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This is a matter that Medicare ready folks who think they may qualify because of low income “LIS” should at least inquire about.

To very clear, if you are eligible as a Medicare beneficiary who has had a limited income, you may qualify for various government programs that helps pay for your Medicare Part D prescription drug costs and your Medicare Part B monthly premium.

Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments. There is also a program called Pace and Pace-net which we will get into a little later.

medicare eligible woman and doctor

If you are seeking help and not sure where to ask, the Social Security program determines if you are eligible for Extra Help. Basically, you would need to fill out an Application for the Extra Help for your Medicare Prescription Drug Plan Costs. 

Ok, so you may be confused if you qualify or not. To help you better understand if you qualify for extra help with Medicare prescription drug plan costs in 2019, you need to be in specific income brackets. If you are a single individual, your annual income must be limited to no more than $18,735. Married couples living together qualify if they have a combined income of no more than $25,365 annually.

Those are the income brackets for assistance in 2019. You want to check these numbers yearly because they do change.

You may also qualify for assistance to help pay for your Medicare Part B monthly premium.  It all depends on your income like any of the programs we are talking about here, this particular program is called QMB which is the acronym for Qualified Medicare Beneficiary.

If you are an individual your monthly income cannot exceed $1,357. For married couples living together your monthly income exceed $1,823. Besides receiving help for your Part B monthly premium, you may also qualify for help with out of pocket costs such as co-pays and deductibles.

Some people ask me if Medicaid is the same thing as low income. It is not, in fact Medicaid pays more benefits for their beneficiaries. The income limits for Medicaid vary from state to state so you would need to contact your State Medical Assistance which is in fact the Medicaid office to see if you qualify.

Regarding Medicaid, it comes down to how little of a low income you have and a lack of assets. So besides getting help paying for your deductibles and coinsurance you may also qualify for help paying for dental care, transportation to doctor appointments, which Medicare does not cover.

One question that is commonly brought up is “can I have Medicare and Medicaid at the same time?”  The answer to that is “yes” The correct term for this situation is called “dual eligible”, which we run into quite often. Dual eligible beneficiaries usually receive enhanced benefits such as not being limited to Medicaid physicians.

Ever since the start of my career as a Medicare broker I have been suggesting low income folks to check into programs like Pace and Pac-net. Both Pace and Pace-net is a Pennsylvania program, which offers assistance for Medicare recipients 65 and older who qualify based on certain low-income brackets to help limit prescription drug costs.

You qualify for Pace as an individual if your income does not exceed $14,500 annually. Your co-pays for generics would be limited to $6 per and for brands only $9 per. If you are a married couple your income could not exceed $17,00 annually.

You may qualify for the Pace-net program as an individual if your annual income does not exceed $27,500 and married couple’s annual income does not exceed $35,500. Both Pace and Pace-net programs will protect the Medicare beneficiary from the costs of the coverage gap known as the “donut hole”.

BGA Insurance Group has tremendous experience guiding seniors through their retirement years.

We cover a lot of ground for Medicare recipients such as Montgomery, Chester, Philadelphia, Bucks and Delaware counties. We also cover all counties in New Jersey, Delaware, North Carolina, South Carolina and Florida.

Pace/Pace-net –  1-800-225-7223  https://pacecares.magellanhealth.com/

Call Social Security at 1-800-772-1213 to apply by phone, get a paper application mailed to you, or make an appointment at your local Social Security office.

Visit Medicare.gov/contacts or call 1-800-MEDICARE (1-800-633-4227) to get the phone number of your local Medicaid office.

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