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.
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Janell Sluga
Q: A couple of weeks ago you had an article about a benefit that paid your Part B premium. My friend gets that benefit, and she makes more per month than I do. I applied for that and got denied. How can that be?
A: A few weeks ago I wrote and article about the Slimb/QI-1 benefit recertifications that were mailed out by Department of Social Services (DSS). This Slimb/QI-1 benefit (entitlement) is part of the Medicare Saving Programs (MSPs). These programs are designed to help individuals and couples with lower incomes. The Slimb/QI-1 benefit has an income cap (maximum) per household. The income cap for those over age 65 is $1,277 for a one-person household and $1,723 for a couple. This income includes all retiree income, (ie; Social Security, IRAs, pensions, retirement annuities, VA pension, etc.). There is no resource test for this benefit. That means that the money in the bank, investments and stocks are not reviewed or included in this application process.
Often our gross income is different than our net income. I remember the difference with a rhyme, "Net is what you get." With regards to Social Security, most Americans have their Medicare Part B premium taken out before they receive their benefit. If someone's Social Security benefit amount is $1,700 per month, their net income is probably $1,601, the amount deposited in their account.
This entitlement does allow for some of your expenses to be deducted from your gross income. Those expenses include your health insurance premiums, dental insurance premiums and Long Term Care Insurance premiums.
Now I want to admit here that I did not always know this. I just learned about the Long Term Care Insurance premiums being an allowable expense. This could make a significant difference for some people. Usually Long Term Care Insurance (LTCI) premiums are a significant amount of money. If you pay $3,000 annually for this insurance premium, that works out to be $250 monthly. This means that an individual with LTCI could make that much more in monthly income and still be eligible for the benefit ($1,277 + $250 = $1,527).
Obviously this is just one of the deductions you can use as mentioned above. You can take that maximum income and review your own insurance premiums and determine if you are close to eligibility.
Another point of interest about the Slimb/QI-1 benefit is that it is what I call a "gateway" benefit. Once you apply and are approved for this benefit, you can get many other benefits, and they usually happen automatically. If eligible for Slimb/QI-1, you also get the Low Income Subsidy (LIS) for your Part D plan, which pays the premium for your Part D coverage and reduces your co-pays at the pharmacy down to $2.60 for generics and $6.50 for brand-name medications covered by your plan. If eligible for Slimb/QI-1, you can also get the 'Life-line' benefit, which is a $10.25 monthly credit on your Windstream phone bill. So, you can see why I so strongly encourage those with Medicare to think about their eligibility for this benefit.
To apply for the Slimb/QI-1 or Medicare Saving Program benefit you must fill out an application for DSS. The application is usually a simplified application consisting of one piece of paper (two sides). When reviewing the income that an individual or couple has, DSS requires proof of income. This application does not require a face to face interview. This application and the required proof of income, expenses and identification can be mailed to DSS or dropped off at DSS.
Hopefully this relatively long explication illustrates why someone making more money than you each month could get this benefit. You can also reapply for this benefit if you have been denied in the past, using these expenses listed above. You may then be eligible for this useful and extremely helpful benefit. I have seen this benefit make a significant difference in the households of many seniors.
Good luck and call with questions.
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.