Dear Marci,
I am having trouble paying for my prescription drugs with the Medicare prescription drug benefit. Are there any federal programs that can help me pay for my medications?
—Rebecca (Shaker Heights, Ohio)
Click on the blue, underlined hyperlinks for related information available through Medicare Interactive!
Dear Rebecca,
There are many programs that might be able to help you pay for some of your prescriptions. There is a federal program called Extra Help that can help you pay for your prescriptions if your income and assets are below a certain level. Extra help can help pay for some or most of the costs of prescriptions if you are eligible.
You may be eligible for Extra Help if your monthly income is below $1,354 ($1,822 for couples) in 2010 and your assets are below specified limits. Even if your income or assets are above the limits, you may still qualify because certain types of income and assets may not be counted.
If you have Medicaid, a Medicare Savings Program or Supplemental Security Income, you will get Extra Help automatically, and you do not need to apply. If you do not get Extra Help automatically, you can apply for Extra Help at any time. You can apply for the Extra Help program though the Social Security Administration or your local Medicaid office. If your application for Extra Help is denied, or you disagree with the award, you can appeal.
If you qualify, you can sign up for Part D without penalty, even if you are enrolling after you were first eligible for the benefit. You will also be granted a Special Enrollment Period to change your Part D plan once a month if you wish.
If you have Extra Help, your costs in 2010 will be as follows:
- If you have Medicaid and your income is below 100 percent of the Federal Poverty Level, you will pay $1.10 for generics and $3.30 for brand-name drugs. After your total drug costs reach $6,440 you will have no copay for generics or brand-name drugs for the rest of the calendar year.
- If you have full Extra Help you will pay $2.50 for generics and $6.30 for brand-names. Once your total drug costs reach $6,440, you will get catastrophic coverage and have no copay for the rest of the calendar year.
- If you have partial Extra Help you will either pay a 15 percent coinsurance for each prescription or your plans standard coinsurance, whichever is cheaper. Once your total drug costs reach $6,440, you will get catastrophic coverage and pay $2.50 for generics and $6.30 for brand-names for the rest of the calendar year.
If you have full Extra Help, you will not have to pay a deductible. If you have partial Extra Help, you will pay either $63 or your plans standard deductible, whichever is cheaper.
If you have Extra Help, you might want to consider enrolling in a Benchmark plan. Benchmark plans, are plans in which Extra Help will pay the full cost of your drug plan premium if it falls below a certain amount. However, there may not always be a benchmark plan that covers the drugs you need. It may be more cost effective if you choose a plan that is not at the benchmark level that covers all of your drugs. If you choose a plan that is above the benchmark, you will have to pay the difference between the premium and the benchmark amount. The benchmark amount varies by state.
—Marci
 | Looking for past Dear Marci Answers? Have other Medicare questions? Find your answers with Medicare Interactive (MI), an independent, public resource of the Medicare Rights Center. MI offers expert information and advice on Medicare. Visit Medicare Interactive today! |
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Do you need individual counseling? Call the Medicare Rights Center's consumer hotline at 800-333-4114, between 9 a.m. and 5 p.m., Eastern Time, Monday through Friday. A Medicare counselor will be happy to answer your question.
You can also call your State Health Insurance Assistance Program (SHIP) for personal counseling on Medicare benefits, rights and options. Call Social Security (800-772-1213) for questions about enrolling in Medicare or applying for Extra Help!
Feel free to send comments about Dear Marci or suggestions about topics you would like Dear Marci to cover.
Health Tip of the Week
Spending several hours sitting in front of a computer can lead to health consequences down the road. To help combat these issues the Occupational Safety and Health Administration (OSHA) released some guidance about the best posture to maintain when sitting at your computer. They suggest sitting in a neutral body position which will help reduce stress and strain on your muscles. Here are some tips for creating a neutral body position.
- Keep your hands, wrists and forearms straight and approximately parallel to the ground.
- Your hips and knees should be at around the same level.
- Your feet should be slightly in front of your hips and knees.
- Shoulders should be relaxed with arms hanging naturally at your sides.
- Elbows should be close to your body and bent between 90 and 120 degrees.
- Your back should be supported by a lumbar support when sitting vertically or leaning back slightly.
You should change your working position slightly during the day, as sitting in the same position for many hours is not healthy. You may want to consider taking a short walk and doing routine stretches. Depending on your chair’s design, you can also make small adjustments to help maintain comfort throughout the day.
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An apple a day might actually keep the doctor away. Microbiologists at the University of Denmark’s National Food Institute studied the impact of apples on digestive health. More information about the study is available in a HealthDay News article.
Researchers found that pectin, a component in the fruit, can increase levels of bacteria that help the digestive system.
The researchers fed rats whole apples and other apple products such as apple juice and apple puree. According to researcher Andrea Wilcks, this apple diet increased a bacteria which improves intestinal health. Wilcks explained that this bacteria produces fatty acids that provide ideal pH conditions and a chemical called butyrate, which is an important fuel for the cells of the intestinal wall.
More research is still needed to determine if this apple diet would have the same effect in humans.
Regardless of the results of future studies, it is still important to eat fruits and vegetables everyday. The Centers for Disease Control and Prevention (CDC) says that fruits and vegetables have important vitamins and minerals that can protect you from chronic diseases. Click here to find out how many fruits and vegetables you need each day.
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