Extra Help with Medicare Costs

Apply for assistance: a few minutes could save you money

You could be one of them, but you will have to apply to find out.

The basics about extra help
Get important information about extra help available to people with Medicare, who is eligible, and how to apply. Get the basics .

You may qualify for assistance
If you participate in Medicare plus another program – i.e., Medicaid, PACE, a Medicare Savings Program, or SSI – you’ll receive help with some Medicare costs automatically. Read about automatic qualification .

You can apply for help if you don’t qualify automatically
Millions qualify for extra help with drug costs, so why not check it out? An online calculator can help you find out if you’re eligible. Even if you’re not sure, it may be worth your time to apply. Find out how to apply .

Where to find more information
Need more details? Want to talk with someone on the phone? Look here for Medicare and Social Security Administration contact information. Find Websites and phone numbers .

• Help with prescription drug costs – With the new prescription drug coverage, the Federal government is helping millions of Medicare beneficiaries pay their prescription drug costs. Those who qualify for extra help will enjoy free or reduced drug coverage premiums and reduced out-of-pocket costs. Some people qualify for prescription drug help automatically, while others need to apply. Keep reading for details.
  
  
• Medicaid – This joint state and Federal program helps people with limited income and resources pay for healthcare. For information about Medicaid, call your State Medical Assistance office. You can find the number on the Medicare Website or call 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-866-653-4261, 24 hours a day, seven days a week.
  
  
• Programs of All-inclusive Care for the Elderly (PACE) – A combination of medical, social, and long-term care services available only in states that choose to offer it under Medicaid. Eligibility requirements vary from state to state. For details, contact your State Medical Assistance office.
  
  
• Medicare Savings Programs – A program where your state Medicaid program helps you pay your Medicare premium and, in some cases, deductibles and coinsurance. Millions of people receive help through Medicare Savings Programs, which have different names in different states. For more information, call your State Medical Assistance office.
  
  
• Supplemental Security Income (SSI) benefits – Help for people who are disabled, blind, or over age 65 AND have limited financial resources. SSI is NOT the same as Social Security benefits. For more information, call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778), or contact your local Social Security office. You can also use the Benefits Eligibility Screening Tool (BEST) on the Social Security Website to find out if you're eligible.

How do I get extra help with prescription drug costs?

• Some people qualify automatically because they participate in Medicare AND another program, such as Medicaid, Medicare Savings Programs, and Social Security Income (SSI) benefits. The government has already contacted these people about extra help, but they still need to choose a prescription drug plan.
  
  
• Millions of others qualify because of limited income and resources, but they need to apply. The Social Security Administration is accepting applications by mail and on their Website at www.ssa.gov.
  
  
• Applying for extra help is NOT the same as joining a prescription drug plan. Whether you qualify for extra help or not, you must also enroll in a plan to get prescription drug coverage.
  
  

What if I’m not sure I qualify?

If you’re not sure you qualify for help with prescription drug costs, go ahead and apply. There’s no risk and no cost, so you might as well try!

You may qualify for assistance

Who qualifies for extra help automatically?

You receive extra help with Medicare costs automatically if you have Medicare and also have:

• Medicaid
  
  
• Programs of All-inclusive Care for the Elderly (PACE)
  
  
• Medicare Savings Programs
  
  
• Supplemental Security Income (SSI) benefits
  
  

How do I choose a plan?

Since you use the Internet, you have easy access to information that can help you select your plan. Make sure the plan you choose:

• Covers the drugs you take – Explore which drugs each plan covers. Go to the plan’s Website or use the “Formulary Finder” on the Medicare Website.
  
  
• Lets you use your favorite pharmacy – Find out which pharmacies are in a given plan’s network. Visit the plan’s Website or call its Member Service phone number.
  
  

What if I discover my plan isn’t a good fit?

If the plan you’re enrolled in doesn’t meet your needs, you can switch to another one during the Annual Election Period (Nov. 15 – Dec. 31). You also have some limited opportunity to switch during Open Enrollment (Jan. 1 – Mar. 31), depending on the plan you are enrolled in, and the type of plan you want to switch to. Medicaid and PACE participants can change plans anytime. For calendar year 2008, all Low Income Subsidiary (LIS) beneficiaries will be able to change plans at any time, if they choose to do so, with an effective enrollment date being the first of the next month.

Applying for help if you don’t qualify automatically

It’s estimated that a third of people with Medicare can get extra help with Medicare costs – but the government may not know if you’re one of them! For that reason, it’s a good idea to apply for extra help, even if you’re not sure you qualify. With a quick visit to the Social Security Administration Website, you can find out if you’re eligible and even apply online.

You may want to use the handy calculator on the Social Security Administration Website, called Find Out If You Qualify.

To use the calculator:

• Go to the SSA Website .
  
  
• Click the button at the bottom right labeled Find Out If You Qualify
  
  
• Answer some questions about your assets and sources of income

In just a few minutes, you’ll get a recommendation on whether you should apply. If the answer is yes, just click on “Apply Now” to start your application.

The simple, four-page application is available at your local Social Security Administration office. You can also get an application form by calling Social Security’s toll-free number: 1-800-772-1213, Monday – Friday, 7 a.m. to 7 p.m. (TTY: 1-800-325-0778).

Or you can apply for extra help online:

• Go to the SSA Webpage Help With Medicare Prescription Drug Plan Costs
  
  
• Click the button at the bottom right labeled Apply Now
  
  
• Read the page and click Continue
  
  
• Answer some questions about your assets and sources of income (if you used the online calculator, your computer may skip this part)
  
  
• Enter information about yourself, your spouse, and how you can be reached
  
  
• Review your application, submit it, and print your “receipt”

The application is secured, which means only you and the Social Security Administration can see the information you provide.

And remember, applying for extra help is NOT the same as joining a prescription drug plan. Whether you qualify for extra help or not, you must also enroll in a plan to get prescription drug coverage.

The amount of extra help varies based on your income and resources. 

Where to find more information

Centers for Medicare & Medicaid Services
Website: www.medicare.gov
Toll-free phone: 1-800-633-4227
TTY: 1-877-486-2048
24 hours a day, seven days a week

Social Security Administration
Website: www.ssa.gov
Toll-free phone: 1-800-772-1213
TTY: 1-800-325-0778
Monday through Friday 7 a.m. to 7 p.m.

Learn more about CarePlus Health Plans, Inc.’s Medicare Advantage plans by calling:1-800-793-9808. We are open 8:00 a.m. to 8:00 p.m, Monday through Sunday. Alternative technical assistance will be available on holidays to return your call within one business day. Hearing impaired call
TTY:1-877-245-7930

This Website is for individual Medicare coverage only.

CarePlus Health Plans, Inc. is a Medicare Advantage Organization with a Medicare contract. You must be enrolled in Medicare Part B and entitled to Part A. You must reside in the service area of the Plan. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. Limitations and co-payments apply.

For Access to Exceptions, Grievance, Appeals, and Coverage Determinations/Redeterminations Information , please see our  Forms  page.

The information in these pages is accurate as of 12/12/2007, and is subject to change without notice.

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