Medicare Part D and Low - Income Subsidy Program：医疗保险D部分和低收入补助计划

SHINE

ServingtheHealthInformationNeedsofEldersMedicarePartA&B

“OriginalMedicare”MedicareOverviewMedicareisahealthinsuranceprogramforPeople65yearsofageandolder

(notnecessarilyfullretirementage)Peopleunderage65withdisabilities

(deemed“disabled”bySocialSecurityforatleast24months)Peopleunderage65andhaveALSorESRD

Note:MedicareisNOTMedicaid(whichishealthinsuranceforverylowincomepopulation)MedicareEligibility65andolderEntitledtoreceiveSocialSecurityBenefitsandcontributedtotheMedicareTaxEntitledtoreceiveRailroadRetirementActretireebenefitsBeaspouse,exspouse(marriagelastedatleast10years),widoworwidower(age65andover)ofapersonwhoqualifiesforSocialSecurityorMedicareBenefitsMedicareEligibilityIndividualscanqualifyforMedicarethroughaspouseifthespouseis:Aged62andoverandWorked10years(40quarters)ContributedtoMedicareTaxIsamemberoftheoppositesexUndertheFederalDefenseofMarriageAct,FederalAgenciescannotrecognizesame-sexmarriagesMedicareEligibilityUnderage65ReceivingSocialSecurityDisabilityInsurance(SSDI)for24monthsEnd-StageRenalDisease(ESRD)AmyotrophicLateralSclerosis(ALS)MedicareParts&PremiumsPartA&B–“OriginalMedicare”PartA–Hospital&SkilledNursingCare (Premiumfreeformostpeople–maypurchaseifinsufficientworkcreditsbutveryexpensive)PartB–Doctors’Visits&OutpatientCare ($104.90/monthin2013forbeneficiarieswithindividualincome<$85,000/year)MedicareAgenciesBeneficiariesmustenrollthroughSocialSecurityAdministration(SSA)forMedicareBenefitsIfalreadyreceivingSocialSecuritybeforeturning65,enrollmentintoPartAandPartBisautomaticIfnotalreadyreceivingSocialSecuritybenefitsanindividualmustcontactSocialSecurity(in-person,online,orphone)toenrollintoMedicareInitialEnrollmentPeriodisthe3monthsbefore,themonthof,and3monthsafter,anindividuals65thbirthday.MaydelayenrollingintoSocialSecurityBenefitsMedicareisadministeredbyTheCentersforMedicare&MedicaidServices(CMS)DelayedEnrollmentMayenrollintoMedicarePartAatanytimeonceeligibleMostpeopleenrollinPartAwhentheyturn65sinceitisusuallypremiumfreeSpecialEnrollmentPeriodforPartBPeoplemaydelayenrollmentwithoutpenaltyifcoveredthroughactiveemploymentbythemselvesorspouse*Willhavea8monthSpecialEnrollmentPeriodwhenactiveemploymentendsotherwisemayhavetopayapenalty.COBRAdoesnotqualifyas“active”employmentanddoesNOTprotectanindividualfromthePartBlateenrollmentpenalty*DOMAexcludesMedicarefromrecognizingsame-sexspousesDelayedEnrollmentGeneralEnrollmentPeriodforPartBJanuary1–March31CoverageeffectiveJuly1PartBPenaltyfordelayedenrollmentincreasedpremiumof10%foreach12monthsofdelayedenrollmentLifetimeIncreaseswithincreasesinpremiumMedicarePartAPartAhelpscover:InpatientcareinhospitalsInpatientcareinaskillednursingfacilityHospicecareservicesHomehealthcareservicesMedicaredoesNOTcoverLongTermCareMedicarePartAInpatientcareinhospitalMedicallynecessaryCosts90RenewabledaysDays1-60–DeductibleDays61-90-Copays60non-renewabledaysCoveredServicesRoom,nursing,testing,supplies,operatingroomMedicarePartASkilledNursingCareDailyskilledcaremedicallynecessaryPriorhospitalstayof3daysormoreAdmittedtoSNFwithin30daysofdischargeCosts100RenewabledaysDay1-20nocostsDays21-100–dailycopayMedicarePartAHomeHealthCarePhysicianmustauthorizeBeneficiarymustbe“homebound”Needforskilledcareonapart-timeorintermittentbasisCostsMedicarecovers100%forallcoveredservicesCoveredservicesSkilledcare,therapy,medicalsupplies,carebyhomehealthaides(bathing,changing,dressing)MedicarePartAHospicePhysicianmustcertifypatientisterminallyill(6months)PatienthaselectedHospicecareMaybeprovidedinhome,facility,hospitalornursinghomeCostsMedicarecovers100%ofmostservicesBeneficiaryonlypayssmallcopaymentfordrugsandrespitecareMedicarePartBPartBhelpscover:PhysicianservicesOut-patienthospitalservicesPreventiveservicesMedicalEquipmentandSuppliesAmbulanceMedically-necessaryservicesServicesorsuppliesthatareneededtodiagnosetotreatyourmedicalconditionMedicarePartB-PreventiveBenefitsACAprovidesaccesstomanyfreepreventivebenefitsMammogramsSomepapsmearandpelvicexamsColorectalScreeningsDiabetesSelf-ManagementTraining/TestsBoneMassMeasurementsProstateCancerScreeningDepressionscreeningObesityscreeningandcounselingAlcoholmisusescreeningandcounselingAnnualWellnessVisitUpdateindividual’smedical&familyhistoryRecordheight,weight,bodymassindex,bloodpressureandotherroutinemeasurementsProvidepersonalhealthadviceandcoordinateappropriatereferralsandhealtheducationMedicarePartB-PreventiveBenefitsMostpreventiveservicesarenotsubjecttoDeductible20%copaymentsFreeAnnualWellnessVisitNOTaphysicalexamServicesprovidedbeyondscopeofAWVmaybesubjecttodeductibleand/orcopaymentsMedicarePartBPhysicianservicesNonetworkorreferralneededAfterannualdeductible,20%copaymentMedicareapprovedamountAcceptingAssignment–acceptingtheMedicareapprovedamountaspaymentinfullBanonbalancebillingInotherstatesthereanexcesschargesof15%isallowableforphysiciansnotacceptingassignmentMedicarePartBMedicalEquipmentandSuppliesSuppliernotrequiredtoacceptassignmentNobanonbalancebillingAmbulanceMedicarewillnotpayforambulanceusedasroutinetransportation2013“Gaps”inOriginalMedicare*A“benefitperiod”startsthedayabeneficiaryisadmittedtothehospitalorSNFandendswhenthebeneficiaryhasnotreceivedhospitalorSNFcarefor60consecutivedaysPartAHospitaldeductible$1,184perbenefitperiod*$296/dayforextendedhospitalstays(days61-90)$148/dayfordays21-100inSNFPartBAnnualdeductible$14720%co-payformostPartBservicesRoutinephysical,hearing,vision,dentalForeigntravelMedicarePartC

(MedicareAdvantagePlans)

&MedigapPlans

SupplementingMedicareOriginalMedicareMedigapPolicyOptional“add-on”(PicksupwhereOriginalMedicareleavesoff)PartDStandAlonePlan++OR…Medicare

AdvantagePlanOptional“Replacement”(ProvidesOriginalMedicarebenefitsplusextraroutineandpreventivebenefits)HMO(HealthMaint.Org.)PPO(Pref’dProviderOrg.)PFFS(PrivateFeeForService)SNP(SpecialNeedsPlan)GenerallyincludesPartDdrugcoverageMedicareSupplements(Medigap)SoldbyprivateinsurancecompaniesOnlyavailabletopeoplewhoareenrolledinMedicarePartA&PartB(continuetopayPartBpremium&useMedicareCard)PayssecondtoMedicareonlyafterMedicarerecognizesserviceasa“covered”service.ContinuousopenenrollmentinMassachusettsMedigapplansdonotincludeprescriptiondrugcoverageMedigapPlansTwoMedigapPlansSoldinMassachusettsCore-leavessomegapsbehind(includinghospitaldeductible&SNFco-pays),butcostslessSupplement1-coversallgaps–butcostsmoreBothplansallowmemberstochoosetheirowndoctors,specialists,andhospitalswithoutreferrals NOTE:Somepeoplearecoveredthrougholderpoliciesnolongeravailabletonewmembers(e.g.“MedexGold”)MedigapPlansin2013MedigapCarriersMedicareSupplementCoreMedicareSupplement1BlueCrossBlueShieldofMass$96.38$183.73Fallon$100.25$182.00HarvardPilgrimHealthCare$100.50$189.50HealthNewEngland$97.00$189.00Humana$137.18$214.41Tufts$102.71$199.70UnitedHealthCare$122.75$211.50OriginalMedicarevsMedigapOriginalMedicareSupplementCoreSupplementOnePremiumB+DB+D+$97B+D+$182HospitalDeductible$1184$1184$0HospitalCopaymentsDays61-90$296/dayDays91-150$592/day$0$0SNFDays21-100$148/dayDays21-100$148/day$0PartBDeductible$147$147$0PartBCo-Insurance20%$0$0MedigapPlansNomatterwhichcompanyabeneficiaryselectsforcoveragetheywillreceivethesamebenefitsSomeMedigapplansofferadiscountofupto15%tobeneficiarieswhoenrollwithin6monthsoftheirMedicareEnrollment.IfanindividualswitchesMedigapcompaniesheorshemustnotifythepreviouscompany.Ifanindividualleavesaplanthatisnolongersoldtheywillbeunabletoreturntothatplan.MedicareAdvantagePlans

(MedicarePartC)PrivateplanscontractwithMedicaretoprovidecoveragecomparableto“Original”MedicarePlansmayaddadditionalbenefits(e.g.dentalcheckups,visionscreening,eyeglasses,hearingaids)Plansusuallychargeadditionalpremium&co-paysMembersmuststillpayPartBpremiumPlansusenetworksofphysiciansMedicareAdvantagePlans

(MedicarePartC)EligibilityMusthavebothPartAandPartBMustlivewithinplanservicearea6monthsayearMustnothaveESRDMustcontinuetopayPartBpremiumSeveralDifferentPlanTypesHMOPPOPFFSSNPMedicareAdvantagePlansEnrollment/DisenrollmentPeriodsInitialCoverageElectionPeriod(ICEP)7monthperiodaround65thbirthdayorifunderage65,7monthperiodaroundfirstmonthofeligibilityOpenEnrollmentPeriod(OEP)October15–December7SpecialElectionPeriod(SEP)MedicareAdvantageDisenrollmentPeriod(MADP)January1–February14MedicareAdvantagePlansEnrollmentisfortheentirecalendaryear.CanonlydisenrollunderspecialcircumstancesMayenrollonline,throughthemailorover-the-phonewithplandirectly,or1-800-MEDICARE/MDonothavetodisenrollfrompreviousplanifyouareswitchingtoanotherMedicareAdvantageorPartDplan.IfleavingaMedigapplanmustcontacttodisenrollHMO-HealthMaintenanceOrganizationMustchooseaPrimaryCarePhysicianMustreceiveallserviceswithintheplan’snetworkNeedreferralsforspecialistsOut-of-networkserviceswillnotwillnotbepaidforbytheplanwiththeexceptionofurgentoremergencycareMayonlyjointhePartDPlanofferedbytheirHMOplanPPO-PreferredProviderOrganizationDefinednetworkofproviders(maynotbethesameasHMOnetwork)PlanprovidesallMedicarebenefitswhetherinoroutofnetworkUsuallypayhigherco-paysforout-of-networkservices(andmayhavetomeetanannualdeductiblefirst)NoreferralsneededtoseespecialistsMayonlyjointhePartDPlanofferedbytheplanPFFS-PrivateFee-For-ServiceOnlyavailableinBerkshire,DukesandNantucketCountiesNodefinednetwork–noneedforreferralsMayuseanyhospitalordoctoracrossthecountrythatacceptstheplan’stermsandconditionsofpaymentPlandetermineshowmuchitwillpayprovidersforallservicesPlanmayormaynotofferPartDcoverageMembersmayjoinastandalonePDPifselectedplandoesnotincludeprescriptioncoverageSNP-SpecialNeedsPlansOnlyavailabletocertaingroups:Institutionalized(e.g.nursinghome)DuallyEligible(Medicare/Medicaid)akaSeniorCareOptions(SCO)Peoplewithcertainchronicconditions*DefinednetworkofprovidersCoversallMedicareservicesANDprovidesextrabenefitsProvidesPartDCoverageContinuousopenenrollmentNoorlowmonthlypremium*Includingheartdisease,diabetes,&cardiovasculardiseasesMedigapvs.MedicareAdvantageOriginalMedicareFallonSuperSaverTuftsPrimeRxSupp.1PremiumB+DB+$0B+$140B+D+$182PCP$147Deductible20%Co-Insurance$25$10$0Hospital$1184DeductibleDays61-90$296/dayDays91-150$592/dayDays1-5$355/day$300peryear$0SNFDays21-100$148/dayDays1-20$65/dayDays1-20$20/day$0MaxNone$3,400$3,400$0Medigapvs.MedicareAdvantageOriginalMedicare+MedigapSupplement1MedicareAdvantagePlanHighermonthlypremiumbutnoco-paysGenerallylowerpremiumsbuthasco-paysFreedomtochoosedoctorsGenerallyrestrictedtonetworkNoreferralsnecessaryMayneedreferralsforspecialistsSomeroutineservicesnotcovered(vision,hearing)Mayincludeextrabenefits(vision,hearing,fitness)CoveredanywhereinUSOnlyemergencyservicesprovidedoutsidecertainareaImportantQuestionstoConsider!Dotheirdoctorsandhospitalsaccepttheplan?

Ifnot,mightconsiderPPObuthigheroutofpocketexpensesHowmucharetheco-pays?Whatistheout-of-pocketmaximumfortheyear?Ingeneral,thelowerthemonthlypremium,thehighertheco-paysforservicesAretheirmedicationsontheplan’sformularyandhowmuchdotheycost?MaycostmoreinMedicareAdvantageplan

OtherwaystoSupplementMedicare

forCertainPopulationsRetireeHealthPlans(groupplans)EachretireeplanisdifferentRequestanoutlineofbenefitstolearnaboutplanMedicaid/MassHealth(forverylow-income)PartAandBdeductiblesandcopaymentscoveredinfullifseeingaMassHealthphysician.VeteransHealthCareSupplementscopaymentswhenvisitingaVAPhysician,HealthClinicorHospitalMedicarePartDOverviewofMedicarePartDBeganJanuary1,2006EligibleifanindividualhasPartAORPartBVoluntaryalateenrollmentpenaltymayapplytothosewhodonotenrollwhenfirsteligible.Penaltyis1%permonthforeachmonthwithoutcreditablecoverageandispermanent.ProvidesoutpatientprescriptiondrugsCoverageforPartDisprovidedby:PrescriptionDrugPlans(PDPs)alsoknownasstandaloneplansMedicareAdvantagePrescriptionDrugPlans(MA-PDs)PrescriptionDrugPlanOptionsOriginalMedicarePartDstandaloneplanMedicareAdvantagePlanForprescriptioncoverageanindividualmustchoosethePartDcoverageofferedbytheirMedicareAdvantagePlan.

Exception:individualsenrolledinaPFFSplanthatdoesnotprovideprescriptioncoveragemaychooseastandalonePartDplan.MedigapPolicyOptional“add-on”Orothersupplementalmedicalcoverage++orMedicarePartDEnrollmentPeriodsInitialCoverageElectionPeriod(ICEP)7monthperiodaround65thbirthdayorifunderage65,7monthperiodaroundfirstmonthofeligibilityOpenEnrollmentPeriod(OEP)October15–December7SpecialElectionPeriod(SEP)MedicareAdvantageDisenrollmentPeriod(MADP)January1–February14SpecialEnrollmentPeriodsWhenoutsideoftheOpenorInitialEnrollmentPeriodanindividualmustmeetoneofthefollowingcriteriatoenroll.:LossofcreditableprescriptiondrugcoverageHaveMassHealthorExtraHelptowardsthecostofyourmedications(LowIncomeSubsidy)orhaverecentlylostthisassistance.Haveastatepharmacyassistanceprogram(SPAP)suchasPrescriptionAdvantageorhaverecentlylostthisassistance.MovedfromonestatetoanotherMovein,livein,ormoveoutofaLongTermCareFacilityCurrentplanisendingitscontractwithCMS.OthersituationasdeemedbyCMS(OncethebeneficiaryhasmadeachoicetheSEPtypicallyends)

LateEnrollmentPenaltyIfanindividualdoesnotenrollwhenfirsteligibleforPartDtheymaypayapenaltyifthey:HavenocoverageorhavecoveragebutitisnotconsideredcreditableHavealapseincoverage(63daysormore)PenaltychargedonceanindividualdoesjoinaPartDplanA1%increaseinpremiumforeachmonthanindividualwentwithoutcreditablecoveragesinceMedicareeligible,lossofcreditablecoverageorMay2006,whicheverislater.Penaltyispermanent.UnabletoenrollintoPartDuntil:AnnualMedicareOpenEnrollment(October15th–December7thforaneffectivedateofJanuary1st.)oreligibleforaSpecialEnrollmentPeriod(SEP)CMSStandardsforPartDCMSsetsStandardBenefitStructurebutplansmayprovidebenefitsbeyond.Eachplanhastocover“allorsubstantiallyall”thedrugsinthefollowingclasses:Antidepressants,Antipsychotic,Anticonvulsant,Anticancer,ImmunosuppressantandHIV/AIDSPlansmustcoveratleasttwodrugsineachtherapeuticclassDrugsexcludedbycoverageOTC,Vitamins,SelectBarbituratesPartDCoverageStandardCoverageLevels2013Deductible$325InitialCoverageLimit$2,970Out-of-PocketThreshold$4,750*CatastrophicCost-Sharing5%or$2.65/6.60*In2013,after$2,970incosts,beneficiarypays47.5%ofbrandnamedrugcostsand89%ofgenericdrugcostsuntiltheyhavespent$4,750outofpocket.Note,inthegap,thefullcostofbrandnamemedicationsiscountedtowardsTROOPHowtoEnrollIntoMedicarePartDReviewplanoptionsConsidercost,coverage,quality,andconveniencePlanFinderToolonMSeekassistancefromSHINEorotheragenciesContactplandirectlyorcall1-800-MedicareEnrollmentcantakeplaceonthephone,online,orthroughamailedinpaperapplication.Enrollmentformwillaskfor:GeneralcontactinformationMedicarecardinformationMethodforpremiumpayment(directorthroughSocialSecuritycheck)OpenEnrollmentPeriodOctober15th–December7th

EveryplanchangesfromyeartoyearPlanscanchangepremiums,copayments,medicationscovered,theplanname,andcanendtheircontractwithMedicareIfanindividualelectsnottodoanythingthentheywillremaininthatplanforthefollowingyearIfanindividualwantsadifferentMedicareAdvantagePlanorMedicarePartDplantheysimplyenrollintothenewplan.ThechangewilltakeeffectJanuary1.AnoteaboutSupplement2MedigapSupplement2isnolongersold(asof12/31/05)MostcommonSupplement2planisMedexGold.VeryhighmonthlypremiumProvidescomprehensiveprescriptioncoveragewithnogapsIfanindividualwantstodropthecoveragetojoinMedicarePartDtheymusthaveanSEPorwaituntiltheAnnualCoordinatedElectionPeriodOctober15th–December7th.Ifanindividualchoosestoleaveplantheyareunabletorejoinatanytime.Assistancewithprescriptioncosts:

MassHealth

ExtraHelp/LowIncomeSubsidy

PrescriptionAdvantageMassHealthandMedicarePartDIndividualswithMassHealthandMedicareareconsidered“DualEligible”SinceJanuary1,2006,MassHealthnolongerprovidesprimaryprescriptioncoveragetoMedicarebeneficiaries.MassHealthremainstopayforcertainclassesofmedicationsdirectlysinceMedicaredoesnotcoverthem.Thesedrugclassesare:SelectBarbiturates(usedtotreatcancer,epilepsyorchronicmentalhealthconditions)CertainOvertheCounterMedications(Ibuprofen&acetaminophen)DualEligibleindividualsmustreceiveprimarycoveragethroughaMedicarePartDplan

Auto-EnrollmentofDualsIndividualswhohaveMassHealthandbecomeeligibleforMedicareareauto-enrolledintotheLimitedIncomeNewlyEligibleTransitionProgram(LI-Net)(thisprocessbeganon1/1/2010)TheLI-Netprogram,administeredbyHumana,providescoverageforindividualsfortwomonths.Aftertwomonths,ifadual-eligibleindividualhasnotselectedaplanontheirowntheywillbeauto-enrolledintoarandomlyselectedplanbelowthebenchmark.$0MonthlyPremiumPlanmaynotcoverallmedicationsDualEligibleIndividualscanchangeplansmonthly(continuousSEP),coveragebeginsfirstofthefollowingmonth.ExtraHelp/LowIncomeSubsidyExtraHelp,alsoknowsasaLowIncomeSubsidy,isafederalassistanceprogramtohelplow-incomeandlow-assetMedicarebeneficiarieswithcostsrelatedtoMedicarePartD.IndividualswithMassHealthassistanceareAutomaticallyeligibleforthisprogramanddonotneedtoapplyAuto-Assignment(Li-Net)andRe-assignment(planchangesinthefall)processesarealsousedforthosewhoqualifyforExtraHelpExtraHelpsubsidizes:Premiums,Deductibles,Copayments,CoverageGapLateEnrollmentPenaltyDoesnotsubsidizenon-formularyorexcludedmedicationsEligibilityTobeeligibleforExtraHelpin2013:Incomebelow150%FPL-$20monthlyunearnedincomeapplied.Furtherallowancesaremadeforanyearnedincome(Thefederalpovertylevelchangeseachspring)Resources(assets)mustbebelow:$13,300foranindividual$26,580foracouple(Resourcelevelsaredeterminedeachyear)Toapplyvisit/prescriptionhelpExtraHelpandPDPsLISCopayments2013Institutionalized$0Upto100%FPL(Fulldualeligible)$1.15/$3.50100–135%FPL(FullLIS)$2.65/$6.60135–150%FPL(PartialLIS)15%co-pay$66deductibleApplyingforExtraHelpIffoundeligibleforExtraHelp:EligiblefortheentirecalendaryearEffectivedateistypicallyback-datedtothedatetheapplicationwasreceived.SubsidyinformationwillbesenttocurrentMedicarePartDplan.InformationsenttoMassHealthtorevieweligibilityforMedicareSavingsProgramsPrescriptionAdvantageMassachusetts’StatePharmacyAssistanceProgram(SPAP)ProvidessecondarycoverageforthosewithMedicareorother“creditable”drugcoverage(i.e.retireeplan)ProvidesprimarycoverageforindividualswhoareNOTeligibleforMedicareBenefitsarebasedonaslidingincomescaleonly–noassetlimit!Differentincomelimitsforunder65vs.65andoverDualeligiblescanNOTjoin(butthosewithLISorMSPcanjoin)PrimaryCoverage

(forthosewithoutMedicare)NomonthlypremiumIfundertheage65andreceivingSSDIincomemustbelow188%FPL,otherwisenoincomeguidelines.Slidingscale,basedonincome,forcopayments,quarterlydeductibles,andout-of-pocketlimitsForthosewithMedicare

or“CreditablePlan”Helpspayfordrugsinthegap(formostmembers)Thoseintopincomecategory(S5)mustpay$200annualfeeforlimitedbenefitsAllmedicationsmustbecoveredbyprimaryplanMembersareprovidedaSEP(oneextratimeeachyearoutsideofopenenrollmenttoenrollorswitchplans)PrescriptionAdvantagedoesnotpaylateenrollmentpenaltyfeeSpecialEnrollmentPeriodPrescriptionAdvantagemembersareprovidedanSEPOneSEPallowedeachyeartoenrollorswitchplansExamples:SwitchtoalowercostingplanRe-enrollintoaplanafterdisenrollmentbecauseofnon-payment(consideredaninvoluntarydisenrollment).EnrollintoplanforthefirsttimePrescriptionAdvantagedoesnotpaylateenrollmentpenaltyfeeHowExtraHelpandPrescriptionAdvantageLowercostsSmartDRxPlanwithPAS2PlanwithPartialExtraHelpPlanwithPAS1PlanwithFullExtraHelpPremium$32.40$32.40ReducedReduced$0Deductible$325$325$66$7/$18$0Generics$0-$20$0-$2015%15%/$7$2.65Brands$35-$85$35-$8515%15%/$18$6.60CovGapGenerics79%$715%15%/$7$2.65CovGapBrands47.5%$1815%15%/$18$6.60OtherWaysto

LowerPrescriptionCostsPatientAssistanceProgramsCopayAssistanceFoundationsMailOrderGenericPricingProgramsAlternativemedicationsMCPHSPharmacyOutreachProgram(MassMedLine)PharmacyOutreachProgramoftheMassachusettsCollegeofPharmacyandHealthSciencesinWorcesterPartiallyfundedbytheExecutiveOfficeofElderAffairsTollFreenumber1-866-633-1617PharmacistandCaseManagersavailablePartDReviewsScreenforfinancialassistanceprogramsProviderecommendationsforalternativemedicationsReviewfordruginteractionsPublicBenefitsSupplementalSecurityIncome(SSI)RaisesincometostandardoflivingincomelevelSSIrecipientsautoenrolledinMassHealth&LISMustmeetincome/assetlimitsMustalsobeaged65+ORblindordisabledBeneficiariesenrollthroughtheSSAMassHealthStandardProvidesafullrangeofmedicalbenefitsIncludinginpatient,outpatient,skillednursingcare,andprescriptioncoverageProvidessecondarycoverageforMedicareBeneficiariesMedicarePartA&Bpremiums,deductibles&coinsuranceDeemedeligibleforExtraHelp–canpayforMedicarePartDpremium,deductible,andreducecopaysformedicationsMassHealthStandardEligibilityIncomelimitAssetlimitIndividual100%FPL$2,000Couple100%FPL$3,000Eligibilityfor65+yearsold;notinstitutionalized

$20unearnedincomedisregardappliedHigherincomedisregardforearnedincomeMassHealthforCaretakerRelativesProvidesMassHealthStandardbenefitsCaretakerrelative:anadultrelativelivinginthesamehomewithachildunder19whoseparentsarenotpresentinthehome;whoisrelatedtothechildby:BloodAdoptionMarriage(oristhespouseorformerspouseofthoserelatives)MassHealthforCaretakerRelativesIncomelimitincreasesto133%FPLNoincomedisregardsappliedNoassetlimitToapply,MedicalBenefitRequestform,regardlessofapplicantageMassHealthforCaretakerRelativesSusan,67,israisinghergranddaughter,Amelia,13.Susanhasbeenstrugglingwithherprescriptioncostsandiswonderingifanyassistanceisavailabletoher.Herincomefromsocialsecurityis$1,500amonthandshehas$20,000isthebank.MassHealthforCaretakerRelativesSusanonherownwouldbeoverincomeandoverassetsforMassHealthSusanisthecaretakerrelativeofachildunder19,shecancompleteaMedicalBenefitRequest(MBR)ThereisnoassettestIncomelimitforahouseholdoftwois$1,720SheandAmeliawouldqualifyforMassHealthStandardSusanwouldautomaticallyqualifyforExtraHelpCommonHealthForadultswithdisabilitieswhoseincomesaretoohightobeeligibleforMassHealthStandardNoincomeorassetlimitsregardlessofagebutthose65andovermustmeetaworkrequirement(40hours/monthtobeeligible.Thoseunder65arenotrequiredtoworkbuthaveaone-timedeductibleSlidingscalemonthlypremiumforthosewithanincomeabove150%FPL.CommonHealthWorkRequirementMustworkatleast40hours/monthandhaveastatementfromtheiremployerasproof.Orworked240hoursinthelastsixmonths“Work”isnotclearlydefinedbyMassHealthMustbepaidsomething;cannotbevolunteerCouldincludesimpletaskssuchas:Walkingadog StuffingenvelopesBabysitting AnsweringphonesCommonHealthRegardlessofagecompleteaMassHealthMBR.Recommendation:WriteCommonHealthonthefrontoftheapplicationifsubmittinginapaperform.IfapprovedwillreceivemanyofthesamebenefitsMassHealthStandardmembersreceiveInpatientandOutpatientServicesTransportationservicesAutomaticallyqualifyforExtraHelpforPartDMaynotqualifyforPartBpremiumassistance.CommonHealthRobertisdisabledandnotworking.HehasbeenonCommonHealthforayear.Heisabouttoturn65.HeisconcernedabouthiscostsunderMedicare.Hissocialsecuritycheckis$1,600amonthandhehasabout$10,000inhissavingsaccount.CommonHealthOnceRobertturns65hewillonlybeabletomaintainCommonHealthifheisabletowork40hours/month.CommonHealthwillassisthimwithhis