Issue 1, January, 2008
FEATURE ARTICLE - MEDICARE PART B BUY IN: UNDERSTANDING YOUR LEGAL RIGHTS
HEALTHLINE - MAKING HEALTHY CHOICES
LEGALLINE - RENDELL ADMINISTRATION EMBRACES "AGING IN PLACE"
CAREGIVER HELPLINE - ADULT DAY HEALTH PROGRAMS HELP THE CAREGIVER

MEDICARE PART B BUY IN: UNDERSTANDING YOUR LEGAL RIGHTS

When I chose to run for the United States Congress in 2006, I announced that healthcare and the need to address unavailable or inadequate healthcare coverage for millions of Americans would be one of my highest priorities. This is an issue that resonates with people across the Delaware Valley and across the nation.

I was particularly concerned about indigent Medicare recipients - the elderly and disabled - who pay the Medicare Part B Premium each month. Many of these people were never informed that the state Medicaid program may pay this premium, which is now $93.50 per month. (This premium increases each January with the cost of living adjustment, and it will increase to $96.40 in January 2008).

Shortly after taking office in January 2007, I discovered that some of my constituents who were potentially eligible to have their Medicare Part B premium paid for by the Medicaid office were not informed about this benefit at the Social Security Administration (SSA) when they applied for or received their benefit. There is no automatic referral between SSA and the Department of Public Welfare (DPW) which approves the benefit. Only if a person is on Supplementary Security Income (SSI), a needs-based program, does the SSA tell the state to make payment for the Medicare premium for Part B (and in this case for Part A also). Therefore, the neediest residents may not be aware of this benefit.

I discovered that some people who had been eligible for years did not know that they could apply for and receive this benefit. For a person whose sole income is the SSA check of $1,000 a month, savings are close to 10% of their income. I made it a priority for my district office staff in Media to make sure local residents are made aware of this important cost-saving benefit.

To qualify to have the state Medicaid program pay this premium, a recipient's income must be below 135% of the Federal poverty level. For 2007, this equates to $1149 per month for a single person or $1541 a month for a married couple. (These amounts increase each year with new amounts announced in February.) The assets limit for these programs is $4,000 for a single person or $6,000 for a married couple. These are the types of help available:

1) The Categorically Needy Program covers the Medicare Part B Buy In. It also includes medical benefits such as prescriptions, doctor and clinic visits, Medicare Part A and B deductibles, and coinsurance if the income limits to qualify are $851 a month for a single person or $1,141 for a married couple.

2) The Medicare Cost Sharing Program pays Medicare premiums and Part A and B deductibles and coinsurance (QMB) if the income limits to qualify are $851 per month for a single person or $1,141 per month for a married couple.

3) The Specified Low Income Medicare Beneficiary Program (SLMB)pays the Medicare Part B Premium if the income limits are $1,021 per month for a single person or $1,369 per month for a married couple.

4) The Qualified Individual Benefit Program (QI1) pays the Medicare premium if the income limits are $1,149 per month for a single person or $1,541 per month for a married couple.

A person may apply for these programs at their local County Assistance Office or online at http://www.compass.state.pa.us

For information, call the DPW Helpline at 1-800-692-7462 or contact your local Area Agency on Aging.

For further information or assistance with any problems related to federal benefits, contact the office of Congressman Joe Sestak at:

600 North Jackson Street, Media, PA 19063
Telephone: 610-892-8623
Fax: 610-892-8628

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