def #97 05/14/10
NEW INITIATIVE AIMS TO HELP WITH MEDICARE SAVINGS PROGRAMS
TOMS RIVER – A new initiative launched by Ocean County and Community Services Inc. is expected to assist
residents living in the county that may be experiencing problems affording health care.
“Today marks the start of intensive community outreach to help eligible persons apply for Medicare Savings
Programs that pay some or all of their Part B and D Medicare premium, deductible, coinsurance and or co-pay costs,”
said Freeholder Joseph H. Vicari, who serves as chairman of Senior Services. “This initiative could help many of our
seniors who are having a difficult time paying for their insurance."
Under the new initiative, Community Services Inc. will partner with the Ocean County Office of Senior Services
and Outreach Programs throughout the county to seek out potential enrollees and assist them in determining eligibility
and if needed help to complete applications for the various benefits. Community educational events will be held in
locations that have been identified with large numbers of people who potentially are eligible for the assistance.
“It is estimated that only 46 percent of individuals eligible for all or part of the Medicare Savings Program
benefits are receiving them and just 53 percent of those eligible for the Low Income Subsidy who are not already
enrolled through Medicaid or SSI are receiving it,” said Jane Maloney, director of the Ocean County Office of Senior
Services. “We want to make a greater effort in informing our seniors of these programs and help those that are eligible
to access them.”
The outreach will be funded by a grant, made possible by the Medicare Improvements for Patients and Providers
Act of 2008 (MIPPA).
The programs promoted by the grant include the Medicare Savings Programs known as QMB, SLMB and QI-1, the
Medicare prescription drug program’s Low Income Subsidy (also known as Extra Help), as well as the state’s
Pharmaceutical Assistance to the Aged and Disabled Program (PAAD).
QMB covers all approved out-of-pocket Medicare expenses for individuals with limited assets who are living
below the federal poverty level, currently set at $10,830 for a single person and $14,570 for a married couple.
Individuals enrolled in QMB with assets up to $4,000 if single and $6,000 if married, are also eligible for Medicaid
SLMB and QI-1 pay Medicare Part B premiums for individuals with incomes between 100 percent and 135 percent of the
federal poverty level, currently standing at $10,830 up to $14,621 for individuals and at $14,570 up to $19,670 for
married couples. Changes in the Medicare law effective Jan. 1, raised the program’s asset limits to $6,600 for
individuals and $9,910 for couples. A beneficiary’s primary residence and vehicle, if used for medical appointments or
for work, are not counted as assets. The Part B premium normally ranges from $96.40 to $110.50 per month and is usually
taken directly out of a person’s Social Security check.
The Low Income Subsidy provides extra help to qualified low-income Medicare beneficiaries in paying their Part D drug
plan’s monthly premium, annual deductible, coinsurance and/or co-pays. Benefit levels vary by income. With LIS, there
is also no Part D coverage gap – commonly called “the donut hole” – and no late enrollment penalty. On full LIS without
Medicaid, individuals pay no more than $2.50 for each generic drug and $6.30 for each brand-name drug they purchase.
To be eligible for LIS, an individual must have an annual income of less than $16,245 and resources less than
$12,510. The income and asset limits for married couples are $21,855 and $25,010, respectively. The asset levels
assume the applicant plans to use $1,500 for burial expenses.
PAAD provides prescription assistance for qualified low-income individuals 65 years of age or older or 18 years
of age or older and receiving Social Security Title II Disability benefits. The income limits are less than $24,432 if
single or less than $29,956 if married. The program has no asset test, but participants must enroll in a Medicare
prescription drug plan with a monthly premium below the regional benchmark. This year that benchmark is $35.01.
“These savings programs although available can be somewhat confusing,” Vicari said. “That is why we wanted to
help our residents through information and outreach.
“It’s important that our seniors, and their caregivers are educated on what is available to them and the ways
they can receive these important benefits,” Vicari said.
For more information on the new initiative contact the Ocean County Office of Senior Services at 732-929-2091.