Medicare FAQ

Questions:

• What is Medicare?
• Who is eligible for Medicare Part A coverage?
• How much of my bill will Medicare Part A pay?
• Who is eligible for Medicare Part B coverage?
• What kinds of costs does Medicare Part B cover?
• How much of my bill will Medicare Part B pay?
• Who is eligible for Medicare Part D coverage?
• How much does Medicare Part D cost?
• Can I get any of Medicare Part D's costs waived?

Answer:

Can I get any of Medicare Part D's costs waived?

Low-income Medicare beneficiaries may qualify for a subsidy to help pay costs associated with Part D plans. This subsidy is called Extra Help. Also, under certain circumstances, the copayment for prescriptions may be waived or reduced.

You may qualify for a low-income Part D subsidy if:

• you are eligible for Medicaid, or
• your income is no more than 149% of the federal poverty guideline (see "2009 HHS Poverty Guidelines", available from the U.S. Department of Health and Human Services' website at http://aspe.hhs.gov), and your assets, not including your own home, are less than $11,570 ($23,120 for a married couple).

You can learn more about eligibility requirements and apply for a subsidy at the Social Security Administration office online at www.ssa.gov.

In addition to low-income subsidies, circumstances exist in which a Part D plan enrollee may not have to pay the normal copayment for a covered drug. These include:

• People who live in a long-term care nursing facility, and who are enrolled in both Medicare Part D and Medicaid, have no copayments.
• Some plans waive or reduce copayments for certain drugs, particularly generic versions, to coax people to join that particular plan. But the plan can change this copayment waiver at any time.
• Pharmacies may waive copayments for any enrollee with a low-income subsidy, for any drug. But the waiver is not automatic; you have to ask for it.

To discover the benefits you're entitled to and claim them as easily as possible, get Social Security, Medicare & Government Pensions: Get the Most Out of Your Retirement & Medical Benefits, by Joseph Matthews with Dorothy Matthews Berman (Nolo).