breaking news Help With Medicare Costs: What You Need to Know lastminute news

Walter Wargo takes eight medications, and sometimes the cost has forced the retired Manhattan resident to make some difficult spending choices …

breaking news Help With Medicare Costs: What You Need to Know lastminute news

Walter Wargo takes eight medications, and sometimes the cost has forced the retired Manhattan resident to make some difficult spending choices …

breaking news Help With Medicare Costs: What You Need to Know lastminute news
21 Mayıs 2022 - 23:31

Walter Wargo takes eight medications, and sometimes the cost has forced the retired Manhattan resident to make some difficult spending choices.

“Sometimes I’ll skip a meal because money is so tight,” he said.

Mr. Wargo, 74, lives on a modest Social Security benefit that often falls short of his living costs, which can be high in an expensive city like New York. “I’ve lived here all of my life, but it can be tough,” he said.

Life became a bit easier recently. Last month, Mr. Wargo qualified for New York State’s Medicare Savings Program, which now pays his Part B premium of $170.10 a month. A second, federal program, known as Extra Help, covers Mr. Wargo’s Part D premium and deductible; he pays only modest co-payments for prescriptions.

“It’s a godsend,” he said, adding that the assistance has given him the chance to afford a few “luxuries.” Such as? “I bought a few new shirts — mine were all from the 1990s. And a new fan for my apartment.”

Medicare covers more than 64.2 million Americans over age 65 or who have disabilities, and many struggle to get by. Half had income below $29,650 in 2019, and one in four was living on less than $17,000, according to the Kaiser Family Foundation.

Mr. Wargo was forced to retire in his 50s from managing bars in New York City because cancer left him disabled; his monthly Social Security benefit is a bit below the national average of $1,657 for a retired worker. He also gets help with his housing costs through a Section 8 housing voucher.

Medicare Savings Programs are available in every state and are administered through state Medicaid agencies — but they often are underutilized because of a lack of awareness or complex application procedures. The federal government sets guidelines for eligibility tied to a definition of poverty that includes both income and assets — but states can be more generous with eligibility requirements.

More New York seniors will be eligible for this crucial assistance under a sizable expansion of eligibility rules approved under the state’s budget for fiscal year 2022-23.

“I’ve seen this program save lives,” said Frederic Riccardi, president of the Medicare Rights Center, an advocacy and consumer organization that pushed for the change along with a coalition of other advocacy groups. The center assisted Mr. Wargo with his application. “It’s one of the issues that I’m most passionate about because I have seen it save people’s lives. I’ve seen it free up money to pay for other things like food and rent,” Mr. Riccardi said.

Under the Medicare Savings Programs, state Medicaid programs help pay for premium and/or cost-sharing assistance for Medicare beneficiaries who have income and assets below certain levels, up to 135 percent of the federally defined poverty level.

This year, that income level is$18,347 for individuals and $24,719 for couples; the asset limits are $8,400 for individuals and $12,600 for couples. In most cases, people eligible for the program also qualify for full Medicaid benefits, which can include long-term care and dental and vision care.

Under the Extra Help program, the federal government subsidizes premiums, deductibles and cost sharing for Part D prescription drug benefits. The assistance varies according to income level — up to $20,385 for individuals and $27,465 for couples this year. The asset limit is $14,010 for individuals and $27,950 for couples.

States expanding Medicare help

Some states have expanded eligibility for their Medicare Savings Programs — as of last year, 15 did so, along with the District of Columbia, according to the Medicare Payment Advisory Commission, an independent Congressional agency charged with advising lawmakers on Medicare.

New York raised its income eligibility as part of a broader move to expand access to Medicaid for seniors and disabled people. Benefits will be extended to people with incomes up to 186 percent of the federal poverty level, up from 135 percent. Beginning on Jan. 1, 2023, a single person with monthly income of $2,107 willqualify, up from $1,529 (for married couples, the comparable income maximum will be $2,838, up from $2,060) according to a Medicare Rights Center estimate. The state eliminated its asset ceiling in 2008.

Much of the expansion in New York State will take advantage of federal subsidies.

In 2020, Massachusetts expanded income eligibility, and doubled the asset limit to $15,720 for an individual and $23,600 for couples. The state’s governor, Charlie Baker, is proposing to further expand income eligibility in 2023.

And California will increase its asset test from $2,000 to $130,000 beginning on July 1 this year — and phase out the test entirely in July 2024. California increased its income eligibility in 2020. This year, the income qualification for the state’s lowest-income beneficiaries is $13,590 for an individual and $18,310 for a married couple.

A need, even in higher-income areas

Enrollment levels in the two programs vary significantly among the states, according to a recent study by K.F.F. For example, in 2019, 33 percent of Medicare enrollees in the District of Columbia were enrolled in its Medicare Savings Program,compared with 19 percent of beneficiaries in New York State, 22 percent in California, and 23 percent in Mississippi. In North Dakota, just 7 percent were enrolled.

Paradoxically, the programs are most needed — and most used — in both the highest- and lowest-income states in the country, says Jan Mutchler, a professor of gerontology at the University of Massachusetts Boston. “One group of people who have trouble meeting their health care expenses live along the coasts, where many people actually do have money for retirement but the costs are very high,” she said. “The other group lives in places where incomes are very low.”

But the need for help exists everywhere. In 2020, 45 percent of men and 54 percent of women living alone lacked the resources to pay for their basic living needs, according to the university’s Elder Index, which measures the typical cost of living for older people for every county in the United States. For couples, who usually benefit from two Social Security checks and are more likely to have other income, the comparable figure was 24 percent.

K.F.F.’s research shows that the programs disproportionately serve beneficiaries in communities of color, those under 65 with disabilities and women, who tend to have lower incomes and levels of savings.

In California, the high cost of living in many parts of the state creates a need for assistance with Medicare costs, even for retirees with higher incomes, said Christina Dimas-Kahn, who leads the board of California Health Advocates, a Medicare advocacy and education nonprofit organization that supports the state’s free State Health Insurance Assistance Program. “We have a hidden poor population here — they’re called middle-income seniors, and everyone’s forgotten about them.”

The San Francisco area, where Ms. Dimas-Kahn lives, offers an instructive example. The cost of meeting basic living expenses in San Mateo County this year for a single elder who rents an apartment is $48,936, or $4,087 a month — 64 percent higher than the California average, according to the U.C.L.A. Center for Health Policy Research.

K.F.F. estimates that only 50 percent to 65 percent of the Medicare beneficiaries with incomes low enough to qualify for the Medicare assistance program are enrolled, and 55 percent to 70 percent of those eligible for Extra Help are signed up.

That is partly because of a complicated application process for the Medicare program, along with a general lack of awareness of the programs, says Meredith Freed, a senior policy analyst at the research organization.

“Enrollment isn’t automatic, and people need to actively apply through their state Medicaid agency to qualify — and they may not even be aware that this is available,” she said.

Since Extra Help is a federal program, enrollment is standardized, and it’s relatively easy to enroll through the Social Security Administration website, by phone or at a field office. But the Medicare Savings Programs are administered by state agencies with varying application procedures. “People have to overcome some hurdles when they apply, but it’s worth the effort,” Mr. Riccardi said.

And eligibility can be sporadic because of the programs’ stringent poverty definitions. Mr. Wargo qualified for both Medicare assistance and Extra Help when he first became ill more than a decade ago. But he became ineligible when an increase in his Social Security benefits put him over the income limits by just a few dollars.

“I was talking with a friend in Florida who gets more Social Security than I do, so I decided to try to get it again,” he said. “Everyone needs to know about this program.”

How to apply

Eligibility: The Medicare Rights Center offers a page detailing eligibility for all Medicare cost-saving programs and can answer questions about these programs via its toll-free number: 800-333-4114.

Medicare Savings Programs: Your State Health Insurance Assistance Program can help with screening and enrollment.

Extra Help: Since the prescription drug assistance program is federal, apply online at the Social Security Administration website or by calling 800-772-1213. You can also apply by visiting your local Social Security office.

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