Need Extra Help Paying for Prescriptions?

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Have you ever heard “I cannot pay for my prescriptions”?  Or, “my husband died and my income has been cut dramatically”. Statements like these are common, especially for people who have been retired for 20 years.  Prescription drugs are the tool for physicians to help people manage chronic conditions.  When prescription costs are too much on one’s budget; that can be a huge problem and health may suffer.  According to CMS.gov over 11 million seniors’ income is at 150% of the federal poverty level (FPL) or below. Many of these people struggle with the costs of their medications.

While everyone on Medicare can have a Medicare Prescription Plan, some people with limited recourses and income may be able to obtain “extra help” with the cost of their drugs and even the prescription plan costs. This extra help is named Limited Income Subsidy or LIS.  So, a person with Medicare Part A can buy a Medicare Prescription Drug Plan. In addition, if their income in 2016 is below 150% of FPL ($17,820 for an individual, $24,030 for a married couple living together); they may be eligible for LIS.

There are also resource limits for LIS.  To be eligible an individual’s would need to be at or below $13,640; or $27,250 for a married couple living together.  Resources are defined as something you own such as: real-estate, other than your primary residence; bank accounts, CDs stocks, bonds, mutual funds, IRAs and cash.

Resources do not include your primary residence, personal possessions, your vehicles(s), life insurance policies burial plans, property needed or self support such as rental property, SSI payments, housing allowances, and other resource exclusions found at SSA.gov.

So can does LIS do for a person?  It will lower their co-pays when dealing with prescriptions. How much the co-pays are lessened is determined by the level of LIS for which a person qualifies. In addition to assistance with co-pays, LIS may help a person with their with their Prescription Drug Plan costs.

Another huge benefit when qualifying for LIS is the granting of a special election period for Medicare prescription Drug Plans. Therefore, a drug not on your current plans formulary or at a high tier level may be reduced to a small co-pay.  The only way to know if you qualify is to apply though SSA.gov, or seek help from someone who can assist you in doing so.

So what if a person’s income is over $17,820?  They still may qualify for a prescription discount program such as RXOutreach.  This program offers a number of prescriptions; many of them at a lower price. RXOutreach requires one’s income to be below 300% of FPL ($35,640 for an individual)

 

So, if you hear a friend saying “I can’t afford my prescriptions, or since my husband died it’s been hard to get by” tell them about LIS and prescription drug discount programs.  Resources include the Social Security office, www.SSA.gov , www.rxoutreach.org or contact our office.

Feel free to contact our office for questions or additional information concerning LIS, prescription discount plans or any questions you may have about Medicare Plans.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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