Asclepios
Making Medicare Affordable
June 11, 2009 • Volume 9, Issue 23
Senator Jeff Bingaman (D-NM) and Representatives Lloyd Doggett (D-TX) and Xavier Becerra (D-CA) have introduced legislation to ensure that millions of low-income older adults and people with disabilities receive assistance in paying for medical care and prescription drugs. The bills expand eligibility for Medicare Savings Programs (MSPs) and the Part D Extra Help program, which are often just out of reach for individuals because of modest earnings or retirement savings. The legislation also includes common-sense reforms that simplify and stabilize these important programs.
Currently, help paying the $1,068 deductible for a hospital stay, as well as the premium and 20 percent coinsurance for doctor visits, chemotherapy drugs and other outpatient services is available through the Medicare Savings Program only to people with Medicare who live below the official poverty line—$903 per month for an individual. The House and Senate bills make this assistance—and the low drug copayments provided by the Extra Help program—available to people earning up to 150 percent of the federal poverty level ($1,345 per month for an individual, $21,855 for a couple).
Under existing rules, a person with Medicare getting by on just $1,805 per month is considered too wealthy to qualify for any assistance under these programs. These bills allow people with Medicare up to this income level—200 percent of the federal poverty level—to qualify for assistance paying the Part B premium through the Medicare Savings Programs and for coverage through the Part D doughnut hole under partial Extra Help.
Access to these programs is further limited by an asset test that disqualifies individuals who have even a modest nest egg for retirement. These bills will help people who have a small amount set aside for retirement by increasing the limit for assets to $27,500 for an individual and $55,000 for a couple.
Income and asset eligibility rules for MSP and Extra Help are similar, but not identical. Individuals eligible for MSP benefits are deemed eligible for Extra Help without having to apply or take any other action. The reverse, however, is not true. These bills also include provisions both to align the eligibility rules for the two programs and to actually allow deeming in both directions, so that an individual found eligible for Extra Help will also receive an MSP, without any further action on their part.
The legislation includes a number of other smaller, but important reforms to both programs. For example, people who get both Medicare and Medicaid and who receive long-term care services in the community would no longer have to pay prescription drug copayments from the very limited amount of income they are permitted to keep for personal needs.
These provisions will help ensure that nearly 20 million people with Medicare with low incomes can afford their prescription drugs and medical care. Making health care affordable for all Americans is a central goal of Congress’s health reform efforts. All Americans includes Americans who rely on Medicare for their health coverage. Please urge Congress to Remember Medicare and make high-quality, affordable health care for older adults and people with disabilities a priority in health care reform.
Medical Record
“All my medical insurance benefits were taken away by General Motors Corp. effective January 2009. It is now June 2009 and GM is going bankrupt and receiving bailout money from the taxpayers. I worked at GM for over 32 years; now I cannot afford supplemental insurance; I have spent hours and hours shopping different companies here in Florida and the bottom line is I do not have the money to purchase any health care insurance or Part D insurance. I am 75 years old and do not know what to do.” (Tell Us Your Story, Personal story submission, June 2009)
“The economic downturn has increased the urgency for fixing the Medicare safety net programs for vulnerable seniors and people with disabilities. This population, typically with incomes below only $20,000, has been hit particularly hard, and tends to be sicker, more isolated and have limited educations. They are high users of medical and other health-related services, and they benefit significantly from financial assistance with growing out-of-pocket costs that, without assistance, create barriers to care and in the long run higher costs to taxpayers for preventable complications and institutionalizations.” (Letter to House of Representatives Leadership, National MSP Coalition, May 2009).
“More than 13 million people with Medicare have incomes below 150 percent of federal poverty levels and are potentially eligible for assistance with their Medicare costs. Another six million have incomes under 200 percent of poverty. People with Medicare should not be denied medical coverage or medicine because they cannot afford them.” (Letter of Support of “Medicare Financial Stability for Beneficiaries Act of 2009", Medicare Rights Center, May 2009)
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The Louder Our Voice, the Stronger Our Message
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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