Help With Medicare For Seniors - Confused?

"What's Your Zip Code" - Will You Qualify For Medicare Discounts?

Confused about the advertisements offering free benefits like dental, vision, and drugs? So were we, and we attempted to navigate through the confusion and hype offered by insurance companies and called Medicare and Social Security directly today.

First we tried to get official information from Medicare directly to see how to qualify for extra help in paying for Medicare. We called 1-800-MEDICARE (1-800-633-4227.)

The operator answered within a few minutes and put us through the screening questions, asking for social security number, name, address. 

Then asking how much Part B Medicare would cost this year and how to quality for extra help, we heard the operator apparently reading from a script explaining how to apply for Social Security and Medicare, information we were't asking for.

It was eventually confirmed that this year's Part B was $170.10 for folks already signed up for Part B. We would have to call Social Security to find out about extra help benefits to pay Medicare premiums, and given the number 1-800-772-1213, and notified they are open 8 a.m. to 7 p.m. Monday through Friday.

Calling Social Security, we were put on hold for 25 minutes, and the operator answering went through the verification process again. 

Asked about enrolling in Part B and the penalty for those who are not currently enrolled, the monthly premium increase 10% for each year not enrolled, so it would double to $340.20 for someone who had waited 10 years to enroll in Part B. 

We were told the Federal government, that is Social Security, does not directly give extra help on paying for Medicare, but each state offers their own plans and restrictions. To get the answer for getting extra help for Part D or help paying Part B as promoted by the insurance company advertising, we were told to call the state's Medicare number.

In South Florida it's SHIP for Florida - SHINE (Serving Health Insurance Needs of Elders), a private non-profit agency at 1-800-963-5337. This office is in Tampa and upon reaching them, were told we need to call the Fort Myers Area Agency On Aging For Southwest Florida at 239-632-6900.

(UPDATE: The new number for Fort Myers AAA for SW Florida is 866-413-5337, then hit #2 for a Shine counselor.)

Working through the 'punch this number and that number', we waited on hold for a SHINE counselor. These are volunteers, trained to help with Medicare questions. After 20 minutes on hold, the phone line disconnected. We didn't try calling back.

Next, we tried to find answers online. Searching on Google for "Florida Medicare Extra Help" we found a selection of websites to choose among. Along with official government sites were lots of insurance company sponsored offerings. We chose what we though was an official Medicare site (not remembering government sites are ".gov"), and were taken to:

https://q1medicare.com/PartD-LISWhaIsPDExtraHelpResourceLimit.php, 

This is one of a large selection of helpful pages online by a private organization, Q1Group. Q1Medicare.com is a neutral online resource to "educate seniors, Medicare beneficiaries, advocates, agents, and members of the general public who are interested in Medicare Part D prescription drug plans and/or Medicare Advantage plans." They provide information on the Medicare Part D program and plans. 

We found this page of additional help on explaining Medicare, Medicaid, "Extra Help" and Low-Income Subsidy (LIS) published again by Q1Medicare.com.

And we check here for Medicare Savings Programs (help from Medicaid paying Medicare premiums).

Unable to yet find an official Medicare page answering the question of who qualifies and of how to get Medicare Part D Extra Help or help paying Medicare Part B, we looked to the above pages as giving some answers we could not find elsewhere.

(UPDATE - Here's a very good summary for getting financial help paying for Medicare and what assets and income qualifies, courtesy of SHINE: https://training.floridashine.org/Website_Resources/Bene_FS/BFinancialAsstBENE.pdf )

We tend not to believe all of the TV advertising claims and expected them to be misleading, It turns out they are probably overstating who can actually quality for all the extra benefits cited. 

While it's true the benefits and savings depend on the "zip code,"  to get extra help on Part D in 2022, your total resources must be no more than to $14,010 for an individual or $27,950 for a married couple living together to get a 25% subsidy and a sliding scale for even lower resources to get up to a 100% subsidy. 

Resources include the value of the things you own. Some examples are:

Real estate (other than your primary residence); (But not including property you need for self-support, such as rental property or land you use to grow produce for home consumption);

Bank accounts, including checking, savings and certificates of deposit;
Stocks;
Bonds, including U.S. Savings Bonds;
Mutual funds;
Individual Retirement Accounts (IRAs); or
Cash at home or anywhere else.

Income Limitations

To add to the limitations "To qualify for extra help with Medicare prescription drug plan costs in 2022, your annual income must be less than $20,385 for an individual ($27,465 for a married couple living together).

For the latest information as of January 2022 see https://q1medicare.com/news/Article.php?article_id=902

To add to the already confusing rules and regulations, we found this from the Social Security Administration for 2021 (we couldn't find the rules for 2022). 

https://www.ssa.gov/open/materials/SSA-L448-2021-English.pdf

These give lower limits for resources and income for the "Medicare Savings Program" and "Extra Help" but indicate each state may have different limits, some higher, some lower! Another chart gives the resource and income limits for the Medicare Extra Help program.

So, what did we conclude? Expect to spend lots of time on the phone if you want to speak to someone, don't expect you will quality for all the free and Medicare discounts advertised on TV unless you have a low income and meager cash reserves, stocks and other resources . And expect to looks at lots of pages of information online to try to figure out all of the complicated variations possible.

- additional information helpfully provided by Dr. Susan E. Johnson, PhD of Q1Medicare.com