Hi Toni:
Maybe you can answer this for my mother who is 84 years old and HAD!!! Medicaid QMB. In June, she lost her Medicaid QMB benefits because she was only $2.00 over the $931allowable amount. Now she has SLMB which only helps with prescriptions, but pays nothing for Medicare’s hospital deductible or her Part B 20% out of pocket. She went to the emergency room at Clear Lake Regional and it cost her $500 which is her 20%.
She now wants to give her “little” cost of living raise back to the government, so she can be below the $931 and wants everything to go back like it was. Change is not easy for an 84 year old who is scared of what the future holds. She is worrying herself silly! Can you please give me some ideas of how I can get the out of pocket for her Medicare paid for that is affordable? There must be something she can do. Thanks, Sammy a frustrated son from Alvin, TX
Hello Sammy:
Since those on Medicare have received the cost of living increase on their Social Security this year, I receive at least 4 calls a week concerning someone losing their Medicaid QMB. I do not believe that your mother can give back her Social Security raise, but it doesn’t hurt to call Social Security at 1/800-772-1213 and ask them. I’ve never heard of anyone giving it back, but it is worth a try. Most are so happy just to be getting a cost of living raise, but that small raise did not help your mother because now she has to pay more for her healthcare.
When one with Medicare has Medicaid QMB (Qualified Medicare Beneficiary), then you have zero out of pocket because the state picks up all of the Medicare deductibles and co-insurance with Medicaid. Your mother now has SLMB (Specified Low-Income Medicare Beneficiary) and her Part B premium of $99.90 as well as her Part D premium should be paid for by the state. Her Part D co pays may be $0, $1.10 or $2.60 for generic drugs and $0, $3.30 or 6.50 for brand name drugs, and the “Donut Hole” or coverage gap for prescription drugs should be waived. She is upset that she lost her Medicaid QMB, but having Medicaid SLMB is a blessing because it can still help with her prescriptions.
To help with the Part A hospital deductible of $1,156 that deductible can be 6 times a year because it is a 60 day benefit (don’t faint) and Part B’s $140 deductible and 20% co-insurance, you mother has 3 options to choose from.
Option #1: Apply for a Medicare Supplement with a stand alone Part D prescription drug plan. There are many to pick from, but she will have a premium. This can be unaffordable if your mother is on a fixed income, but she can pick and choose her doctors/providers if they are currently accepting “Original” Medicare.
Option #2: Look into Medicare Advantage Plans and many plans can have
“Extra Help” or Special Needs plans for those with SLMB. Many plans have zero (0) co pays for Part A and B out of pocket expenses. You can also have Part D included in the Medicare Advantage plan.
Option #3: Is “Original” Medicare with a stand alone Part D prescription drug plan.
The income eligibility for:
- QMB income must be equal to or below $931/individual or $1261/couple
- SLMB income must be equal to or below $1,117/individual or $1513/couple
If you income is above these amounts, then you will lose those Medicaid benefits and $1 can be too much. This is just so sad when everyone is trying to save a dollar and does not know what the future holds.
Toni King is an advocate/consultant for those “Confused about Medicare”. Medicare open enrollment begins Oct 15th and if you would like a Confused about Medicare workshop for your church, group or company send Toni an email at asktoni@medicaretruths.com or call 281/830-3896. Visit www.medicaretruths.com and visit Toni’s new blog “Toni Says” at tonisays.com
