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Medicare Extra Help and Low Income Subsidy: What It Is, Qualifications And Change In Status


Medicare Extra Help or the Medicare Savings Program, as it's sometimes called, is a great program for seniors on Medicare with very limited incomes and assets. Many seniors qualify, but don't know they qualify because they've never asked for help and didn't know they had to apply to get Extra Help with their premiums, medical costs and prescription costs. In the next few paragraphs, I will highlight why this is so important. So, let's get down to the nuts and bolts of this program.


The Medicare Savings Program is for seniors on Medicare with very low incomes and resources. How low of an income do you need to qualify? Below I have listed the four kinds of Medicare Savings Programs and each program's qualifications.


Qualified Medicare Beneficiary Program: As of 2020, your monthly income can not be more than $1,084 for an individual or $1,457 for a married couple to qualify. An individual's resource limit can not be more than $7,860 or $11,800 for a married couple. If you qualify for this program, this program helps pay for Part A and Part B premiums and deductibles, coinsurance and copayments.


Specified Low-Income Medicare Beneficiary Program: You qualify for this program if you have a monthly income of not more than $1,296 for an individual or $1,744 for a married couple. An individual's resource limit can not be more than $7,860 or $11,800 for a married couple. If you qualify for this program, the program helps pay for your Part B premiums, which are currently $148.50 monthly.


Qualifying Individual Program: To qualify for this program, your monthly income can not be more than $1,456 for an individual or $1,960 for a married couple. An individual's resource limit can not be more than $7,860 or $11,800 for a married couple. If based off of your income and resources you qualify at this level, you get help paying your Part B premiums. However, the Qualifying Individual program is a state program and you must reapply every year for these benefits that are on a first-come, first-served basis with priority given to those who had Qualifying Individual benefits the previous year.


Qualified Disabled and Working Individuals Program: To qualify for this program which pays for your Part A premiums, you are either a working disabled person under 65, you lost your premium free Part A when you went back to work, you aren't getting medical assistance from your state, or you meet the income and resources limit for your state, which is $4,339 monthly for an individual or $5,833 for a married couple.


If you qualify for either of the Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary or Qualifying Individual Programs, you automatically get Extra Help paying for prescription coverage or what is referred to as a Low Income Subsidy (LIS).

Applying for Extra Help through the Medicare Savings Program: There a few ways to apply. You can either call your state's Medicaid office and apply that way or you can do a simple search for your state's Medicare Savings Program application online, print out a paper application, fill out the application and mail it in. The paper application for Kentucky is here. If you have further questions about applying, you can reach out to me here on the site or call me at 270-231-2623. If you think you may qualify for the Medicare Savings Program, please apply! It can make a big difference in your quality of life. I see seniors often who qualify and don't know they qualify and have been through more stress than is necessary.


Medicare Savings Program Change in Status: So, what if you are already receiving benefits from the Medicare Savings Program and have a change in your Extra Help status due to an increase in income? If this happens and you are currently on a specific Medicare Advantage plan called a Dual-Eligible Special Needs plan or DSNP, don't fret if the company you have your plan with sends you a letter that states you must leave your plan. You have two months to change to a plan that will still work fantastic for you, and you may possibly still be able to keep the Low Income Subsidy for your prescriptions. If you are in this situation, reach out to us here at Knelson Financial and we'll help you navigate this issue stress free.


At Knelson Financial, we are always available to help!








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