San Antonio Express-News
February 11, 2003

Medicare Savings Programs

copyright 2003, Paul Premack

Dear Mr. Premack: I am retired and money is tighter than I could ever have imagined. We cannot afford to pay for insurance like AARP offers, the kind that covers our Medicare deductibles and copayments. My wife is ill, and even though we have Medicare A and B we won’t be able to afford the $840 deductible if she has to go to the hospital. It is a budget struggle just to get by after they take the $58.70 from our checks each month to pay the part B premium. Do you have any suggestions? Does Medicare ever drop the deductibles if the patient can’t afford them? – F.N.

The type of insurance you are referring to is Medicare Supplemental Insurance, commonly called "medigap." Federal law mandates that insurance companies offer these policies to people at age 65, regardless of preexisting conditions. Like you, some people cannot afford the extra coverage. There are several options under Medicare law you can consider in your situation.

First, consider looking at a Medicare +Choice program. Federal law distinguishes between traditional Medicare and +Choice by relying on Health Maintenance Organizations (HMOs) for +Choice services. This limits what doctors and hospitals you can use, but reduces your financial burden. For instance, with one HMO available in Bexar County, you pay $600 for each Medicare-covered stay in a network hospital. Under regular Medicare, you would pay the $840 deductible, and then pay $210 per day for any stay beyond 60 days.

Second, depending on your real income and assets, you may be able to participate in the one of the Texas Medicare Savings Programs (the biggest of which is the Qualified Medicare Beneficiary (QMB) program). Under federal law, certain aged and disabled people are entitled to have Medicaid pay their Medicare premiums, deductibles and coinsurance. To qualify, you must meet three standards:

1. You must a fairly low monthly income. This year, the income limit is $759 per month for an individual and $1015 per month for a couple after disregarding the first $20 of your income.

2. Your countable resources must be below $4000 for an individual and $6000 for a couple. Some things, like your homestead, an automobile, burial plots and personal possessions usually do not count as resources.

3. You must already participate in Medicare part A, or get enrolled by March 31. Most seniors receive Part A without paying an extra premium because of their (or their spouse’s) employment record. However, some seniors age 65 and up only get Part A if they elect to participate in Part B and to purchase Part A as an extra. Some people under 65 can get Part A if on kidney dialysis, or if on disability benefits from either Social Security or the Railroad Retirement Board for more than 24 months.

If you meet all these legal standards, then Texas QMB will pay your Medicare Part A and B premiums, deductibles, and coinsurance – making Medicare practically cost free. For those with slightly higher monthly incomes, the "Specified Low-income Medicare Beneficiary (SLMB) program" pays the Medicare Part B premium, saving you the $58.70 each month.

To find out more about Texas Medicare Savings programs, contact the Texas Department of Human Services toll free at (888) 834-7406, or visit my website at www.Premack.com.