidelines (Alaska Only)


Family Size

100% FPL

120% FPL

135% FPL

150% FPL

1

$1,127.50

$1,353.00

$1,522.13

$1,691.25

2

$1,517.50

$1,821.00

$2,048.63

$2,276.25

3

$1,907.50

$2,289.00

$2,575,13

$2,861.25

*Indicates maximum income to qualify for LIS*
2009 Resource Guidelines (Does not include your home, vehicles, personal possessions, burial plots)
Individual $12,510 Married Couple $25,010

Some People Automatically Qualify for LIS. They are:

  1. Those who have Medicare and full Medicaid coverage (also known as “dual-eligibles”).
  2.  Those who get help from the state Medicaid program with paying Medicare premiums (belong to the Medicare Savings or “Buy-in” program).
  3.  Those who get Supplemental Security Income (SSI) benefits

How do I apply for LIS or “extra help”?

  1. The fastest way is online: https://secure.ssa.gov/apps6z/i1020/main.html. You will get a letter within a month.
  2.  You can also contact Social Security to complete an application by calling 1-800-772-1213 (Monday through Friday, from 7 a.m. to 7 p.m.).
  3. Contact us for assistance with MEDICARE in Alaska 1-800-478-6065 or in Anchorage

269-3669