There are many programs at the state and federal level that can assist your Medicare clients with the cost of their healthcare. Let’s look at the main ones.
Medicaid Is A Joint Venture Between Each State And The Federal Government
That means that we have 50 different Medicaid programs and if you work in multiple states you have a huge learning curve! In general, Medicaid is for people with low incomes and low assets. Your Medicare clients may be eligible for both Medicare and Medicaid. Medicaid may help pay for the copays and deductible not covered by Medicare. Medicaid in many states offers extra benefits not found in original Medicare, such as dental coverage. Some state Medicaid programs offer free transportation to doctor visits.
Extra Help Is A Federal Program To Assist With Part D Drug Costs
Also known as a Low Income Subsidy (LIS), Extra Help allows your clients with low incomes and minimal assets to get help paying for their prescriptions. Sometimes you won’t have to apply for Extra Help if you’ve already been enrolled into the Medicare Savings Program below, as the government automatically enrolls your clients. Help your clients apply for Extra Help here.
Medicare Savings Program Help Cover Medicare Costs
A MSP helps people who don’t qualify for Medicaid but still need help paying for their Medicare costs. There are several different types of MSP and they will all pay the Medicare Part B monthly premium.
Each State Also Has A Drug Assistance Program (SPAP) For Low Income Members
Like the other assistance programs above, SPAPs also have income thresholds to qualify. Some states are very lenient (NY) and others not so much. Check out this list of plans by state. This catches Medicare members when they move to new states and find out their new home is not as generous with its pharmacy assistance program. For example, in my home state of Indiana our program is called Hoosier Rx. To qualify, your client’s income must be $18,975 or less if she is single or $25,605 a year or less if married and living together. Your clients must show proof of income to apply and it typically takes about 4-6 weeks for acceptance or denial.
Caution: A Small Inheritance Can Cause Your Clients To Lose Assistance
I see this every year. A client who can’t figure out why he lost his assistance. Upon questioning, he inherited a small amount of money that he put in the bank for a rainy day–and it caused him to lose his benefits. Agents may recommend that the inheritance be spent on home repairs, a new car or a gift to a child, so the member can regain the monthly benefits. Doing the math, the inheritance could cost more than it was worth!
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Sylvia Gordon and her sister, Rebecca, run Gordon Marketing, one of the nation’s largest Medicare FMO/NMA offices. They have a team of over 100 that train and support independent insurance agents in all 50 states. You can find Sylvia’s weekly posts on LinkedIn and the sisters' Youtube channel posts 2 training videos each week. Contact Sylvia at sgordon@gordonmarketing.com or 800-388-8342.