From premiums to copays and deductibles, it can feel so difficult to afford health insurance—especially with rising costs all around us. In this Medicare Minute, we’ll tell you about programs that can help you save on your Medicare costs. Expect to hear about programs like the Medicare Savings Program, Extra Help, and more. You can also attend our “SHINE Medicare Financial Assistance” webinar held by our SHINE Medicare experts at the beginning of every month. Visit our event calendar for dates.
What is the Medicare Savings Programs?
Medicare Savings Programs (MSPs) are state programs that help cover your Medicare costs. To qualify for a MSP, you must meet your state’s income and asset limits. Below are the baseline federal income and asset limits for each MSP. Most states use these limits, but some states have different guidelines, such as different income limits or not imposing asset limits. You should consider applying for the MSP even if you are over the limits, because some income and assets are not counted toward the limits. There are three main programs, each with different benefits and eligibility requirements:
MSP
|
Benefits
|
Monthly income limit
|
Asset limit
|
Qualified Medicare Beneficiary (QMB)
|
– Pays Part A and B premiums
– Eliminates cost-sharing for Medicare-covered services
|
Individual: $1,275
Couple: $1,724
|
Individual: $9,430
Couple: $14,130
|
Specified Low-income Medicare Beneficiary (SLMB)
|
– Pays Part B premium
|
Individual: $1,526
Couple: $2,064
|
Individual: $9,430
Couple: $14,130
|
Qualifying Individual (QI)
|
– Pays Part B premium
|
Individual: $1,715
Couple: $2,320
|
Individual: $9,430
Couple: $14,130
|
What is Extra Help?
Extra Help is a federal program that helps pay for most of the out-of-pocket costs of Medicare prescription drug coverage. If you have Medicaid, and MSP or receive Supplemental Security Income, you will be automatically enrolled in Extra Help. If you are not enrolled in these programs, you must apply directly and meet the eligibility requirements below:
Income limit
|
Asset limit
|
Benefits
|
Individual: $1,903 /month
Couples: $2,575 /month
|
Individual: $17,220
Couples: $34,360
|
$4.50 generic copay
$11.20 brand-name copay
$0 deductible and premium (for a basic Part D plan with a premium at or below your state benchmark)
|
Medicare Cost Assistance Programs
Below is information on programs that can help you save on your Medicare costs. To learn more about these programs and receive help with applications, contact your local State Health Insurance Assistance Program (SHIP), known as SHINE (Serving Health Insurance Needs of Elders) in Southwest Florida, at 866-413-5337 or email shineinfo@aaaswfl.org.
What other programs can help me save money on my care?
State Pharmaceutical Assistance Programs (SPAPs)
• Many states offer SPAPs to help residents pay for prescription drugs.
• Each program works differently and has different requirements for eligibility.
• To learn if your state has an SPAP and find out if you qualify, call your SHIP.
Facilities that may offer care at a reduced cost
- Human Resources and Services Administration (HRSA) facilities
- HRSA facilities may also be called Federally Qualified Health Centers (FQHCs).
- Hundreds of these government-funded health centers around the country provide medical care regardless of your ability to pay.
- For more information, contact your SHIP.
- The Hill-Burton Program
- The Hill-Burton Program offers free or reduced cost care at Hill-Burton facilities.
- Most states have the Hill-Burton program.
- Services that are fully covered by other types of insurance (like Medicare or Medicaid) are not eligible for Hill-Burton coverage.
- Eligibility for the Hill-Burton program is based on your income and family size.
- To apply, call the Admission, Business, or Patient Accounts office at a Hill-Burton facility.
Medicaid
- People can be eligible for both Medicare and Medicaid.
- Medicaid can cover services that Medicare does not, like long-term care.
- It can also pay secondary to Medicare, picking up Medicare’s out-of-pocket costs, like copayments or coinsurances.
- Generally, your income and assets must be below a certain amount to qualify, but this amount varies from state to state and from program to program.
- Call your local Medicaid office to learn about Medicaid programs in your state.
What other benefits, rights, and protections come with MSP? Download the full handout on Medicare Savings Programs this post is an excerpt from for more.
Call your local SHIP and SMP at 866-413-5337 or email shineinfo@aaaswfl.org for assistance.
The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. [July 2024]
Last Updated: July 30, 2024 by Leave a Comment
Medicare Minute: Common Fall Open Enrollment Notices
In the month or two leading up to Medicare’s Open Enrollment that runs from October 15 to December 7, expect some important letters about your Medicare! These notices will tell you how your coverage and costs are changing next year. During this Medicare Minute, you’ll learn what to look out for in these notices so that you can evaluate how well your coverage will meet your needs in 2025. For details and a quick reference guide, a handout by the State Health Insurance Assistance Program (SHIP) is available for download.
Common Open Enrollment Notices include:
Reminder to Read Your Medicare Statements
It is important to read your Medicare statements especially during Open Enrollment as you may be switching plans.
You should receive Medicare Summary Notices (MSNs) if you have Original Medicare (You can also review your MSNs on your online Medicare.gov account).
You should receive Explanation of Benefits (EOBs) if you have a Medicare Advantage Plan or Part D plan.
MSNs and EOBs provide a summary of the services and items you have received and how much you may be billed for them. Remember that MSNs and EOBs are not bills. If you need help reviewing your Medicare statements, you can contact your local SHIP or Senior Medicare Patrol (SMP).
Reading your MSNs and EOBs is an important strategy for detecting potential Medicare fraud, errors, or abuse. Keep the following tips in mind:
For more help, contact your local SHIP, also known as SHINE in Florida (Serving Health Insurance Needs of Elders). Call 866-413-5337 or email shineinfo@aaaswfl.org.
Contact your local SMP if you receive any notices or Medicare statement charges that seem suspicious. SMP representative can teach you how to spot and protect yourself from potential Medicare fraud, errors or abuse. Your local SMP can be reached at 66-413-5337 or by emailing shineinfo@aaaswfl.org.
The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. [July 2024]
Last Updated: August 27, 2024 by Leave a Comment
Area Agency on Aging Hosts 2nd Annual Community Resource Fair
In an effort to connect older adults and adults with disabilities in Southwest Florida to important resources and services, the Area Agency on Aging for Southwest Florida (AAASWFL) is hosting their second annual Community Resource Fair at its offices in Fort Myers. The event is scheduled for Friday, September 13, 2024, from 10:00 a.m. to 12:00 p.m. at 2830 Winkler Avenue, Suite 112, Fort Myers, FL 33916.
Anticipated exhibitors that community members can engage with include Lee Health – providing free health screenings, Florida Power & Light (FPL) – sharing information about lowering utility costs, and Sam’s Club – providing membership opportunities.
Door prizes will be raffled during the event and community members can connect with essential resources for living safely and independently. The Pacos Tacos food truck will be on-site and open for purchasing snacks.
If you plan on attending AAASWFL’s 2024 Community Resource Fair, complete this brief form: Event Registration.
Exhibitor opportunities are still available, contact Sarah Gualco, Director of Programs and Planning at sarah.gualco@aaaswfl.org if your organization is interested in partnering with the Area Agency on Aging for SWFL for this event.
The Area Agency on Aging for Southwest Florida is a 501(c)3 organization serving Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota Counties. AAASWFL has been operating for 45+ years to provide information and referrals, screening and assessment for Long-Term Care programs, and Medicare counseling. More information is available by visiting the AAASWFL website (www.aaaswfl.org) or by calling the Helpline: (866) 413-5337.
Posted: July 29, 2024 by Leave a Comment
Helping Seniors Stay Connected with Free Tablets!
To help combat social isolation and promote digital literacy, the Area Agency on Aging for SWFL recently offered free tablets along with technology training in three of the seven counties we serve. We partnered with several local organizations to host and assist with training.
Thank you to the following organizations for your support in engaging members of your community:
Collier County Public Library, Everglades City
Dr. Piper Center for Social Services
Lee County Library System
Neighbors Network of Lee County
Senior Friendship Centers of DeSoto County
Unity of Fort Myers
The training sessions also served as an opportunity for the Area Agency on Aging for Southwest Florida to share valuable resources with participants, including navigating our website to find upcoming events, connecting to SHINE Medicare counseling, and signing up for health and wellness classes.
It was a great experience for everyone involved.
We appreciate The Community Foundation for the generous grant that made this opportunity possible!
Posted: July 26, 2024 by Leave a Comment
Make a Difference by Helping Others Navigate Medicare!
Navigating Medicare can be complicated but SHIP counselors can help by answering questions and providing personalized guidance to those who need it.
Make a difference by helping others navigate Medicare, join our team! In Florida, your local SHIP program is SHINE (Serving Health Insurance Needs of Elders). Learn more about volunteering with SHINE. We currently need volunteers in DeSoto, Glades, Hendry and Sarasota counties.
SHINE provides unbiased support to Medicare beneficiaries and their families so they can make informed decisions about their care and benefits.
Last Updated: July 29, 2024 by Leave a Comment
Medicare Minute: Cost Saving Programs
From premiums to copays and deductibles, it can feel so difficult to afford health insurance—especially with rising costs all around us. In this Medicare Minute, we’ll tell you about programs that can help you save on your Medicare costs. Expect to hear about programs like the Medicare Savings Program, Extra Help, and more. You can also attend our “SHINE Medicare Financial Assistance” webinar held by our SHINE Medicare experts at the beginning of every month. Visit our event calendar for dates.
What is the Medicare Savings Programs?
Medicare Savings Programs (MSPs) are state programs that help cover your Medicare costs. To qualify for a MSP, you must meet your state’s income and asset limits. Below are the baseline federal income and asset limits for each MSP. Most states use these limits, but some states have different guidelines, such as different income limits or not imposing asset limits. You should consider applying for the MSP even if you are over the limits, because some income and assets are not counted toward the limits. There are three main programs, each with different benefits and eligibility requirements:
MSP
Benefits
Monthly income limit
Asset limit
Qualified Medicare Beneficiary (QMB)
– Pays Part A and B premiums
– Eliminates cost-sharing for Medicare-covered services
Individual: $1,275
Couple: $1,724
Individual: $9,430
Couple: $14,130
Specified Low-income Medicare Beneficiary (SLMB)
– Pays Part B premium
Individual: $1,526
Couple: $2,064
Individual: $9,430
Couple: $14,130
Qualifying Individual (QI)
– Pays Part B premium
Individual: $1,715
Couple: $2,320
Individual: $9,430
Couple: $14,130
What is Extra Help?
Extra Help is a federal program that helps pay for most of the out-of-pocket costs of Medicare prescription drug coverage. If you have Medicaid, and MSP or receive Supplemental Security Income, you will be automatically enrolled in Extra Help. If you are not enrolled in these programs, you must apply directly and meet the eligibility requirements below:
Income limit
Asset limit
Benefits
Individual: $1,903 /month
Couples: $2,575 /month
Individual: $17,220
Couples: $34,360
$4.50 generic copay
$11.20 brand-name copay
$0 deductible and premium (for a basic Part D plan with a premium at or below your state benchmark)
Medicare Cost Assistance Programs
Below is information on programs that can help you save on your Medicare costs. To learn more about these programs and receive help with applications, contact your local State Health Insurance Assistance Program (SHIP), known as SHINE (Serving Health Insurance Needs of Elders) in Southwest Florida, at 866-413-5337 or email shineinfo@aaaswfl.org.
What other programs can help me save money on my care?
State Pharmaceutical Assistance Programs (SPAPs)
• Many states offer SPAPs to help residents pay for prescription drugs.
• Each program works differently and has different requirements for eligibility.
• To learn if your state has an SPAP and find out if you qualify, call your SHIP.
Facilities that may offer care at a reduced cost
Medicaid
What other benefits, rights, and protections come with MSP? Download the full handout on Medicare Savings Programs this post is an excerpt from for more.
Call your local SHIP and SMP at 866-413-5337 or email shineinfo@aaaswfl.org for assistance.
The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. [July 2024]
Posted: June 24, 2024 by Leave a Comment
Donut Hole? Medicare Drug Plan Coverage Gaps
Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for drugs. You enter the coverage gap when your total drug costs—including what you and your plan have paid for your drugs—reaches a certain limit.
In 2024, that limit is $5,030. While in the coverage gap, you are responsible for 25% of the cost of your drugs.
A SHIP (SHINE) counselor can answer your Medicare questions and help you understand coverage and options!
To reach SHINE, call the Helpline at 866-413-5337.
Posted: May 28, 2024 by Leave a Comment
Medicare Minute: New to Medicare
If you or a loved one will soon be eligible for Medicare, join us for this Medicare Minute! We’ll go over all the basics you should know—from enrollment periods to coverage choices and beyond.
Some people are automatically enrolled in Medicare. For example, if you are already receiving retirement benefits from Social Security when you become Medicare-eligible, or if you’ve been collecting Social Security Disability Insurance for two years. If you are automatically enrolled, you should receive a package in the mail with your Medicare insurance card telling you so. Otherwise, there are three times to enroll in Parts A and B:
Initial Enrollment Period (IEP): The three months before, the month of, and the three months after your 65th birthday.
Special Enrollment Period (SEP): Allows you to delay Medicare enrollment without owing a late enrollment penalty. You may qualify for an SEP if:
General Enrollment Period (GEP): Every year from January 1 through March 31. You may owe a late enrollment penalty and face gaps in coverage if you use the GEP.
Download the full “New to Medicare” handout by the State Health Insurance Assistance Program (SHIP).
The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. [April 2024]
Posted: April 30, 2024 by Leave a Comment
Spot the Signs of Elder Abuse
Abuse can happen to any older person. Learn about the different types of abuse, how to recognize the signs, and where to get help.
Source: NIIH.org
There are different types of abuse:
Be alert to the following signs:
Depressed, confused or withdrawn
Isolated from friends and family
Unexplained bruises, burns or scars
Appear dirty, underfed, dehydrated, over or under medicated
Bed sores
Changes in banking or spending patterns
Posted: April 30, 2024 by Leave a Comment
Medicare Minute: Preparing for Future Health Care Needs
Many people assume that their family members would automatically be able to make decisions about medical treatments if they were to become incapacitated. However, rules vary greatly from state to state:
It’s important to have a plan ahead of time to avoid disagreements around treatment issues and to ensure your wishes are honored if you are incapacitated. Advance directives, living wills, health care proxies, and powers of attorney can help ensure that decisions made on your behalf meet your needs and preferences.
Important documents to have include:
For detailed tips on preparing these documents download the “Preparing for Future Health Care Needs” handout by the Medicare Rights Center.
To understand how Medicare covers hospice and for answers to other Medicare coverage questions, contact your State Health Insurance Assistance Program (SHIP). You can visit www.shiphelp.org or call your local SHINE Medicare Counselors at 1-866-413-5337.
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