Question; I recently received a packet of information from a third party who appears to be affiliated with my Medicare Advantage Plan. It says I may be eligible for the Medicare Savings Program you talked about a few weeks ago. It wants me to fill out the paperwork and send all my personal documents to them, and they will apply on my behalf. Is this a good idea?

Answer: I have recently received this type of question many times from individuals with Medicare Advantage Plans. Many of those Insurance companies, hire third party companies to handle this issue. So, the mail you received is most likely a legitimate mailing. My concern is the process they are using.

As I said in my article a couple of weeks ago, we are talking about the Medicare Savings Program (MSP). This is a Medicaid benefit administered by the Department of Social Services (DSS) in Chautauqua and Cattaraugus Counties.

Because the benefit is administered by our local county government, I don’t love the idea of mailing all your documents and personal information to a company in another state, who will then process it and send it back to your County Department of Social Services. I believe it makes more sense to simply complete the application yourself and deliver to your local DSS office. That way your personal documents are not mailed multiple times, increasing the possibility of getting lost or stolen.

I believe the Medicare Savings Program is a wonderful benefit and very much want you to apply for it, if you believe you are eligible. I would recommend you keep the information and application process closer to home.

I will briefly review the income rules and then talk about how to apply. The Medicare Saving Savings Program (MSP) includes multiple levels of benefits. I will be using the highest income allowed, which is the QI-1 level. The QI-1 benefit has an income cap (maximum) per household. The income cap for those over age 65 is $2494 for a one-person household and $3375 for a couple. This income includes all retiree income, (ie; Social Security, IRA’s, 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 reviewed in this application process, but not included in the calculation of your income.

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.

This reduction in your gross income could make a significant difference for some people. Some of these premiums could be significant. Medicare Supplement Insurance premiums have increased over the years, you may pay $250 monthly. This means that an individual with this monthly premium could make that much more in monthly income and still be eligible for the benefit ($2494 + $250 = $2744). This equation illustrates that higher income individual could be eligible for the QI-1 benefit.

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. Also remember this benefit does not count your assets (money you already have).

The QI-1 benefit (entitlement) pays your Medicare Part B premium, which means your SS benefit goes back to the gross amount that you receive in the bank. This benefit also could pay your Part D premium and reduces the cost of your medications at the pharmacy.

This benefit is what I call a ‘gateway’ benefit. Once you apply and are approved for this benefit, you also get the Low Income Subsidy (LIS) for your Part D plan, which pays the premium for your Part D coverage (up to $58.82) and reduces your co-pays at the pharmacy down to $5.10 for generics and $12.65 for brand name medications covered by your plan.

The application(s) for the MSP benefit can be obtained by going to the DSS office closest to you, Jamestown, Mayville, or Dunkirk in Chaut Co. In Catt Co you can go to Olean, or Little Valley. They can also be found on the www.mybenefits.ny.gov/ website. You can also call your local DSS office and request one be mailed to you.

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. Also remember this benefit does not count your assets (money you already have).

To apply for the Medicare Saving Program benefits 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 and IRA/401K type of assets. This application and the required proof of income, expenses and identification can be mailed to DSS or dropped off at DSS.

You can apply for this benefit anytime during the year. 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.

Thank you for being careful about responding to mail and phone calls you are not sure about. This protects you and your family from being taken advantage of or scammed. Consider the process I laid out and reach out for help and assistance.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.