Q: My medication co-pays have increased significantly. I don't think I can afford all these bills. What can we do to get help? What are the eligibility levels for Medicaid and how do we qualify?
A: Beginning Jan. 1, the changes to EPIC could impact seniors at the pharmacy in a pretty expensive way. Seniors will now be paying the co-pays that reflect their Medicare Part D plan only, with no additional coverage thru EPIC (until they have reached the coverage gap). Once seniors have reached the coverage gap in their Medicare Part D plan, EPIC helps pay for their medications.
This means that some seniors will be paying much more for their medications. Those of us who work with seniors and help them figure out these problems want you to know there are some solutions to those high co-pays.
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Senior Life Matters
One solution is to use generic medication whenever you can. This generic medication will cost you less money when you fill them at the pharmacy.
Another solution is to consider applying for Medicaid. Medicaid is an entitlement program that helps seniors to pay their medical bills. This benefit is calculated on the amount of monthly income that you have. Some of the Medicaid programs also include your resources or assets, some programs do not.
In the application process for Medicaid you complete the application and then supply proof of your income and expenses. If your income is too high to be covered, you can deduct certain expenses to reduce your income to the allowable amount.
Fact Box
As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms are different, the prices are different, the products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
For example, to qualify for the Medicare buy-in program or Qualified Medicare Beneficiary (QMB) program, the monthly income cap for a one-person household is $928, or for a two-person household is $1,246.
You may look at those incomes and say, ''I make more than that, so I don't qualify.'' That may be true, but you may be able to reduce your income with expenses that you have. You make $1,300 in Social Security and your retiree pension. Your health insurance costs $111 monthly, your medications for the month of January cost $320. They cost that much because you were in the deductible for your Part D Plan. You could apply for the QMB program in the month of January or February because your monthly income would be reduced by your monthly expenses. The medications you paid for can be used to reduce that income. This means that you could be approved for the QMB program and your medication co-pays would be reduced to $2.50 and $6.30 for your generic and name-brand medications. This would require a one-time application, but save you money all year long.
This particular program does not include a resource test - that means it doesn't include your resources as part of the requirements.
Those individuals who have lower resources (under $13,800) could apply for Community Medicaid, giving them even more benefits and cost reductions. For a Community Medicaid application, the worker not only looks at your monthly income, but also reviews the money, investments and resources that you have. This includes money in the bank, stocks, bonds, credit union accounts, property/real estate and investments. The asset test for a two-person household is $20,100.
For Community Medicaid (those individuals living in their own apartment or homes, and in some situations an adult home or assisted living facility), you can receive $767 per month. A two-person household can receive $1,117 per month, and if you are over 65 years of age, are blind or disabled, this income amount increases by $20 a month.
It is my hope that seniors throughout our area will take advantage of these programs and apply for Medicaid. This application process may sound like a hassle, but if your medication co-pays have increased significantly this year, or you have medications which are not covered by Medicare Part D and you are paying full price for them, this program can save you a lot of money in 2012 and maybe beyond that.
To apply for Medicaid you contact your local Department of Social Services Office (DSS) at 661-8246. DSS will mail you information about these programs, mail you an application and set up an appointment if one is necessary. You do not need to go to DSS to process the application, it can be done thru the mail or in person.
As with all programs like this, your application and approval for this entitlement could make a significant positive difference in your life. I know that seniors are paying more for their prescription this year and that worries me. It is important to realize there are many opportunities to save you money, which you may not know about. Your higher cost of living and taking medications may very well be helped with the Medicaid options available to you.
Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing, and has worked in Chautauqua County with seniors for more than 18 years. She is HIICAP (Health Insurance Information, Counseling & Assistance Program) counselor-trained by Office for the Aging. She does not sell insurance or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.
You may submit questions to be answered in later columns to Janell Sluga at Senior Life Matters, 737 Falconer St., Jamestown, NY 14701, or call 716-720-9797, or by email at janells@lutheran-jamestown.org. Please remember that not all questions can be answered in this format, but as many as can be, will be.