What if I can’t afford the Part B – Doctor Visit Premium
of $148/month?

Medicare Savings Program

Medicare Premium Payment Buy In Program

Check out the programs below to pay or help pay for your Medicare Part B Doctor visits premium of $148/month.

Medicare Savings Programs (MSPs)

Qualification at a Glance 2020

Program/Benefits Income Limits Asset Limits
Qualified Medicare Beneficiary (QMB)

  • Premiums for
    Parts A & B
  • Deductibles for
    Parts A & B
  • Coinsurance for Parts A & B
Single:
$1,074/mo., $12,880/yr.*
Couple:
$1,452/mo., $17,420/yr.*
Single: $7,970 / Couple: $11,960

Assets exclude: one home, household goods and personal belongings, one car, and prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Specified Low-Income Medicare Beneficiary (SLMB)

  • Part B Premium
Single:
$1,288/mo., $15,456/yr.*
Couple:
$1,742/mo., $20,904/yr.*
Single: $7,970 / Couple: $11,960

Assets exclude: one home, household goods and personal belongings, one car, and prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Qualified Individual (QI)

  • Part B Premium
Single:
$1,449/mo., $17,338/yr.*
Couple:
$1,960/mo., $23,517/yr.*
Single: $7,970 / Couple: $11,960

Assets exclude: one home, household goods and personal belongings, one car, and prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Qualified Disabled Working Individual (QDWI)

Single:
$4,379/mo.
Couple:
$5,892/mo.
Single: $4,000 / Couple: $6,000

Assets exclude: one home, household goods and personal belongings, one car, and prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

250% California Working Disabled (CWD)

  • Medi-Cal coverage (with monthly premium)
Single:
$2,684/mo.*
Couple:
$3,630/mo.*
Income excludes disability benefits
Single: $2,000 / Couple: $3,000

Other exclusions apply

* Income figures do not include a $20 disregard, in which $20 is subtracted from your monthly income (earned or unearned).

 

Medicare Savings Programs (MSP’s)

How to Apply
Click here for instructions

ONLINE California Medi-Cal Enrollment

Disability Benefits 101

medi helper.com They can help you qualify… they do charge a fee based on the complexity of the case. Free Intake – Assessment Form

Protecting Dual Eligibles from Balance Billing – Justice in Aging.com Power Point

Medicare Part D, Prescription Drug Program

Medicare Prescription Drug

In 2003, Congress signed into law the Medicare Prescription Drug, Improvement and Modernization Act. This law includes a prescription drug benefit called Medicare Part D. This new law makes prescription drug coverage available to all Medicare beneficiaries beginning January 1, 2006.

If you are enrolled in Medi-Cal and have Medicare also, the new Medicare prescription drug benefit will replace most of the Medi-Cal prescription drugs that you currently receive beginning January 1, 2006.

Medicare Forum – Making Sense of Part D

Medicare Forum:  Making Sense of Part D is a half hour television program that will address basic and commonly asked questions about this complicated plan.  Your local PBS station will air the program in April.  Please check your local listing for the day and time it’s on your station.

​​​​​​​Medicare Part D, Frequently Asked Questions

Medicare Part D Home Page

Enrolled in Medicare and Medi-Cal  |  Medicare Only

Medicare and Medi-Cal

What is Medicare Part D and when will it start?

Beginning on January 1, 2006, Medicare will pay for all or most of your prescription drugs. This change in coverage is called “Medicare Part D.”​

Will Medicare Part D affect how I get my prescription drugs?

Yes. As of January 1, 2006, you must belong to a Medicare prescription drug plan. Your Medicare prescription drug plan will cover the cost of your prescription drugs.

D​o I need to sign-up for a Medicare prescription drug plan? ​​

No. Medicare will put you in a Medicare prescription drug plan. Medicare will then send you a letter with information about your prescription drug plan.

What if I want to be in another prescription drug plan?

You can change Medicare prescription drug plans for any reason. To change drug plans:

  • You must wait until November 15, 2005, and
  • You must call the Medicare prescription drug plan you want to join. That Medicare prescription drug plan will help you switch.

Where can I get information about different Medicare prescription drug plans?

  • Ask your pharmacy which Medicare prescription drug plans it accepts.
  • Ask your doctor which Medicare prescription drug plans cover most of your prescriptions.
  • Call a Medicare counselor at 1-800-434-0222. Calls to this number are free.

How will I know if I qualify for “extra help”?

Medicare should have sent you a letter saying that you qualify for “extra help.” Keep this letter. If you do not have this letter, call Medicare at 1-800-633-4227.  Calls to this number are free.

You will get “extra help” if:

  • You paid your Share of Cost in just one month between March and December 2005. Then you will get “extra help” for all of 2006.
  • You pay your Share of Cost for at least one month of 2006. Then you will get “extra help” for the rest of 2006.
  • You meet your Share of Cost anytime between September and December 2006. Then you will get “extra help” for all of 2007.

If I get “extra help,” will my prescription drugs be free?

No. You will still have a co-pay between $1 and $5. You will pay this each time you fill a prescription.

What will happen if I have Medi-Cal with a Share of Cost?

Medicare Part D will pay for your prescription drugs as of January 1, 2006. Medi-Cal will pay for your other health care needs after you meet your Share of Cost. (Your “Share of Cost” is the amount you pay before Medi-Cal starts to pay. Your Share of Cost amount is based on how much money you make. You only pay your Share of Cost in the months you get health care services.)

Once you meet your Share of Cost:

  • Medi-Cal will tell Medicare, and
  • Medicare will give you “extra help” paying for prescription drugs.

What if I do not meet my Share of Cost?  Can I still get “extra help”?

Yes, but you have to apply for “extra help.” To apply you can:

  • Go to your local Social Security or Medi-Cal office.
  • Call 1-800-772-1213.
  • Get help from your local HICAP program. You can call HICAP at 1-800-434-0222. Calls to this number are free.
  • Go to www.socialsecurity.gov . Download and complete the  “Application for Help with Medicare Prescription Drug Plan Costs.”  If Social Security sent you a letter about “extra help,” attach a copy of this letter to your application.

I still have questions. Who do I call?

Call us at 1-800-MEDICARE(1-800-633-4227). Calls to this number are free. TTY users can call us for free at 1-877-486-2048.   You can also call a Medicare HICAP counselor for free at 1-800-434-0222.  Dhcs.gov *

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Video

Video understanding medicare advantage mapd

Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.

That's why the premium is very low or ZERO!

Seminar Notes

Share of Cost

Full Medi-Cal – pays Part A

Dual Demonstration Project – Cal Medi Connect

Can get MAPD too – stability, committement, qualify products – quality medical groups –

Plan 1 all UHC

Plan 2 – Health Care Partners – lower co pays

Plan 3 transportation, full network, ancillary benefits look a like plan, includes transportation

How to verify between Cal Medi Connect shows pcp and Medi-Cal Plan – no MD show

Show MAPD card, then don’t have to show Medi-Cal card

Medi-Cal picks up co pays

Continuous SEP

Share of Cost vs Fully qualified

Can no longer dual SNP – look a like plans are OK

2 comments on “Part B Medicare Premium paid by Medi Cal – Part D Rx?

  1. I’m turning 65 and thought I was on Medi-Cal and would only have benefits by also getting Medicare.

    What’s this that now I have to pay $148/month for Medicare Part B Dr. Visits?

    Turns out I had Covered CA Silver 94.

    What’s the difference between Covered CA subsidy and enhanced silver programs & Medi Cal?

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