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IDOI > Medicare and SHIP > Help Paying for your Medicare Costs Help Paying for your Medicare Costs

 

Extra Help Paying for Medicare Prescription Drug Coverage (Part D)

Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help, also called the low-income subsidy (LIS) if your yearly income and resources are below the following limits in 2012:

  • Single person—Income less than $16,355 and resources less than $13,070
  • Married person living with a spouse and no other dependents—Income less than $22,695 and resources less than $26,120

These amounts may change in 2013. You may qualify even if you have a higher income (like if you still work, live in Alaska or Hawaii, or have dependants living with you). Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs). Resources don’t include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person), or life insurance policies. If you qualify for Extra Help and join a Medicare drug plan, you will get the following:

  • Help paying your Medicare drug plan’s monthly premium, yearly deductible, coinsurance, and copayments
  • No coverage gap
  • No late enrollment penalty
  • You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:
  • You have full Medicaid coverage
  • You get help from your state Medicaid program paying your Part B premiums (in a Medicare Savings Program)
  • You get Supplemental Security Income (SSI) benefits

About the Medicare Savings Program

Indiana helps eligible, low-income beneficiaries pay for Medicare with the Medicaid program.
Medicaid is a health care program that helps pay for medical services for people who meet specific requirements.

You may be eligible depending on your income and the value of things you own (Effective March, 2012):

  • Do you have Medicare Part A Hospital Insurance? (Look at your Medicare card.)
  • Is your monthly income at or below $1,277 (single person) or $1,723 (married couple)?
  • Are your financial assets, such as bank accounts, below $6,680 (single person) or $10,020 (married couple)?


INCOME ASSETS
Qualified Medicare Beneficiary SINGLE $951 $6,940
COUPLES $1,533 $10,410
Specified Low Income Beneficiary SINGLE $1,137 $6,940
COUPLES $1,471 $10,410
Qualified Individual SINGLE $1,277 $6,940
COUPLES $1,723 $10,410

Assets are things you own, such as checking and savings accounts, certificates of deposit, cash value of life insurance, stocks and bonds.  Some things you own don't count toward your asset limit, such as your home and furnishings, your car, burial plots, and, at least $1,500 in life insurance.

These limits are guidelines. The only way to know for sure if you are eligible is to apply.

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Application Information

You may visit or call your local Office of Family and Children to apply for Medicare Buy-In.  You will need to complete an application form and participate in an interview.  The interview can take place in person or over the telephone.  Within 45 days, you will receive a notice in the mail that tells you whether your application was approved.

Click here for the application.

For more information about enrollment centers or Medicaid call:

  • Your Area Agency on Aging (AAA) at 1-800-986-3505
  • SHIP at 1-800-452-4800

If your application is denied, you have the right to appeal within 30 days of the denial.  You may contact your local Area Agency on Aging or Senior Law Project for assistance with appeals.

Local Agency Contacts

View a complete list of agency contacts.

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Prescription Drug Plan Options

There are a variety of prescription drug plans to choose from.  These plans include:

  • Medicare Prescription Drug Plans
  • Hoosier Rx
  • Low Cost Drugs 
  • Finding Help with Prescriptions Guide 
  • Pharmaceutical Manufacturers Association Free Medications Directory

2013 Standard Part D Benefit

 Benefit Parameters  2012  2013
 Deductible  $320  $325
 Initial Coverage Limit $2,930  $2,970 
 Out-of-Pocket Threshold  $4,700 $4,750 
 Total Covered Drug Spend at Out-of-Pocket Threshold  $6,657.50 $6,733.75 
 Minimum Cost-Sharing in Catastrophic Coverage  $2.60/$6.50 or 5% $2.65/$6.60 or 5% 
 LIS Copayments  2012 2013
 Institutionalized (with full Medicaid benefits)  $0 $0 
 Up to or at 100% FPL  $1.10/$3.30 $1.15/$3.50 
 Other LIS  $2.60/$6.50 $2.65/$6.50 
 Partial LIS Deductible/ Cost-Sharing  $65/ 15%  $66/ 15%

$0 Premium LIS Qualified Plans in Indiana for 2013

Organization  Plan Name Phone Number 
 Express Scripts Medicare Express Scripts Medicare Value   800-447-5704
 HealthMarkets Medicare Reader's Digest Value Rx  888-625-5531 
 SmartD Rx SmartD Rx Saver  855-976-2781 
 Cigna Medicare Rx Cigna Medicare Rx Plan One  800-735-1459 
 First Health Part D First Health Part D Premier  800-588-3322 
 SilverScript SilverScript Basic  866-552-6106 
 United American Insurance Company United American Select  866-524-4169 
 Envision Rx Plus Envision Rx Plus Silver  866-250-2005 
 Humana Insurance Company Humana Walmart - Prefered Plan   800-706-0872
 United Healthcare AARP MedicareRx Saver Plus  866-679-3282 
 Aetna Medicare Aetna CVS/Pharmacy Prescription Drug Plan 800-832-2640 

Medicare Prescription Drug Plans

People with Medicare can enroll in a Medicare prescription drug plan and receive extra help paying for the premiums, deductibles, gaps in coverage and co-pays. The 2012 resource limits are $8,440 ($13,410 if married) for the full low-income subsidy.

Hoosier Rx

Hoosier Rx is Indiana's prescription drug plan for low-income seniors. If you are an Indiana resident, age 65 or over, receive a low monthly income, and are without insurance that has a prescription drug benefit, you may qualify.

HoosierRx does not consider your assets; it only considers your income. So if your yearly net income is $16,995 or less for an individual or $22,935 or less for a couple, you could receive help paying for your Medicare prescription drugs.

To apply call free of charge 1-866-267-4679 or visit the Hoosier Rx website.

Click here for the Hoosier Rx application.

VA Prescription Benefit

If you are an honorably discharged veteran, consider using your VA drug benefit ($8 per prescription per month).  Veteran can use the VA drug benefit by mail order for their monthly maintenance drugs and still use Medicare Part D for other prescriptions.  To apply, call 1-877-222-8387.

Low Cost Drugs

Several national pharmacies have announced they are drastically reducing the cost of generic prescription drugs. Meijer boasts no cost for generic antibiotics. Target, Wal-Mart and Sam's Club charge $4 for generic drugs, but the list includes more than antibiotics.

For a complete listing of what each pharmacy offers, log onto their respective Web sites

Pharmaceutical Manufacturers Association Free Medications Directory

Many pharmaceutical companies have programs which provide free or low cost medications to those in need regardless of age.

Most of these programs require that you:

  • Do not have insurance that covers outpatient prescription drugs
  • Do not qualify for government assistance
  • Have income within their stated guidelines

The application process is different for each company. Usually a doctor must sign your completed application form and have his/her office submit it for you. Rx for Indiana can provide assistance with matching your prescriptions with these assistance programs. Contact Rx for Indiana at 1-877-483-9275.

Visit the Rx for Indiana website.

Trained SHIP counselors at sites throughout Indiana can also guide you in getting and completing applications from drug companies.   

Finding Help with Prescriptions Guide

"Finding Help with Prescriptions" Guide is a free publication. It provides helpful information for lowering your prescription costs including low-income assistance, patient assistance programs, mail order prescription services, veterans pharmacy benefits, and Community Health Centers.

To request a copy, call SHIP free of charge 1-800-452-4800.  

To request a copy online and request a copy click here.