Q & A: March/April 2022

Q:  I Need Help With Healthcare Costs, But My Income Is Too High.  What Can I Do?

Since getting COVID a year ago, I’ve developed asthma after having no asthma symptoms for over 35 years. Now I need a medication to prevent the asthma attacks I get almost daily, but it costs over $700 a month.  I’m unable to afford it so instead I use an emergency generic inhaler which sometimes doesn’t work.  I supposedly make too much money to qualify for food stamps, but after paying for Medicare and my supplemental coverage, I’m left with $1,600 a month.  It’s not enough for my expenses. With the asthma and being over age 65, I can’t work and need help.  P. W., FL

A:  For help with prescription drug costs, try the Medicare Extra Help Program.  The program helps people with limited income and resources pay costs associated with prescription drug coverage.  It pays most, or all, of the monthly premium of the drug plan, as well as the annual deductible and co-payments.  Medicare estimates the coverage to be worth about $5,100 per year.  Many people qualify and don’t even know it.

It appears to us that your income might be low enough to qualify for benefits.  (Medicare Extra Help allows you to have slightly more income than you are allowed to have for food stamp programs.)  To qualify for Extra Help, your annual income must be limited to $20,385 for an individual or $27,465 for a married couple living together.  However, there are also resource limits to satisfy as well.

Resources include the value of bank accounts, savings and certificates of deposit, stocks, bonds, mutual funds, Individual Retirement Accounts (IRAs) and real estate other than your primary residence.  To qualify for Extra Help, your resources must be limited to $15,510 for individuals or $30,950 if you are married and filing jointly.  The Social Security Administration does not count the value of your primary residence as a resource, your vehicle and a number of other things, such as housing assistance.

To determine if you are eligible for Extra Help, you must file an Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020) on the Social Security Administration’s website.  After you apply, your application will be reviewed and you will be sent a letter to let you know if you qualify for Extra Help.

If you qualify, you will still need to select a drug or Medicare Advantage plan and enroll to get coverage.  To get additional assistance, you may want to speak to a Medicare benefits counselor for advice and assistance in choosing your best plan.  You can get contact information for counselors in your area by visiting the website of State Health Insurance Assistance Programs (SHIP) — https://www.shiphelp.org.