For many people, Medicare can be expensive. Although it now covers more preventive care than it ever did before, Medicare does not pay for all the health care that someone may need, and there can be deductibles, monthly premiums, and out-of-pocket costs that beneficiaries must pay.
However, there is help with these Medicare costs. Medicaid provides additional health care coverage and help with out-of-pocket Medicare expenses for many low-income Medicare beneficiaries who live in New Jersey. The program that helps these beneficiaries is called the Medicare Savings Program. In 2009, if you have Medicare Part A and your assets are no more than $4,000 for an individual or $6,000 for a married couple, and your gross income matches the levels described in the categories below, you may be eligible for Medicaid to pay for medical care that Medicare does not cover and/or to help pay your Medicare premiums and co-insurance costs.
Please note that both income and asset limits increase each year. The income levels for 2010 have not been announced yet. But in 2010, Medicare beneficiaries in New Jersey who qualify for two of the Medicare Savings Programs described below will be given a higher asset limit to qualify for extra help with the costs of prescription medicines for the Medicare Part D program. For this help, called the Low-Income Subsidy (LIS), the Part D asset limit for Specified Low-Income Medicare Beneficiaries (see descriptions below) will increase to $8,100 for an individual and $12,910 for a married couple in New Jersey.*
Not all income and assets count toward eligibility for these Medicare Savings Programs. If you think you might be eligible, see below for information about how to apply.
Qualified Medicare Beneficiaries/Dual Eligibles
$923/Monthly Income and $4,000/Assets for an Individual
$1,235/Monthly Income and $6,000/Assets for a Couple
Medicare beneficiaries with the lowest income are called Qualified Medicare Beneficiaries (QMBs) or Dual Eligibles. In New Jersey, a QMB is a Medicare beneficiary who is also “dually eligible” for Medicaid. QMBs have bothMedicare and Medicaid.
If your income and assets are not more than the levels described above, you may be eligible for full Medicaid benefits to cover health care services that are not paid for by Medicare. If eligible, you will have coverage by both Medicare and Medicaid, and New Jersey Medicaid will pay your Medicare deductibles, premiums or co-pays.
Specified Low-Income Medicare Beneficiaries
$1,103/Monthly Income and $4,000/Assets for an Individual
$1,477/Monthly Income and $6,000/Assets for a Couple
Medicare beneficiaries with slightly more income are called Specified Low-Income Medicare Beneficiaries (SLMBs). If your income and assets* are not more than the levels described above, you may be eligible for financial help with your Medicare Part B and Part D premiums in New Jersey from Medicaid or the State’s PAAD program (Pharmaceutical Assistance for the Aged and Disabled), which has no asset limit for eligibility. To apply, call 1-800-792-9745 or apply online through the Universal Application for PAAD, Senior Gold and Other Special Benefit Programs (from the New Jersey Department of Health and Senior Services).
Specified Low-Income Medicare Beneficiaries-Qualified Individuals
$1,239/Monthly Income and $4,000/Assets for an Individual
$1,660/Monthly Income and $6,000/Assets for a Couple
If you are a Medicare beneficiary whose income and assets are below the levels for a Specified Low-Income Medicare Beneficiary-Qualified Individual, you also may be eligible for help with your Medicare Part B and Part D premiums in New Jersey. If you meet these income and asset* requirements you should apply through the State’s PAAD program (Pharmaceutical Assistance for the Aged and Disabled), which has no asset limit for eligibility, by calling 1-800-792-9745 or applying online through the Universal Application for PAAD, Senior Gold and Other Special Benefit Programs (from the New Jersey Department of Health and Senior Services).
How to Apply for Help with Medicare Costs
If you think you might be eligible for help from the PAAD program or Medicaid in New Jersey to help you with your Medicare costs, contact the PAAD program (1-800-792-9745) or apply online through the Universal Application for PAAD, Senior Gold and Other Special Benefit Programs (from the New Jersey Department of Health and Senior Services).You may also contact your county welfare agency (from the New Jersey Department of Human Services)—sometimes called the county board of social services.
*Note: In 2010, asset limits for SLMBs and SLMB-QIs in New Jersey will be increased to $8,100 for an individual and $12,910 for a married couple to be eligible for extra help with costs in the Medicare Part D drug program. These higher asset limits for Part D extra help for SLMBs and SLMB-QIs will not be the same in all states. New Jersey will allow its beneficiaries to disregard $1500 in assets to be used toward burial costs. Not all states choose this higher asset limit.
If you think you may be eligible in 2010, you should apply for help from PAAD or Medicaid after January 1, 2010. If you are denied by either program and think that you should be eligible, you may contact your regional Legal Services office or the Health Care Access Project through Legal Services of New Jersey’s statewide, toll-free legal hotline at 1-888-576-5529 for legal assistance.
This information last reviewed 3/21/10. |
