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Millions of seniors miss out on Medicare prescription drug savings
More than 2 million people on Medicare could be getting their prescription drugs nearly for free, but don’t. That’s because they have not signed up for Extra Help, an important Medicare benefit that subsidizes drug costs for low-income senior citizens.
Extra Help can pay nearly all of the prescription drug costs a senior incurs in a Part D drug plan. It is provided automatically to seniors receiving Medicaid or Supplemental Security Income benefits. In some states, Extra Help also is automatic for people receiving benefits through the Medicare Savings Program, which helps subsidize Medicare Part A (hospitalization) and Part B (outpatient) premiums. The RX Solution
But among seniors who do not automatically qualify, less than half are enrolled in Extra Help, according to Jack Hoadley, a research professor at the Health Policy Institute of Georgetown University who tracks the program.
“The government reaches out with information on this from time to time,” Hoadley says. “What’s harder is to figure out how to reach out specifically to people who are eligible.” The RX Solution
With Medicare’s annual fall enrollment season in full swing – and running through December 7 – it is a good time to remind seniors that they may be eligible. The benefit is substantial – annual savings can easily total $800 on premiums and deductibles, and can be much higher for seniors with high drug spending.
Two factors determine your eligibility for Extra Help: income and assets.
Your income cannot exceed the federal poverty level guidelines. For seniors with incomes of 135 percent of the federal poverty level or lower, Medicare pays the entire annual premium, expected to average $480 next year, according to the Kaiser Family Foundation. Extra Help also covers deductibles, which typically run $310 for the year.
What’s more, Extra Help enrollees are exempt from the notorious donut hole – the coverage gap that next year will begin when combined spending by patients and insurers hit $2,850, and ends when spending reaches $4,550.
Enrollees are responsible only for a small co-pay for drugs that are covered under the plan – the cost is $2.55 for generic drugs, and $6.35 for brand-name medications.
Seniors with incomes ranging from 135 percent to 150 percent of the federal poverty level get a partial subsidy of premiums and deductibles on a sliding scale, and are responsible for somewhat higher co-pays.