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)
|
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)
|
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)
|
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)
|
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
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
SSI-Related Programs & Coverage Groups
Income & Assets Chart
Our web pages on:
- Aged and Disabled Federal Poverty Level Program
- Part D Rx Low Income Subsidy – LIS – Extra Help
- Hospice Coverage – Medicare
#Medicare10050 and You 2021
Everything you want to know - Read Along
Your Medicare Benefits # 10116
- Enroll in Blue Cross
- Learn about UHC United Health Care
- Enroll in Blue Shield
- Don't like computers? Prefer a printed version be mailed to you? Audio MP 3
- Use our scheduler to Set a phone, Skype or Face to Face meeting
- #Intake Form - We can better prepare for the meeting
#My Medi-Cal
How to get the Health Care You Need
24 pages
Smart Phones - try turning sideways to view pdf better
- Medi Cal Explained CHCF
- 10 Essential Health Benefits
- Our Webpage on Medi & Denti Cal Benefits
- Western Poverty Law - Exact Legal Rules on Coverage for Low Income Californian's
Nolo Social Security, Medicare, Medi Cal & Government Pensions
Our Webpage on
COVID 19
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.
- If you are enrolled in Medicare and Medi-Cal, Frequently Asked Questions.
- If you are enrolled in a Medi-Cal Managed Care Plan.
-
Centers for Medicare and Medicaid Services (CMS)1-800-MEDICARE or 1-800-633-4227
-
Social Security Administration (SSA)1-800-772-1213
-
CA Health Insurance Counseling and Advocacy Program (HICAP)1-800-434-0222 (For free Medicare Counseling)
-
Department of Aging1-800-510-2020
- dhcs.ca.gov/services/MedicarePartD
Medicare Part D, Frequently Asked Questions
Enrolled in Medicare and Medi-Cal | Medicare Only
Medicare and Medi-Cal
- What is Medicare Part D and when will it start?
- Will Medicare Part D affect how I get my prescription drugs?
- Do I need to sign-up for a Medicare prescription drug plan?
- What if I want to be in another prescription drug plan?
- Where can I get information about different Medicare prescription drug plans?
- How will I know if I qualify for “extra help”?
- If I get “extra help,” will my prescription drugs be free?
- What will happen if I have Medi-Cal with a Share of Cost?
- What if I do not meet my Share of Cost? Can I still get “extra help”?
- I still have questions. Who do I call?
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.
Do 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 *
True #Freedom Plans
"Prepaid Home Health Care?"
Watch 3 minute simple plain English Video
- Email us for more information [email protected]
- Our webpage on Long Term & Home Health Care
- Our webpage on True Freedom
Resources & Related Pages
ca health advocates.org/qualification-at-a-glance
(Our Website for MAGI based qualification under 65
♦ MediCal Resources.org) If you would be on Medi-Medi – Cal MediConnect – Cal Duals (our website)
Learn more on categories of dual eligibles whose out of pocket costs are paid by Medi-Cal
4 programs that can help pay Medical Expenses Publication # 11445
Publication 10126 Getting Help with Medicare Costs
What if you no longer qualify for Extra Help Publication # 11215
Medi Helper.com They can help you qualify… they do charge a fee based on the complexity of the case.
Medi-Cal Estate Recovery
- Low Income Subsidy – LIS
- Limited Income – Resources
- Rx Assistance from Manufacturer
Medi Medi – Medi-Cal & Medicare, Together Medicaid (Medi-Cal) Getting Started Publication # 11409
- Social Security Disability – SSI, SSDI
- Publications – SSDI, SSI
- Questions from Website Visitors
- SSI – Supplemental Security Benefits
Medicare Part A Hospital & B Doctor Visits Eligibility & Premium Calculator
#Understanding Medicare Advantage Plans (PDF) #12026
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!
- Set a phone or Skype Meeting
- #Intake Form - We can better prepare for the meeting
- Get Quotes, Full Information and Enroll
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
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?
Here’s a video from Covered CA on the differences
Here’s our webpage on what Medi Cal covers with no premium, including dental and vision
You’re paying the neighborhood of $50/month for your coverage right? No dental or vision, right? Your income is above 138% of Federal Poverty Level, chart right, which puts you into Covered CA subsidies and not Medi-Cal, right?
Excerpt from Income Chart