Get Help With Your Healthcare Costs

You may qualify for help with your premiums, deductibles, copayments, or prescription costs with Extra Help or with a Medicare Savings Program.

 

Medicare has 4 savings programs that can help with your healthcare costs:

 

Qualified Medicare Beneficiary (QMB) Program (also known as the Medicare Buy-in)

 
Individual monthly income limit* – $1,001
Married couple monthly income limit* – $1,348
Program helps pay for:  Part A premiums, Part B premiums, Deductibles, coinsurance, and copayments
 
 

Specified Low-Income Medicare Beneficiary (SLMB)

 
Individual monthly income limit* – $1,197
Married couple monthly income limit* – $1,613
Program helps pay for:  Part B premiums only
 
 

Qualified Individual (QI) Program

 
Individual monthly income limit* – $1,345
Married couple monthly income limit* – $1,813
Program helps pay for: Part B premiums only
 
 

Qualified Disabled and Working Individuals (QDWI)

 
Individual monthly income limit* – $1,962
Married couple monthly income limit* – $2,655
Program helps pay for:  Part A premiums only
 

 

Save on Drug Costs

If you have limited income and resources, you may also qualify for “Extra Help” to help pay your Medicare prescription drug costs, like premiums, deductibles, and co-payments.
 
In 2015, drug costs for most people who qualify are no more than $2.65 for each generic/$6.60 for each brand-name covered drug.  Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. 
 
In 2015, you may qualify if you have up to $17,505 in yearly income ($23,595 for a married couple) and up to $13,440 in resources ($26,860 for a married couple).
 
If you don’t qualify for Extra Help, your state may have programs that can help pay your prescription drug costs. Contact your State Medical Assistance (Medicaid) office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.  (To apply online follow the link at the end of this article.)
 

Countable resources include:

  • Money in a checking or savings account
  • Stocks
  • Bonds

Countable resources don’t include:

  • Your home
  • One car
  • Burial plot
  • Up to $1,500 for burial expenses if you have put that money aside
  • Furniture
  • Other household and personal items

Apply for Extra Help – Contact Social Security.

Find out if you qualify for a Medicare Savings Program. You can apply online or visit your local State Health Insurance Program. Call Social Security toll-free at:  1-800-772-1213 or TTY 1-800-325-0778, Monday-Friday 7am-7pm
 

Would you like my help?

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.  The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

*Medicare Savings Program Income Limits are for 2015 (2016 amounts are released in March).

Turning 65 and still working?

Should I apply for Medicare even though I have insurance at work?

 
Yes.  If you’re not retiring and you are continuing to work then you may want to consider enrolling in Medicare Part A and delaying Part B until you retire and leave your employer sponsored health insurance plan.  Even if you’re not receiving Social Security benefits at age 65, you’re still eligible for full Medicare benefits. This includes the Part A (hospitalization), as well as Part B (doctors’ visits and outpatient care) and Part D (prescription drugs); you pay a premium for each.  But if you are not collecting social security benefits then it’s up to you to contact Social Security to sign up for Medicare only.  You must do this within your “initial enrollment period.” This period starts three months BEFORE the month you turn 65, includes the month you turn 65 and continues three months AFTER that — a seven-month period.
 

Do you have an HSA?

If you enroll in Medicare Part A and/or B you can no longer contribute to your Health Savings Account (HSA). Whether you should delay enrollment in Medicare so you can continue contributing to your HSA depends on your circumstances. Carefully weigh the savings of enrolling in Medicare against the advantages of continuing to save money in a tax-free HSA.
 

You don’t have to enroll in all parts of Medicare.

Only the parts you need.

In a situation where you are still working at age 65 and have health insurance through your employer you don’t have to enroll in all parts of Medicare until you retire. If you have creditable insurance coverage through an employer plan, you can apply for Part A only. Part A might help pay for some of the costs not covered by your group plan such as your deductible if you go into the hospital for a surgery or if you need to stay in a skilled nursing facility.  And as long as you have group coverage, you won’t be penalized for delaying Part B or Part D (Medicare Prescription Drug Coverage). When your employment or group coverage ends, you then have eight months in which to sign up for Part B and enroll in a Medicare Supplement or a Medicare Advantage plan.  This is where I come in!   There are a lot of different plans available and finding a plan that covers your doctors and your specific medications at the best price is what I do best.  I’ve helped hundreds of people find the right plan and saved THOUSANDS in the process.
 
Your decision to enroll in Medicare Part B if you are still working is really a cost/value decision. The standard monthly premium for Part B is $121.80 in 2016. Where as Part A in most cases has no monthly premium.  So your decision to enroll in Part B while you’re still working might depend on how much money you’re making and what your current costs are with your employer health insurance plan.  You also need to consider what you’re getting. If you work for a company with 20 or more employees, your group health plan is still the primary payer of your medical bills, making your Medicare benefits of limited value. However, if your company has fewer than 20 employees, Medicare would be the primary payer and your company’s plan the secondary payer. In this case, it’s best to talk to your employee benefits administrator to see how Medicare would work with your insurance.  The Part B coverage may well be worth the monthly premium.
 

What if I retire and then go back to work?

It’s not unheard of for insurance needs to change as people move in and out of the work force. So what happens if you retire, enroll in Part B and then find yourself back at work with employer coverage once again?
 In this situation, you can drop Part B while working and re-enroll at any time while you have group coverage or during the eight months after your employer coverage ends, without risk of penalty or higher premiums.
 

 

For now, I suggest you mark the dates of your initial enrollment period on your calendar.

 
Then when the time comes, call the Social Security Administration at 800-772-1213 to sign up for Medicare Part A and/or Part B.  You can also go to www.ssa.gov for more information.
 
No matter how long you choose to work, there’s no reason not to take advantage of the benefits you’ve earned.  Keep in mind, this information is no substitute for an individualized consultation. You can Contact Me to schedule an appointment and we can sit down and talk about your individual needs and answer any of your questions. There is no cost or obligation to talk or meet with me.  I would be glad to talk to you and answer questions about your options.  You can reach me toll free at (866) 976-9038 or CLICK HERE if you would prefer e-mail.  I am looking forward to answering your questions and helping you get the coverage that you need.

-Todd 🙂

 

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Beware of Scare Tactics about Obamacare

Regardless of your political sensibilities, intentionally scaring people with inaccurate and incomplete information is unethical.  The tactic of frightening senior citizens in order to advance a political agenda has become far too common.  When a new client asked me not about the security and peace of mind that Medicare would bring him but instead about how he would pay for his medical care once “Medicare premiums double or triple in the next two years” I decided things had gone too far.
 
Over the past few weeks I have been getting a lot of questions about rumors that Obamacare is going to cause Medicare premiums to double or triple by 2014.   It seems to have started with an email circulating that states as part of Obamacare (known more formally as the Patient Protection and Affordable Care Act, or PPACA) the Medicare premium will increase to $247 in 2014. The short answer to the question of the whether these figures for Medicare insurance premiums are accurate is no.
 
In the last few years, the standard monthly premiums for Medicare Part B have been set as follows:
2009 $96.40*
2010 $110.50*
2011 $115.40*
2012 $99.90*
(The actual premiums paid by some Medicare participants may be slightly higher or lower than these standard amounts.  For example, many beneficiaries paid less than the listed amounts in 2010 and 2011 because of the “hold-harmless” provision of Medicare which states that if the dollar increase in your Medicare Part B premium is bigger than the dollar increase in your Social Security check, you don’t have to pay the difference.)
 
As for future Medicare Part B premium rates, the information cited in the rumors that this email has generated is wrong on two counts: No provision of the health care legislation passed during the Obama administration sets Medicare premium rates, nor is a whopping jump of over 100% to a $247.00 monthly premium in 2014 a realistic figure.  New Medicare premium rates come out each fall and take effect in January.   Medicare beneficiaries as a group are required to pay one-fourth the cost of running Medicare, and annual premiums are set at a figure calculated to achieve that level of revenue.  In other words, Medicare beneficiaries receive a 75% subsidy for Part B, with every $1 in Part B premiums for enrollees matched by $3 in general revenues.
 
Although the annual premium rates aren’t officially set until they are announced each fall, Medicare administrators track trends and anticipated changes and use them to formulate projections of Medicare premiums for the next several years.  According to the most recent report (https://www.cms.gov/ReportsTrustFunds/downloads/tr2011.pdf) of the system’s trustees, issued in May 2011, those projected premiums (as listed on page 218) are:
 
2013: $110.50
2014: $115.80 
2015: $120.80
2016: $126.00
2017: $132.70
2018: $140.30
2019: $148.40 
2020: $158.60
 
I hope this helps put your mind at ease! Please share this with your friends who have also heard this terrible untruth!  
 
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