Medicare - Programs to Assist with Cost Sharing

Overview

T + T

Summary

This chapter discusses programs to assist with costs related to Medicare:

Medicare Savings Programs (MSP) assist with Part A and/or Part B cost-sharing. There are four different MSPs: QMB, SLMB, QI and QDWI. Note that QDWI is a very limited program. The most common programs, QMB, SLMB and QI are highly beneficial to those who qualify. There are income limits for each of the MSPs, and there is no resource test for QMB, SLMB and QI. MSPs are administered by the Local Department of Social Services (HRA in NYC).

The Low Income Subsidy Program, also known as Extra Help, assist with Part D costs. There is Full Extra Help and Partial Extra Help; each program has different income and resource limits. People with Medicaid or a MSP are automatically enrolled into Full Extra Help. Others can apply for Extra Help through the Social Security Administration which administers the program.

The Elderly Pharmaceutical Insurance Coverage Program (EPIC) is a New York State program that assists with Part D drug costs. One must have a Part D plan in order to have EPIC, as EPIC serves as secondary coverage to Part D. Individuals who appear to be income eligible for Extra Help are required to apply for Extra Help as a condition of having EPIC. There are two programs within EPIC: the Fee Plan and the Deductible Plan. Applicants are assigned to one of the plans based on their income. EPIC is only for those who are 65+, so younger disabled Medicare beneficiaries are not eligible for EPIC. Individuals with annual incomes up to $75,000/single and $100,000 married couple may be eligible for EPIC. EPIC is administered by the NYS Department of Health.

One can apply for any of these programs at any time of the year. In addition to the cost savings that these programs offer, individuals in these programs may also benefit from having additional flexibilities in changing their Part D coverage mid-year.